Submandibular Gland Transfer Research Articles

Management of blood vessels in the vascularized autogenous submandibular gland transfer for severe keratoconjunctivitis sicca

To summarize the management of blood vessels in the transfer of vascularized autogenous submandibular gland. Sixty-eight cases of vascularized transfer of autogenous submandibular gland for severe keratoconjunctivitis sicca performed from August 1999 to April 2004 were reviewed. Data collected for each patient included general items, donor and recipient vessels, vessel crisis, salvage of the vessel thrombosis, and survival of transferred glands. Among the 68 cases, all the donor and recipient arteries were facial artery and superficial temporal artery respectively. For donor veins, 55 were facial veins, 1 was vein near the duct, and 12 were venae comitantes of facial artery. For recipient veins, 62 were superficial temporary veins and five were veins in the upper neck, one was deep temporary vein. Vessel thromboses occurred in 10 cases, 9 were venous and 1 were arterial. The salvage rate was 10.0%, with the overall survival rate of 86.8% of transferred gland. Variation in venous outflow is common in microvascular transfer of submandibular gland, and anastomosis between venae comitante of facial artery and superficial temporal vein is most dependable. Vessel anastomosis under microscope may reduce the vessel thrombosis rate after operation.

39 Submandibular Salivary Gland Transfer Procedure for the Prevention of XRT Induced Xerostomia in Patients with Carcinoma of the Nasopharynx

39 Submandibular Salivary Gland Transfer Procedure for the Prevention of XRT Induced Xerostomia in Patients with Carcinoma of the Nasopharynx

Submandibular Gland Transfer for Prevention of Xerostomia After Radiation Therapy: Swallowing Outcomes

To assess swallowing outcomes in patients with oropharyngeal carcinoma in relation to the Seikaly-Jha procedure for submandibular gland transfer (SJP). The SJP has recently been described as beneficial in the prevention of xerostomia induced by radiation therapy in patients with head and neck cancer. Inception cohort. University-affiliated primary care center. A phase 2 clinical trial was conducted from February 1, 1999, through February 28, 2002, to evaluate SJP in patients with head and neck cancer. During that period, a consecutive sample of 51 patients who underwent surgical resection and reconstruction with a radial forearm free flap for oropharyngeal carcinoma were referred for functional assessment of swallowing after completion of adjuvant radiation therapy. At 6 months after surgery, swallowing assessments for 24 patients were available. The cohort of 24 patients included 13 who had preservation of 1 submandibular gland (SJP group) and 11 who did not (control group). Quantitative and qualitative aspects of swallowing were obtained to determine whether patients in the SJP group performed more optimally than those in the control group. Baseline and stimulated salivary flow rates were significantly different between groups. Patients in the SJP group were able to move the bolus through the oral cavity and into the pharynx faster than those in the control group. In addition, patients in the SJP group swallowed less often per bolus than patients in the control group. The complete swallowing sequence was twice as long in controls. The SJP for submandibular gland transfer appears to be beneficial in promoting more time-efficient swallowing behaviors. This efficiency has implications for the overall well-being and nutritional status of patients with head and neck cancer.

Upfront submandibular salivary gland transfer in pharyngeal cancers

Head and neck irradiation results in salivary dysfunction and subsequent xerostomia. Twenty two patients with squamous cancer of oropharynx or hypopharynx underwent contralateral submandibular salivary gland transfer (SMSGT) to submental triangle to shield it from subsequent radiotherapy. Resting salivary outputs of transferred and untransferred gland (control) were measured before and after SMSGT and following radiotherapy, by cannulating individual submandibular duct. They were compared by paired samples t-test. Following radiation therapy transferred gland retained 73% and untransferred gland (control) retained 27% of baseline salivary output. This significant difference in post-radiation salivary outputs suggests preservation of function of transferred salivary gland.

