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Case Reports
. 2022 Dec 22;55(4):400-405.
doi: 10.1055/s-0042-1759551. eCollection 2022 Dec.

Bilateral Microvascular Submandibular Gland Transfer with Implantation of Wharton's Duct in Superior Conjunctival Fornix: A Vision-Saving Procedure for Severe Dry Eye Disease

Mohit Sharma  1 , Anil Radhakrishnan  2 , Shravan Rai  1 , Gopal S Pillai  2 , Deepak Balasubramanian  3 , Krishnakumar Thankappan  3 , Srilekha Reddy G  1 , Vasundhra Jain  1 , Abhinandan Badam  1 , Kannisha Shah  2 , Amritha V Rajan  2
Affiliations
Case Reports

Bilateral Microvascular Submandibular Gland Transfer with Implantation of Wharton's Duct in Superior Conjunctival Fornix: A Vision-Saving Procedure for Severe Dry Eye Disease

Mohit Sharma et al. Indian J Plast Surg. .

Abstract

Dry eye can initially cause mild symptoms of irritation and may rapidly progress to corneal scarring and blindness. Tear substitutes can only help for mild cases. With the advancement in microsurgical techniques, an option of transferring vascularized salivary glands has shown positive results. We present a case of a 5-year-old boy with congenital alacrimia with ocular surface damage. Vascularized autologous submandibular gland transfer was considered as a viable option for this patient. We performed the gland transfer in two separate stages for the two eyes (1 year 5 months apart). The patient was evaluated for up to 2 years for the right eye and for 7 months for the left eye. Dry eye workup showed drastic improvement (right > left). Biochemical analysis showed gradual transition to resemble that of natural tears. This procedure can result in significant symptomatic improvement and can be a promising treatment option for cases of severe dry eye.

Keywords: dry eyes; keratoconjunctivitis sicca; microvascular submandibular gland transfer; salivary gland.

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Conflict of interest statement

Conflict of Interest None declared.

Figures

Fig. 1
Fig. 1
Preoperative marking.
Fig. 2
Fig. 2
Space created in the temporalis muscle for the submandibular gland.
Fig. 3
Fig. 3
Harvested submandibular gland.
Fig. 4
Fig. 4
Gland after microvascular anastomosis.
Fig. 5
Fig. 5
Salivary duct fixation in superior fornix of right eye.
Fig. 6
Fig. 6
Preoperative and 2 weeks postoperative right eye.
Fig. 7
Fig. 7
Preoperative and 1 year postoperative right eye.
Fig. 8
Fig. 8
Preoperative and 3 months postoperative left eye.
Fig. 9
Fig. 9
Pre- and postoperative Tc-pertechnetate scintigraphy.
See this image and copyright information in PMC

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