Submandibular gland transfer for severe xerophthalmia.
OBJECTIVE
To report early clinical experience with a new microvascular reconstructive procedure for patients with severe xerophthalmia.


METHODS
Retrospective clinical series.


METHODS
Patients with severe xerophthalmia were referred for treatment after having exhausted all conventional means of treatment. The ipsilateral submandibular gland was transferred to the temporal fossa, as described by Macleod et al., and revascularized using the superficial temporal artery and appropriate vein(s). The submandibular duct was directed to the superolateral fornix so that the saliva produced moistened the eye. Results and complications were reviewed.


RESULTS
Seven microvascular submandibular gland transfer procedures were performed in five patients, ages 6 to 54. The etiology of severe xerophthalmia was Stevens-Johnson syndrome in four and chemical burn in one. Follow-up time was 4 to 20 months. Successful transfer with revascularization was achieved in six of seven (86%) cases. Schirmer's test scores improved from 1.3 pretransfer to 8.1 posttransfer (P = .005). Patients experienced symptomatic relief within 1 month, and the microenvironment of the eye surface improved enough to make them candidates for visual restorative eye surgery. There were no major complications.


CONCLUSIONS
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.
Paniello
Randal C
RC
Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, USA. PanielloR@ent.wustl.edu
D000328:Adult; D002648:Child; D005126:Eye Burns / Q000150:complications; D005145:Face / Q000098:blood supply; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013262:Stevens-Johnson Syndrome / Q000150:complications*; D013363:Submandibular Gland / Q000637:transplantation*; D016896:Treatment Outcome; D014985:Xerophthalmia / Q000209:etiology / Q000601:surgery*