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Microvascular autologous transplantation of partial submandibular gland for severe keratoconjunctivitis sicca
21st ICOMS 2013 - Abstracts: Oral Papers
1351
T31.OR018
T31.OR020
Botulinum neurotoxin A reduces salivary secretion by inhibiting AQP5 activity in rat submandibular gland
Microvascular autologous transplantation of partial submandibular gland for severe keratoconjunctivitis sicca
H. Xu 1,∗ , X. Shan 1 , Z. Cai 1 , L. Wu 2
L. Zhang 1,∗ , J. Qin 1 , Z. Cai 1 , L. Lv 2 , G.Y. Yu 1
1
1 Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, China 2 Department of Ophthalmology, Affiliated Beijing Tong Ren Hospital, Capital University of Medical Science, China
Peking University School and Hospital of Stomatology, China Peking University Health Science Centre and Key Laboratory of Molecular Cardiovascular Sciences, China
2
Objective: Botulinum neurotoxin type A (BoNT/A) shows effective in the treatment of sialorrhea. The purpose of this study was to investigate the long-term morphological and functional effects of BoNT/A on submandibular glands (SMGs) and elucidated its underline mechanisms. Methods: In rats treated with BoNT/A, we measured salivary flow rate of SMGs with modified Schirmer test and examined morphological changes through light and electron microscopic examinations at different time points (1, 2, 4, 12 and 24 weeks) after operation. Immunohistochemistry was used to evaluate acetylcholinesterase (AchE). Western blot were used to evaluate the protein levels of synaptosome-associated protein of 25 kDa (SNAP-25), M3 muscarinic acetylcholine receptor (M3R) and aquaporin 5 (AQP5). Immunofluorescence was used to assess the distribution of AQP5. Results: The salivary flow of the BoNT/A-treated glands decreased accompanied with glandular atrophy. The protein levels of SNAP-25 and AchE were downregulated while the protein levels of M3R were upregulated in treated glands. BoNT/A decreased the expression of AQP5 and inhibited translocations of AQP5 from the cytoplasm to the plasma membrane. These effects could be observed after 1 week, peaked at 2 weeks and recovered to normal level at 24 weeks. Conclusions: BoNT/A recoverably decreased salivary flow in a dose-dependent manner and led to temporary glandular atrophy. BoNT/A-induced inhibitory secretory mechanism involved not only temporary glandular denervation, but also the direct inhibition of AQP5 activity in SMGs. http://dx.doi.org/10.1016/j.ijom.2013.07.637
Objective: To evaluate the feasibility of microvascular autologous transplantation of partial submandibular gland (SMG) to prevent or reduce epiphora in severe keratoconjunctivitis sicca (KCS). Methods: Thirty-nine patients with KCS, for 42 eyes, were randomized to undergo transplantation of partial or total SMG from January 2006 to December 2009. Survival rate of transplanted SMG; ophthalmologic features of best-corrected visual acuity, Schirmer’s test results, break-up time (BUT) of tear film, and fluorescence staining; incidence of postoperative epiphora and frequency of subsequent surgery. Results: Total SMG transplantation was performed in 22 cases, and partial SMG transplantation was performed in other 20 cases. All transplanted SMGs survived. Microvascular crisis occurred in 1 case of partial SMG transplantation, but the gland survived after exploration to remove the venous thrombus. Obstruction of ductal orifice in 1 case of partial SMG transplantation was resolved by reconstruction of the ductal orifice. Symptoms of dry eyes disappeared, and patients were able to discontinue use of artificial tears. Severe epiphroa occurred in 6 eyes undergoing partial SMG transplantation and in 19 undergoing total SMG transplantation (P < 0.01). Surgical reduction was performed in 6 eyes undergoing partial SMG transplantation and 18 undergoing total SMG transplantation (P < 0.01). Conclusion: Microvascular transplantation of partial SMG is feasible and effective for severe KCS and does not decrease the survival rate of transplanted SMG. For ample SMGs with normal function, transplantation of partial SMG alleviates the symptoms of dry eye and significantly reduces the incidence of severe postoperative epiphora.
