Submandibular Gland Autotransplantation Can Help Prevent Xerostomia

What are the long-term results of preventing xerostomia through autotransplantation of the human submandibular gland?

Background: Intensity-modulated radiotherapy (RT) plays an important role in head and neck squamous cell carcinoma treatment. Generally, patients have a variety of subjective complaints because the parotid glands are spared only to some extent. One of the major side effects is xerostomia, which induces dysphagia, recurrent oral infections, and dysgeusia. Using autotransplantation, the irradiation dosage involving the submandibular gland can be partially reduced.

Study design: Follow-up on 11 patients enrolled in the study from November 2011 to May 2014.

Setting: University Hospital Wuerzburg, Germany.

Synopsis: Saliva production on the forearm could be seen immediately in all transplanted glands when microanastomoses were reopened. However, wound healing was sometimes prolonged because of direct contact between saliva and the forearm skin. In patients 1 and 4, the excretory duct had to be revised because of granulation tissue and necrosis at the orifice due to saliva contact. In patients 6, 7, and 8, a venous insufficiency occurred during the first postoperative days; patients 6 and 8 had their glands explanted, and patient 7’s gland atrophied and was left in the forearm. Unfortunately, three patients died during the study (aggressive tumor growth/metastases of the lung; side effects of radiation; unknown causes). Wound healing in the floor of the mouth was mostly regular, with some granulation tissue at the excretory duct in two patients. At the six-month follow-up, saliva weight was almost stable or improved compared to after the second surgical step. The Visual Analog Scale revealed stable or improved data compared wiht data taken after the second surgical step. There were stable or diminished scores in three patients using the EORTC QLQ–HN35, but scores rose in two patients compared with data after the second surgical step.

Bottom line: Following the two-stage autotransplantation, xerostomia was reduced in the long term due to improved saliva production of the reimplanted gland. Whether this promising novel approach is a reliable treatment option for RT patients in general should be evaluated in further studies.

Citation: Burghartz M, Ginzkey C, Hackenberg S, Hagen R. Two-stage autotransplantation of the human submandibular gland: first long-term results. Laryngoscope. 2016;126:1551-1555.