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Long-Term Follow-Up After Autologous Microvascular Submandibular Gland Transfer for Severe Keratoconjunctivitis Sicca
Oral Abstract Session 3 copy and further investigated by duct casting and magnetic resonance sialograph (MRS). Results: In submandibular gland, the features of 128 were found endoscopically and radiographically, and endoscopic findings were of three types: sialolith (n⫽114, 89%), mucus plug (n⫽8, 6%), and stenosis (n⫽6, 5%). Forty-seven obstructions were successfully removed surgically, giving a success rate of (47/51, 92%). sixty-three patients were treated by interventional sialoendoscopy, and in 52 cases the sialoliths were removed directly by sialoendoscopy (52/63, 83%). The unsuccessful cases were treated in succession by sialoendoscopy or surgical method. Obstructive symptoms were relieved in 12 cases of 14 without stones by dilation and irrigation under sialoendoscopy. Of 109 stones, the sialoliths of 67 (61%) were located in the distal region (behind the first molar). The results showed that the further back the stone was, the more difficult it was to remove. 3 failure cases were treated by resection of the gland finally. Basin-like structure in hilus region had been found in 86 cases (86/128, 67%) by sialoendoscopy, and was further demonstrated as a widening of the duct in the hilus region by duct casting and MRS. 5 cases had been found the foreign body (fish bone) wrapped by sialolith. Conclusion: Sialoendoscopy is a new technique to detect obstructive causes in submandibular gland directly and manage the chronic obstructive submandibular gland effectively combined with surgical method simultaneously. We identified a special anatomical structure in the submandibular hilus by sialoendoscopy, and it could be responsible for the sialolith formation in submandibular gland, especially in hilus region. We also presumed the foreign body and mucus plug that were supposed to act as a nidus for the sialolith. References Nahlieli O, Baruchin AM. long-term experience with endoscopic diagnosis and treatment of salivary gland inflammatory diseases. Laryngoscope. 2000, 110(6): 988-993 Marchal F, Kurt AM, Lehmann W. Retrograde theory in sialolithiasis formation: role of an anatomical sphincter. Otolaryngol, Head and Neck Surg. 2001;15:11-13
Objective: To assess the long-term results of autologous microvascular submandibular gland transfer for severe cases of keratoconjunctivitis sicca. Methods: From 1999 to 2006, 103 patients (106 glands) with severe keratoconjunctivitis sicca were treated by autologous microvascular submandibular gland transfer. Postoperative scientigraphy with Tc99m was performed to validate the vitality and function of the transferred glands. Subjective investigation and ophthalmologic examination were performed in the follow-up (more than one year) study. Wherever possible, second stage ocular surface reconstruction operation was undertaken to improve the visual acuity. The secretion of the transferred glands (“saliva-tear”) were collected and analyzed in comparison to the submandibualr saliva and natural tear. Results: Clinically and scintgraphically, the transplants were successful in 96 glands, whose symptoms of xerophthalmia disappeared. Ten transferred glands did not survive. No severe complication occurred. Epiphora occurred in 50 patients (53 glands) at 4 months after transfer and it was managed successfully by surgical reduction of the graft volume. Obliteration of Wharton’s duct occurred in 5 cases and was treated by the reconstruction of the ducts. Subjective satisfactions were over 80%. Ocular surface was improved in 48 cases. Corneal transplantations were performed in 7 cases, 3 cases succeeded. Chemical analysis showed that the saliva-tear was more similar to the natural tear than the submandibualr saliva. Conclusions: Microvascular autologous submandibular gland transfer is a lasting and effective treatment for severe cases of keratoconjunctivitis sicca. The secretion of the transferred gland is beneficial to the ocular surface. References