T31.OR019 Transoral management of large calculi in submandibular gland with sialendoscopy C. Yu ∗ , L. Zheng, C. Yang
http://dx.doi.org/10.1016/j.ijom.2013.07.639 T32.OR001
Shanghai 9th People’s Hospital, Shanghai Jiao Tong University, School of Medicine, China T32.Skin Tumours of the Head and Neck Objective: Recently, different minimally invasive techniques have been developed for the management of the submandibular calculi. This retrospective study concluded our experience about transoral management of large submandibular calculi with sialendoscopy. Methods: During a period of 10 years from 2002, patients with swelling symptom in submandibular gland were diagnosed and confirmed large calculi (>or = 10 mm) by routine methods. All cases were evaluated the degree of symptom by VAS, and some long history cases (more than 1 year) were further assessed uptake and excretion function by Tc-99m pertechnetate scintigraph. Large calculi were removed by transoral approach (gland preserving) combined with sialendoscopic management. Failure cases could be removal of the glands. Evaluation of the results included VAS assessment after big calculi removed successfully. Results: 106 cases were found large calculi in submandibular duct (anterior 33, posterior 73). 19 cases were evaluated function by scintigraphic examination, and only 6 cases (31.6%) had the almost total function loss, and 9 cases were partial loss, 4 cases had the same function curve as other side. The success rate of transoral sialolithectomy was 101 cases (101/106, 95.3%). Residual calculi were detected in distal duct in 29 anterior cases under sialendoscopy, and 23 cases were removed successfully by forceps or basket simultaneously. 5 failure cases had undergone the gland resection ultimately. Most cases after management had relieved symptom by VAS evaluation. Conclusion: Large submandibular calculi can be removed by gland-preserving procedures and most cases were asymptom after joint management with sialendoscopy. http://dx.doi.org/10.1016/j.ijom.2013.07.638
The role of ultrasound scanning of the neck in pre-operative staging of cutaneous squamous-cell carcinoma of the head and neck J.N. Ban ∗ , D.P. Ramkumar, M. Tariq, S. Mustafa Prince Charles Hospital, United Kingdom Background: The increased average age of the world population coupled with long-term sun exposure has led to an increase in the incidence of cutaneous squamous cell carcinoma (cSCC). The incidence of nodal metastasis in such patients is thought to range from less than 5% to up to 20% in some reports. Mortality rates following a metastasis have been shown to be high, demonstrating the importance of early detection of metastatic nodes. The aim of our study was to ascertain the value of a routine ultrasound scan (USS) for every patient following head and neck cSCC diagnosis in screening for metastatic disease. Method: A 41 month retrospective analysis was carried out (January 2009–May 2012) involving all patients with cSCC treated by the OSMF Department at Prince Charles Hospital and the Royal Glamorgan Hospital in South Wales, UK. There were a total number of 108 incidences of cSCC. The following criteria were used in the data collection process: 1. Anatomical characteristics (site); 2. Pathological characteristics (size, depth, margins and differentiation); 3. Patient factors (immunosuppression); 4. USS findings. Results: Of the 108 incidences, one patient was diagnosed with a metastatic lymph node following USS. This patient exhibited one of five metastatic risk factors and the node was clinically palpable meaning a USS would have been carried out as per the existing British Association of Dermatology guidelines. Conclusion: The pick up rate of cervical lymph node metastasis from routine USSs of all cSCCs is not high enough to warrant the application of this investigation to all patients routinely. It should therefore be reserved for high-risk cases where it is felt that a scan is justified on clinical grounds. Work is underway to ascertain whether or not high risk cases would benefit from routine USS of the neck to detect early metastasis. http://dx.doi.org/10.1016/j.ijom.2013.07.640
1351
T31.OR018
T31.OR020
Botulinum neurotoxin A reduces salivary secretion by inhibiting AQP5 activity in rat submandibular gland
Microvascular autologous transplantation of partial submandibular gland for severe keratoconjunctivitis sicca
H. Xu 1,∗ , X. Shan 1 , Z. Cai 1 , L. Wu 2
L. Zhang 1,∗ , J. Qin 1 , Z. Cai 1 , L. Lv 2 , G.Y. Yu 1
1
1 Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, China 2 Department of Ophthalmology, Affiliated Beijing Tong Ren Hospital, Capital University of Medical Science, China
Peking University School and Hospital of Stomatology, China Peking University Health Science Centre and Key Laboratory of Molecular Cardiovascular Sciences, China
2
Objective: Botulinum neurotoxin type A (BoNT/A) shows effective in the treatment of sialorrhea. The purpose of this study was to investigate the long-term morphological and functional effects of BoNT/A on submandibular glands (SMGs) and elucidated its underline mechanisms. Methods: In rats treated with BoNT/A, we measured salivary flow rate of SMGs with modified Schirmer test and examined morphological changes through light and electron microscopic examinations at different time points (1, 2, 4, 12 and 24 weeks) after operation. Immunohistochemistry was used to evaluate acetylcholinesterase (AchE). Western blot were used to evaluate the protein levels of synaptosome-associated protein of 25 kDa (SNAP-25), M3 muscarinic acetylcholine receptor (M3R) and aquaporin 5 (AQP5). Immunofluorescence was used to assess the distribution of AQP5. Results: The salivary flow of the BoNT/A-treated glands decreased accompanied with glandular atrophy. The protein levels of SNAP-25 and AchE were downregulated while the protein levels of M3R were upregulated in treated glands. BoNT/A decreased the expression of AQP5 and inhibited translocations of AQP5 from the cytoplasm to the plasma membrane. These effects could be observed after 1 week, peaked at 2 weeks and recovered to normal level at 24 weeks. Conclusions: BoNT/A recoverably decreased salivary flow in a dose-dependent manner and led to temporary glandular atrophy. BoNT/A-induced inhibitory secretory mechanism involved not only temporary glandular denervation, but also the direct inhibition of AQP5 activity in SMGs. http://dx.doi.org/10.1016/j.ijom.2013.07.637
Objective: To evaluate the feasibility of microvascular autologous transplantation of partial submandibular gland (SMG) to prevent or reduce epiphora in severe keratoconjunctivitis sicca (KCS). Methods: Thirty-nine patients with KCS, for 42 eyes, were randomized to undergo transplantation of partial or total SMG from January 2006 to December 2009. Survival rate of transplanted SMG; ophthalmologic features of best-corrected visual acuity, Schirmer’s test results, break-up time (BUT) of tear film, and fluorescence staining; incidence of postoperative epiphora and frequency of subsequent surgery. Results: Total SMG transplantation was performed in 22 cases, and partial SMG transplantation was performed in other 20 cases. All transplanted SMGs survived. Microvascular crisis occurred in 1 case of partial SMG transplantation, but the gland survived after exploration to remove the venous thrombus. Obstruction of ductal orifice in 1 case of partial SMG transplantation was resolved by reconstruction of the ductal orifice. Symptoms of dry eyes disappeared, and patients were able to discontinue use of artificial tears. Severe epiphroa occurred in 6 eyes undergoing partial SMG transplantation and in 19 undergoing total SMG transplantation (P < 0.01). Surgical reduction was performed in 6 eyes undergoing partial SMG transplantation and 18 undergoing total SMG transplantation (P < 0.01). Conclusion: Microvascular transplantation of partial SMG is feasible and effective for severe KCS and does not decrease the survival rate of transplanted SMG. For ample SMGs with normal function, transplantation of partial SMG alleviates the symptoms of dry eye and significantly reduces the incidence of severe postoperative epiphora.
