Submandibular gland transfer: A new method of preventing radiation-inducedxerostomia

Objective: Radiation-induced xerostomia is a significant morbidity of radia tion therapy in the management of patients with head and neck cancers. We h ave recently reported a method of transfer of one submandibular gland to th e submental space in a small pilot series of eligible surgical patients. Th e submental space was shielded during postoperative radiation therapy. The transferred gland continued to function after the completion of radiation t herapy and none of the patients developed xerostomia The purpose of this ar ticle is to present the technique of submandibular gland transfer in detail and to evaluate the postoperative survival and function of the transferred submandibular glands. Design: Prospective clinical trial. Methods: The sub mandibular gland was transferred on eligible patients as part of their surg ical intervention. The patients were followed clinically, with salivary flo w and radioisotope studies, Results: We performed the surgical transfer of the submandibular salivary gland in 24 of 25 patients placed on the protoco l. All the glands survived transfer and functioned well postoperatively as demonstrated on the salivary flow and the radioisotope studies. The surgica l transfer was relatively simple and added 45 minutes to the surgical proce dure. There were no complications attributed to the submandibular gland tra nsfer. Conclusions: We have successfully demonstrated that the submandibula r gland can be surgically transferred to the submental space with its funct ion preserved. The gland seems to continue functioning even after radiation therapy with the appropriate shielding. This surgical transfer procedure h as the potential to change the way we currently manage patients with head a nd neck cancer.