Submandibular Gland Transfer for Severe Xerophthalmia

Abstract

Microvascular submandibular gland transfer is an effective approach for correcting severe xerophthalmia. The procedure should be within the skills of any reconstructive microsurgeon. This procedure offers a unique opportunity for otolaryngologist-head and neck reconstructive surgeons to help restore vision to this unfortunate group of patients.

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.…”

Schirmer Test in Transplanted Submandibular Gland

“…[5][6][7][8][9][10]16,17 Improvement of both subjective symptoms and objective parameters has been verified in long-term follow-up with the procedure. [6][7][8]10 Secretion of the transplanted SMG is used as a substitute for natural tears. Schirmer test, being the most commonly used test to measure tear production, has been used to measure secretion of the transplanted SMG.…”

“…This procedure has been effective for severe cases of KCS. [5][6][7][8][9][10] Clinical results showed that the secretions from all viable transplanted SMGs maintained stable function in the long term. 11 The uncomfortable symptoms were relieved, and the frequency of use of pharmaceutical tear substitutes was reduced.…”

“…The most commonly used method of measurement is the Schirmer test, which is one of the most commonly used tests to measure tear production. [5][6][7][8][9][10] The secretions from the main lacrimal gland are triggered by emotion or local physical irritation. 12,13 Increase in the secretion of normal SMG originates primarily from the gustatory reflex secretion.…”

Treatment of Severe Keratoconjunctivitis Sicca by Parotid Duct Transposition after Tympanic Neurectomy in Rabbits

“…1,[5][6][7][8] This procedure could offer a permanent autologous source of tears with the basal secretion of a transplanted revascularized but denervated submandibular gland and so overcome gustatory epiphora. However, the surgical procedure was complicated, and a perfect microsurgical technique was needed.…”