Impact of computed tomography venography on donor selection in submandibular gland transplantation

Abstract

Objective: A reliable anterior facial vein (AFV) is of critical importance for the success of microvascular submandibular gland (SMG) transplantation. The purpose of this study was to document the impact of preoperative computed tomography (CT) venography in determining AFV variations and facilitating donor selection for SMG transplantation. Methods: Consecutive patients with severe dry eye referred to us for SMG transplantation were enrolled. CT venography was performed and bilateral AFVs disadvantageous variations for vascular anastomosis, including not draining the SMG and not matching the superficial temporal vein (STV) (calibers ratio of AFV to STV ≥3) were determined on CT images. When ipsilateral AFVs showed variations, the contralateral side SMGs would be evaluated as potential donors. The CT results were checked for the accuracy according to intraoperative findings. Findings: 42 donor SMGs from 39 patients were included. The average calibres of AFV and STV between CT and intraoperative measurements had no significant differences. 10 of the contralateral SMGs (23.8%) were chosen as better donors according to the CT findings, which were all confirmed during operation. In determining the AFV variation of not matching the STV, the CT results showed both sensitivity and specificity equaling 100%. In determining the AFV variation of not draining the SMG, the CT results showed sensitivity of 94.7% and specificity of 100%. The surgical success rate of the 42 transplantations was 95.2%. Conclusion: The preoperative CT venography was valuable in determining AFV disadvantageous variations for anastomosis, and choosing a reliable donor from bilateral SMGs.