Submandibular gland transfer: a new method of preventing radiation-induced xerostomia.
OBJECTIVE
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.


METHODS
Prospective clinical trial.


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
Seikaly
H
H
Division of Otolaryngology Head and Neck Surgery, University of Alberta, Edmonton, Canada. hseikaly@netcom.ca
Jha
N
N
McGaw
T
T
Coulter
L
L
Liu
R
R
Oldring
D
D
D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010039:Otorhinolaryngologic Neoplasms / Q000532:radiotherapy*; D011446:Prospective Studies; D011832:Radiation Injuries / Q000517:prevention & control*; D011835:Radiation Protection; D012472:Salivation / Q000528:radiation effects; D013363:Submandibular Gland / Q000528:radiation effects / Q000601:surgery*; D014022:Tissue Survival / Q000528:radiation effects; D014987:Xerostomia / Q000517:prevention & control*