Long-Term Follow-Up After Autologous Microvascular Submandibular Gland Transfer for Severe Keratoconjunctivitis Sicca
Yu GY, Zhu ZH, Mao C, Cai ZG, Zou LH, Lu L, Zhang L, Peng X, Li N, Huang Z. Microvascular autologous submandibular gland transfer in severe cases of keratoconjunctivitis sicca. Int J Oral Maxillofac Surg. 2004,33:235-239 Lei Zhang, Zheng-hong Zhu, Hao-jie Dai, Zhi-gang Cai, Chi Mao, Xin Peng, Guang-yan Yu. Application of 99mTc-Pertechnetate Scintigraphy to Microvascular Autologous Transplantation of the Submandibular Gland in Patients with Severe Keratoconjunctivitis Sicca. The Journal of Nuclear Medicine,2007,48:1431-1435
Guang-yan Yu, DDS, MD, 22 South Avenue Zongguancun Haidian District, Peking University School of Stomatology, Beijing, 100081, China (Zhang L; Wang Y; Mao C; Cai ZG; Zhu ZH; Zou LH; Lv L)
Funding Source: This study was supported by the grants from National Nature Science Foundation of China (NO.30640093, 30730102), Grant for Capital Medical Development (NO.2005-2009), Ministry of Science and Technology (NO. 2003CCC00800)
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Objective: To assess the long-term results of autologous microvascular submandibular gland transfer for severe cases of keratoconjunctivitis sicca. Methods: From 1999 to 2006, 103 patients (106 glands) with severe keratoconjunctivitis sicca were treated by autologous microvascular submandibular gland transfer. Postoperative scientigraphy with Tc99m was performed to validate the vitality and function of the transferred glands. Subjective investigation and ophthalmologic examination were performed in the follow-up (more than one year) study. Wherever possible, second stage ocular surface reconstruction operation was undertaken to improve the visual acuity. The secretion of the transferred glands (“saliva-tear”) were collected and analyzed in comparison to the submandibualr saliva and natural tear. Results: Clinically and scintgraphically, the transplants were successful in 96 glands, whose symptoms of xerophthalmia disappeared. Ten transferred glands did not survive. No severe complication occurred. Epiphora occurred in 50 patients (53 glands) at 4 months after transfer and it was managed successfully by surgical reduction of the graft volume. Obliteration of Wharton’s duct occurred in 5 cases and was treated by the reconstruction of the ducts. Subjective satisfactions were over 80%. Ocular surface was improved in 48 cases. Corneal transplantations were performed in 7 cases, 3 cases succeeded. Chemical analysis showed that the saliva-tear was more similar to the natural tear than the submandibualr saliva. Conclusions: Microvascular autologous submandibular gland transfer is a lasting and effective treatment for severe cases of keratoconjunctivitis sicca. The secretion of the transferred gland is beneficial to the ocular surface. References
Long-Term Follow-Up After Autologous Microvascular Submandibular Gland Transfer for Severe Keratoconjunctivitis Sicca
Yu GY, Zhu ZH, Mao C, Cai ZG, Zou LH, Lu L, Zhang L, Peng X, Li N, Huang Z. Microvascular autologous submandibular gland transfer in severe cases of keratoconjunctivitis sicca. Int J Oral Maxillofac Surg. 2004,33:235-239 Lei Zhang, Zheng-hong Zhu, Hao-jie Dai, Zhi-gang Cai, Chi Mao, Xin Peng, Guang-yan Yu. Application of 99mTc-Pertechnetate Scintigraphy to Microvascular Autologous Transplantation of the Submandibular Gland in Patients with Severe Keratoconjunctivitis Sicca. The Journal of Nuclear Medicine,2007,48:1431-1435
Guang-yan Yu, DDS, MD, 22 South Avenue Zongguancun Haidian District, Peking University School of Stomatology, Beijing, 100081, China (Zhang L; Wang Y; Mao C; Cai ZG; Zhu ZH; Zou LH; Lv L)
Funding Source: This study was supported by the grants from National Nature Science Foundation of China (NO.30640093, 30730102), Grant for Capital Medical Development (NO.2005-2009), Ministry of Science and Technology (NO. 2003CCC00800)
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