2 Comparison of the dose to the salivary gland with the Quality of Life (QoL) and Salivary Flow Measurements (SFM) in the submandibular salivary gland transfer procedure for the prevention of radiation induced xerostomia

2 Comparison of the dose to the salivary gland with the Quality of Life (QoL) and Salivary Flow Measurements (SFM) in the submandibular salivary gland transfer procedure for the prevention of radiation induced xerostomia

Prevention of Radiation Induced Xerostomia and Improved Quality of Life: Submandibular Salivary Gland Transfer

Over 60,000 new cases of head and neck cancers, and approximately 15,000 deaths occur every year in the United States (1). Head and neck cancers affect more men then women by a factor of 2:1, although the incidence of women is increasing as a result of increased tobacco use (2). Over 90% of all head and neck cancers are squamous cell carcinomas; most of the remaining cancers are adenocarcinomas. A combination of radiation therapy and surgery is used as the standard, primary treatment modality. Xerostomia occurs when the salivary glands are affected by irradiation. Patients experiencing xerostomia are at an increased risk for a wide variety of oral problems; all adversely affecting one's quality of life. Currently patients make lifestyle changes, dietary modifications, and use artificial salivas, sprays, gels, and lozenges to help mask their xerostomia. However, none of these products stimulate natural salivary production and act as a replacement therapy rather then a cure for xerostomia. A new protocol, RTOG 1083 has been approved by the Radiation Therapy Oncology Group, which involves a surgical transfer of a submandibular salivary gland to the submental space (where it can be easily shielded) as a method of prevention of radiation induced xerostomia.

Regeneration potential of the submandibular gland after transplantation: An immunohistological and scintigraphic study

Summary The aim of this study was to evaluate the regeneration potential of the submandibular gland and the associated morphological and functional impairment after a transient warm ischemia as a result of submandibular gland transfer in humans. 42 rabbits were used for the study. After 1.5 h of transient ischemia, submandibular glands were studied histologically in the following 14 days, one month, two and four months in 32 rabbits. Additionally, the glands were functionally evaluated after one and four months in eleven of these rabbits. Ten rabbits were used to establish the scintigraphic method. In the evaluation of the results unpublished data derived from a previous study by our group has also been considered. The Ki-67 index showed a significant increase of the proliferating rate reaching a peak after 14 days ( p = 0.006) and still evident after four months involving mostly the terminal ductal system. There was only a slight increase in the tracer uptake of ischemic glands after one month and a more pronounced one after four months. It was concluded that initial loss of acinar cells by 1.5 h of ischemia released a regeneration process which stabilised after 14 days but continued throughout the whole time of the study. These results correlate with clinical observation in patients with submandibular gland transfer for the treatment of keratoconjunctivitis sicca and explain the alternating secretory function observed within the four months following surgery. Scintigraphy has been found to play a limited role in the evaluation of the regeneration process.

Anatomic Study of Submandibular Gland Transfer in an Attempt to Prevent Postradiation Xerostomia

Xerostomia is the most common negative sequela after radiotherapy for head and neck cancer and results from destruction of normal salivary gland tissue by radiation. We hypothesized that transferring a single submandibular gland outside the radiation field to the submental region may preserve its function, thus preventing xerostomia and its consequences. This anatomic study was designed to evaluate different methods of submandibular gland transfer to the submental region. Eight submandibular glands were dissected in four fresh human cadavers. The anatomy and blood supply of the region were documented. Each gland was transferred to the submental region by either free microvascular transfer or based on retrograde flow through the distal facial vessels. Both methods of transfer resulted in complete relocation of the submandibular gland into the submental region.

Submandibular Gland Transfer: A New Method of Preventing Radiation‐Induced Xerostomia

