Sjögren's syndrome (SS) is an autoimmune disease characterised by the destruction of exocrine glands.1 Its diagnosis is based on several characteristics, of which focal lymphocytic sialadenitis seen on minor salivary gland biopsy (MSGB) is the criterion with the highest specificity and sensitivity for diagnosis.1–3 Stitches are placed4 for 7 days following the biopsy. During this period, they can cause tissue tension, pain, accumulation of microorganisms and chronic inflammation.5

In physics, ionising a gas produces the fourth state of matter, known as plasma, which can be generated non-thermally at atmospheric pressure (NTAP). There are reports showing a reduction in wound repair time using NTAP generated with helium gas.6,7 To generate NTAP, a coaxial "needle reactor" configuration is used: the nozzle has a radius of 1mm containing a copper inner electrode coated with a ceramic, and the outer electrode is made of stainless steel. The NTAP is produced by a radiofrequency generator at 13.56MHZ and helium is the gas used, at a flow rate of. 5lpm.

We present the cases of two patients with clinical criteria of SS, females aged 51 and 76 years, with hyposalivation that restricted oral functions. Both underwent MSGB4 under informed consent, and instead of suturing, two applications of 3min each of NTAP were performed at 5mm from the wound (Fig. 1).

Fig. 1.

Cases that underwent MSGB. Case 1: 1a) Surgical incision and initial application of NTAP. 1b) Incision in the process of repair after the two applications of NTAP (1h after taking the biopsy). 1c) Labial mucosa in the biopsy site, regenerated after two days. Case 2: 2a) Surgical incision. 2b) Incision in the process of repair after the two applications of NTAP (1h after the biopsy). 2c) Labial mucosa regenerated after 3 days following the biopsy.

Case 1. Reported asymptomatic one hour after application of NTAP and showed wound repair at 2 days. Case 2. Reported asymptomatic 24h after NTAP application and showed wound repair at 3 days.

Due to the complications that can arise from sutures, several authors have conducted research on means to replace suturing. One study that performed oral surgeries using laser diode to promote healing, saw tissue repair 10 days after the surgical procedures,8 while in the two reported cases the MSGB wounds healed rapidly using NTAP. With wound healing in less than 3 days, post-surgical complications such as infection and wound dehiscence, which are more common in patients with hyposalivation because of decreased salivary flow, were avoided.5 Sensitivity changes at the biopsy site are reported by many patients. In one study, symptoms following parotid and labial mucosal MSGB were assessed, and for the latter patients reported changes in sensitivity at the post-surgical site that lasted between one week and 6 months.9 The patients reported here were asymptomatic in under 24h, recovering tissue function during this period. The follow-up of the patients included an exploration of the biopsy site, identifying that it recovered normal characteristics; this may be the result of NTAP application, as it releases free radicals that stimulate angiogenesis and fibroblasts, resulting in an organised tissue repair process.6,7,10

In conclusion, with the cases presented, NTAP proved a useful and safe alternative for patients, as tissue regeneration was observed within 72h following the biopsy, thus avoiding postoperative complications.