title: Long-term results of autologous submandibular gland transfer for the surgical treatment of severe keratoconjunctivitis sicca.
abstract: OBJECTIVE
  The aim of this study was to assess the long-term results of autologous submandibular gland transfer for surgical correction of severe keratoconjunctivitis sicca.
  
  
  METHODS
  A survey was undertaken of 32 patients who had undergone submandibular gland transfer (42 glands) and by following up 11 patients (15 glands) for 5-10 years. Subjective benefit was evaluated as well as clinical findings at the ocular surface. The biochemical consistency of the secreted "saliva-tear" was analysed and compared with natural submandibular saliva of a matched control-group. The vitality and function of the transplants was tested by means of sialoscintigraphy. Immunohistochemical investigations were carried out in specimens of submandibular tissue, gained during reduction procedures of the transplants to correct secretory excess.
  
  
  RESULTS
  Patient evaluation and clinical assessment revealed a long-lasting subjective benefit in 2/3 of the patients and a stabilisation at the ocular surface in all cases. The secretion remained as highly concentrated submandibular saliva. Glandular vitality and function was shown scintgraphically. Immunohistochemical investigations revealed no progressive atrophy after transplantation, the ability of cell division remained intact and there was still neuronal tissue in all transplants, even several years after transfer. As all transplants responded well to parasympathomimetic drugs, this might be an indication of re-innervation of the gland.
authors.affiliation: Department of Maxillofacial Surgery, University of Luebeck, Germany. hans-christian.jacobsen@uk-sh.de
authors.forename: Hans-Christian
authors.initials: HC
authors.lastname: Jacobsen
authors.forename: Samer G
authors.initials: SG
authors.lastname: Hakim
authors.forename: Isabel
authors.initials: I
authors.lastname: Lauer
authors.forename: Andreas
authors.initials: A
authors.lastname: Dendorfer
authors.forename: Thilo
authors.initials: T
authors.lastname: Wedel
authors.forename: Peter
authors.initials: P
authors.lastname: Sieg
mesh_terms: D000714:Anastomosis, Surgical; D005260:Female; D006651:Histocytochemistry; D006801:Humans; D007638:Keratoconjunctivitis Sicca / Q000601:surgery*; D019394:Ki-67 Antigen / Q000032:analysis; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D012463:Saliva / Q000737:chemistry; D013670:Sodium Pertechnetate Tc 99m; D013363:Submandibular Gland / Q000000981:diagnostic imaging / Q000637:transplantation*; D011795:Surveys and Questionnaires
chemical_list: D019394:Ki-67 Antigen; D019275:Radiopharmaceuticals; D013670:Sodium Pertechnetate Tc 99m