Radiation-induced xerostomia is a significant morbidity of radiation therapy in the management of patients with head and neck cancers. We have recently reported a method of transfer of one submandibular gland to the submental space in a small pilot series of eligible surgical patients. The submental space was shielded during postoperative radiation therapy. The transferred gland continued to function after the completion of radiation therapy and none of the patients developed xerostomia. The purpose of this article is to present the technique of submandibular gland transfer in detail and to evaluate the postoperative survival and function of the transferred submandibular glands. Prospective clinical trial. The submandibular gland was transferred on eligible patients as part of their surgical intervention. The patients were followed clinically, with salivary flow and radioisotope studies. We performed the surgical transfer of the submandibular salivary gland in 24 of 25 patients placed on the protocol. All the glands survived transfer and functioned well postoperatively as demonstrated on the salivary flow and the radioisotope studies. The surgical transfer was relatively simple and added 45 minutes to the surgical procedure. There were no complications attributed to the submandibular gland transfer. We have successfully demonstrated that the submandibular gland can be surgically transferred to the submental space with its function preserved. The gland seems to continue functioning even after radiation therapy with the appropriate shielding. This surgical transfer procedure has the potential to change the way we currently manage patients with head and neck cancer.

Microvascular submandibular gland transfer for severe cases of keratoconjunctivitis sicca. Sieg P,∗ Geerling G, Kosmehl H, Lauer I, Warnecke K, von Domarus H. Plast Reconstr Surg 2000;106:554–560.

Free submandibular salivary gland transfer was investigated as a surgical method for the treatment of severe keratoconjunctivitis sicca. In an animal model, the authors examined the tolerance of warm ischemia of the submandibular gland. After temporary interruption of the blood supply (one to six hours), the morphologic changes in the submandibular gland were analyzed histologically and immunohistochemically in 41 rabbits. From 1.5 hours ischemia onward, an increasing structural damage of the parenchyma with emphasis on the secretory cells was seen. Six hours of ischemia caused total necrosis of the salivary gland. The authors clinical experience includes 24 highly selected patients suffering from keratoconjunctivitis sicca, in whom they transferred 31 autologous submandibular glands to the temple for permanent autologous tear substitution within the past four years. The glands were implanted into a pocket prepared in the temporalis muscle, and the nourishing vessels were anastomosed to the superficial temporal artery and vein. The submandibular duct was implanted into the upper lateral conjunctival fornix. The transferred glands were left denervated. In addition to the clinical examination, scintigraphy with Tc 99m pertechnetate was used to document the graft’s viability after the transfer. Viable incorporation with longstanding secretory function occurred in 26 of the 30 transplanted denervated salivary glands. The resulting lubrication of the treated eyes was irregular for up to three months in almost every case. One year after surgery, all patients with a viable transplant developed at least occasional epiphora, which was surgically managed by reducing the size of the graft in 10 patients. The ophthalmologic evaluation of the method included the assessment of dry eye symptoms and of the volume and quality of ocular lubrication (Schirmer test, fluorescein break-up time), the pathology of the ocular surface (rose bengal staining), and the need for tear substitutes. One year after surgery, 18 of 27 cases assessed were judged as significantly improved by these tests.—Thomas J. Liesegang.

Microvascular Submandibular Gland Transfer for Severe Cases of Keratoconjunctivitis Sicca

Free submandibular salivary gland transfer was investigated as a surgical method for the treatment of severe keratoconjunctivitis sicca. In an animal model, we examined the tolerance of warm ischemia of the submandibular gland. After temporary interruption of the blood supply (1 to 6 hours), the morphologic changes in the submandibular gland were analyzed histologically and immunohistochemically in 41 rabbits. From 1.5 hours ischemia onward, an increasing structural damage of the parenchyma with emphasis on the secretory cells was seen. Six hours of ischemia caused total necrosis of the salivary gland. Our clinical experience includes 24 highly selected patients suffering from keratoconjunctivitis sicca, in whom we transferred 31 autologous submandibular glands to the temple for permanent autologous tear substitution within the past 4 years. The glands were implanted into a pocket prepared in the temporalis muscle, and the nourishing vessels were anastomosed to the superficial temporal artery and vein. The submandibular duct was implanted into the upper lateral conjunctival fornix. The transferred glands were left denervated. In addition to the clinical examination, scintigraphy with Tc 99m pertechnetate was used to document the graft's viability after the transfer. Viable incorporation with longstanding secretory function occurred in 26 of the 30 transplanted denervated salivary glands. The resulting lubrication of the treated eyes was irregular for up to 3 months in almost even case. One year after surgery, all patients with a viable transplant developed at least occasional epiphora, which was surgically managed by reducing the size of the graft in 10 patients. No severe side effects were seen in this series. The ophthalmologic evaluation of the method included the assessment of dry eye symptoms and of the volume and quality of ocular lubrication (Schirmer test, fluorescein break-up time), the pathology of the ocular surface (rose bengal staining), and the need for pharmaceutical tear substitutes. One year after surgery, 18 of 27 cases assessed were judged as significantly improved by these tests.