T31.OR019 Transoral management of large calculi in submandibular gland with sialendoscopy C. Yu ∗ , L. Zheng, C. Yang
http://dx.doi.org/10.1016/j.ijom.2013.07.639 T32.OR001
Shanghai 9th People’s Hospital, Shanghai Jiao Tong University, School of Medicine, China T32.Skin Tumours of the Head and Neck Objective: Recently, different minimally invasive techniques have been developed for the management of the submandibular calculi. This retrospective study concluded our experience about transoral management of large submandibular calculi with sialendoscopy. Methods: During a period of 10 years from 2002, patients with swelling symptom in submandibular gland were diagnosed and confirmed large calculi (>or = 10 mm) by routine methods. All cases were evaluated the degree of symptom by VAS, and some long history cases (more than 1 year) were further assessed uptake and excretion function by Tc-99m pertechnetate scintigraph. Large calculi were removed by transoral approach (gland preserving) combined with sialendoscopic management. Failure cases could be removal of the glands. Evaluation of the results included VAS assessment after big calculi removed successfully. Results: 106 cases were found large calculi in submandibular duct (anterior 33, posterior 73). 19 cases were evaluated function by scintigraphic examination, and only 6 cases (31.6%) had the almost total function loss, and 9 cases were partial loss, 4 cases had the same function curve as other side. The success rate of transoral sialolithectomy was 101 cases (101/106, 95.3%). Residual calculi were detected in distal duct in 29 anterior cases under sialendoscopy, and 23 cases were removed successfully by forceps or basket simultaneously. 5 failure cases had undergone the gland resection ultimately. Most cases after management had relieved symptom by VAS evaluation. Conclusion: Large submandibular calculi can be removed by gland-preserving procedures and most cases were asymptom after joint management with sialendoscopy. http://dx.doi.org/10.1016/j.ijom.2013.07.638
The role of ultrasound scanning of the neck in pre-operative staging of cutaneous squamous-cell carcinoma of the head and neck J.N. Ban ∗ , D.P. Ramkumar, M. Tariq, S. Mustafa Prince Charles Hospital, United Kingdom Background: The increased average age of the world population coupled with long-term sun exposure has led to an increase in the incidence of cutaneous squamous cell carcinoma (cSCC). The incidence of nodal metastasis in such patients is thought to range from less than 5% to up to 20% in some reports. Mortality rates following a metastasis have been shown to be high, demonstrating the importance of early detection of metastatic nodes. The aim of our study was to ascertain the value of a routine ultrasound scan (USS) for every patient following head and neck cSCC diagnosis in screening for metastatic disease. Method: A 41 month retrospective analysis was carried out (January 2009–May 2012) involving all patients with cSCC treated by the OSMF Department at Prince Charles Hospital and the Royal Glamorgan Hospital in South Wales, UK. There were a total number of 108 incidences of cSCC. The following criteria were used in the data collection process: 1. Anatomical characteristics (site); 2. Pathological characteristics (size, depth, margins and differentiation); 3. Patient factors (immunosuppression); 4. USS findings. Results: Of the 108 incidences, one patient was diagnosed with a metastatic lymph node following USS. This patient exhibited one of five metastatic risk factors and the node was clinically palpable meaning a USS would have been carried out as per the existing British Association of Dermatology guidelines. Conclusion: The pick up rate of cervical lymph node metastasis from routine USSs of all cSCCs is not high enough to warrant the application of this investigation to all patients routinely. It should therefore be reserved for high-risk cases where it is felt that a scan is justified on clinical grounds. Work is underway to ascertain whether or not high risk cases would benefit from routine USS of the neck to detect early metastasis. http://dx.doi.org/10.1016/j.ijom.2013.07.640