Long-Term Follow-up after Submandibular Gland Transplantation in Severe Dry Eyes Secondary to Cicatrizing Conjunctivitis

The timing of acid-induced increase in saliva secretion in transplanted submandibular glands

“…Autologous microvascular transplantation of the submandibular gland (SMG) has proven to be an effective treatment for patients with severe KCS. [1][2][3][4][5][6][7][8][9][10] In our experience of SMG transplantation in 180 patients (195 glands), all viable transplanted SMGs retain their secretion function in the long term and the symptoms of dry eye are greatly relieved. 3,8 However, excessive secretion, or epiphora, occurs in more than 40% of patients at >6 months after surgery.…”

Two-stage autotransplantation of human submandibular gland: a novel approach to treat postradiogenic xerostomia

“…However, harvesting of the gland from its natural bed is only possible following denervation of the organ. As previously demonstrated in an experimental series [28,29] and in a clinical setting, in patients with severe keratoconjunctivitis [21][22][23][24]26] where one gland was transplanted to the temporal region and the submandibular duct connected to the lateral conjunctival fornix, this denervation had no detrimental effect on basic saliva production. The idea of performing a two-stage autotransplantation of one submandibular gland to treat postradiotherapeutic xerostomia, as originally proposed by Spiegel et al [27,28,29], appeared to be a surgical approach with an acceptable perioperative risk in relation to the expected benefit.…”

“…In 1998, Geerling et al [21] reported on the successful microvascular transplantation of one submandibular gland to the temporal region in patients with severe keratoconjunctivitis sicca. It has also been demonstrated that, in spite of denervation of the gland following complete organ transfer, the amount of salivary production remained stable for years [22][23][24]. On the basis of these two independent findings, this prospective study was undertaken to evaluate whether a two-stage autotransplantation of the human submandibular gland was feasible in treating xerostomia following RT of HNSCC.…”

Transplantation of the Major Salivary Glands

“…We have transplanted 42 SMG in 34 patients and collected complete ophthalmologic follow-up examinations for up to 7 years [4,20,[26][27][28]. Based on Schirmer's test, improvement of clinical symptoms and 99m Tc-pertechnetate scintigraphy, 32 of the 42 (72%) SMG grafts remained viable until the last follow-up [7].…”