Microvascular Submandibular Gland Transfer for Severe Cases of Keratoconjunctivitis Sicca

Free submandibular salivary gland transfer was investigated as a surgical method for the treatment of severe keratoconjunctivitis sicca. In an animal model, we examined the tolerance of warm ischemia of the submandibular gland. After temporary interruption of the blood supply (1 to 6 hours), the morphologic changes in the submandibular gland were analyzed histologically and immunohistochemically in 41 rabbits. From 1.5 hours ischemia onward, an increasing structural damage of the parenchyma with emphasis on the secretory cells was seen. Six hours of ischemia caused total necrosis of the salivary gland. Our clinical experience includes 24 highly selected patients suffering from keratoconjunctivitis sicca, in whom we transferred 31 autologous submandibular glands to the temple for permanent autologous tear substitution within the past 4 years. The glands were implanted into a pocket prepared in the temporalis muscle, and the nourishing vessels were anastomosed to the superficial temporal artery and vein. The submandibular duct was implanted into the upper lateral conjunctival fornix. The transferred glands were left denervated. In addition to the clinical examination, scintigraphy with Tc 99m pertechnetate was used to document the graft's viability after the transfer. Viable incorporation with longstanding secretory function occurred in 26 of the 30 transplanted denervated salivary glands. The resulting lubrication of the treated eyes was irregular for up to 3 months in almost every case. One year after surgery, all patients with a viable transplant developed at least occasional epiphora, which was surgically managed by reducing the size of the graft in 10 patients. No severe side effects were seen in this series. The ophthalmologic evaluation of the method included the assessment of dry eye symptoms and of the volume and quality of ocular lubrication (Schirmer test, fluorescein break-up time), the pathology of the ocular surface (rose bengal staining), and the need for pharmaceutical tear substitutes. One year after surgery, 18 of 27 cases assessed were judged as significantly improved by these tests. (Plast. Reconstr. Surg. 106: 554, 2000.)

Submandibular gland transfer for correction of the dry eye: Surgical experience and two-year follow-up

Submandibular gland transfer for correction of the dry eye: Surgical experience and two-year follow-up

Long term results of submandibular gland transfer for the management of xerophthalmia

Free submandibular gland transfer is potentially the best surgical solution to total xerophthalmia. Experimentally, gland function has only previously been followed for 2 months. This study was designed to investigate the long term effects of free transfer on gland function. Simultaneous creation of experimental xerophthalmia and free microvascular transfer of the submandibular gland to the orbit was completed in 10 rabbits. Two died before the end of the experimental period and the study was based on the remaining eight. Six months after transfer, five of the eight transferred glands were histologically normal and contained healthy neurones and nerve terminals. In these animals, tear secretion in the transfer eye was significantly greater than that of the control eye at 2 (p < 0.05) and 6 months (p < 0.02) after transfer. In the transfer eye, tear secretion was also found to have significantly increased from preoperative levels at 2 (p < 0.05) and 6 months (p < 0.01). The observed innervation of the transferred glands may play a role in maintaining secretion in the long term.

Microvascular submandibular gland transfer for the management of xerophthalmia; an experimental study

Free submandibular salivary gland transfer was investigated as a method of treatment for xerophthalmia. Xerophthalmia was created in rabbits by surgical removal of the lacrimal gland and the incidence of corneal ulceration was seen to correlate with the decrease in tear secretion. Microvascular transfer of the submandibular salivary gland to drain saliva into the conjunctival fornix prevented the development of corneal ulceration in 63% of the cases.