Submandibular gland transplantation for the severely dry eye: Part I - The surgical experience

Within the last four years 30 autologous submandibular gland transplantations to the temple were performed for permanent autologous tear substitution on 24 high selected patients suffering from severe Keratoconjunctivitis sicca (KCS). The glands were transferred to a pocket prepared in the temporalis muscle and the nourishing vessels were anastomized to the superficial temporal artery and vein. The submandibular duct was implanted in the upper lateral conjunctival fornix. The transferred glands were left denervated. In addition to clinical examination duplex sonography and scintigraphy with ^99mTc Pertechnetate were used to document the graft viability after the transfer. The grafts remained viable in 25 of the 30 transplanted denervated salivary glands. The resulting lubrication of the treated eyes was irregular up to the three-month-checkup in almost every case. One year after surgery all patients developed at least occasional epiphora in 10 patients - this was surgically managed by reducing the size of the graft. No severe side effects like nerve damage were seen in this series. A more detailed ophthalmological analysis of the effects of this operation on the signs and symptoms of dry eyes is given in the subsequent publication.