Prevention of radiation induced xerostomia by surgical transfer of submandibular salivary gland into the submental space.
OBJECTIVE
Xerostomia is a significant morbidity of radiation treatment in the management of head and neck cancers. We hypothesized that the surgical transfer of one submandibular salivary gland to the submental space, where it can be shielded from radiation treatment (XRT), would prevent xerostomia.


METHODS
We conducted a prospective Phase II clinical trial and the patients were followed clinically with salivary flow studies and the University of Washington Quality of Life questionnaire.


RESULTS
We report the results on 76 evaluable patients. The salivary gland transfer was done in 60 patients. Nine patients (of 60) did not have postoperative XRT and in eight patients (of 60) the transferred gland was not shielded from XRT due to proximity of disease. The median follow up is 14 months. Of the 43 patients with the salivary gland transfer and post-operative XRT with protection of the transferred gland, 81% have none or minimal xerostomia, and 19% developed moderate to severe xerostomia. Three patients (6.9%) developed local recurrence, five patients (11.6%) developed distant metastases and five patients (11.6%) have died. There were no complications attributed to the surgical procedure.


CONCLUSIONS
Surgical transfer of a submandibular salivary gland to the submental space preserves its function and prevents the development of radiation induced xerostomia.
Department of Radiation Oncology, University of Alberta, Edmonton, Alberta, Canada.
Naresh
N
Jha
Hadi
H
Seikaly
Jeff
J
Harris
David
D
Williams
Richard
R
Liu
Timothy
T
McGaw
Henry
H
Hofmann
Don
D
Robinson
John
J
Hanson
Pam
P
Barnaby
D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000532:radiotherapy*; D005260:Female; D006258:Head and Neck Neoplasms / Q000532:radiotherapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011788:Quality of Life; D011832:Radiation Injuries / Q000517:prevention & control*; D011878:Radiotherapy / Q000009:adverse effects; D013363:Submandibular Gland / Q000528:radiation effects / Q000601:surgery*; D014987:Xerostomia / Q000209:etiology / Q000517:prevention & control*