Prevention of radiation-induced xerostomia by submandibular gland transfer

Abstract

Background: This study was carried out for the purpose of evaluating the efficacy of submandibular gland transfer to prevent radiation-induced xerostomia.

Methods: Thirty-eight patients with oropharyngeal carcinoma were recruited. Twenty-six submandibular glands were transferred into the submental space to elude radiotherapy in 24 patients (transfer group); the submandibular gland was not disturbed in the control group (n = 14). The salivary flow rate, xerostomia, and quality of life (QOL) were assessed preoperatively, postoperatively, and after radiotherapy. The swallowing function was then evaluated after radiotherapy.

Results: All the transferred glands survived and functioned after radiotherapy. The submandibular salivary flow rate recovered by 6 months after radiotherapy in the transfer group, whereas the flow rate declined drastically after radiotherapy and remained at a low level in the longer term in the control group. Two years after radiotherapy, 92.3% of patients in the transfer group had no or minimal xerostomia. QOL in the transfer group was better than that in the control group from 3 months after radiotherapy. Histologically, the majority of the transferred glands had normal glandular acini and ducts. There was no significant difference in dysphagia between the groups.

Conclusions: The submandibular gland can be successfully transferred to the submental space, thus preserving salivary function and preventing radiation-induced xerostomia. The transfer of the submandibular gland can improve the QOL by alleviating xerostomia, although it did not relieve dysphagia in this study.