A 20-year study on microvascular autologous transplantation of submandibular gland for treatment of severe dry eye.
- Author:
Guang Yan YU
1
;
Li Ling WU
2
,
3
;
Zhi Gang CAI
1
;
Lan LV
4
;
Xin CONG
2
,
3
Author Information
1. Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China.
2. Center for Salivary Gland Diseases, Peking University School and Hospital of Stomatology & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
3. Department of Physiology and Pathophysiology, Peking University School of Basic Medical Sciences, Beijing 100191, China.
4. Department of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing 100069, China.
- Publication Type:Journal Article
- MeSH:
Humans;
Lacrimal Apparatus Diseases/therapy*;
Salivary Ducts;
Submandibular Gland/transplantation*;
Tears;
Transplantation, Autologous
- From:
Journal of Peking University(Health Sciences)
2018;50(1):1-4
- CountryChina
- Language:Chinese
-
Abstract:
Severe dry eye is a refractory ophthalmologic disease. Our multidisciplinary research group treated severe dry eye by microvascular autologous transplantation of submandibular gland (SMG) during the past 20 years. The SMG, with its blood vessels and Wharton's duct, was harvested from the submandibular triangle and transferred to the temporal area. The blood vessels in the SMG were anastomosed with the temporal blood vessels using a microsurgical technique. Then, the distal end of Wharton's duct was sutured to form an opening in the upper lateral conjunctival fold. The tear was replaced by the secretion of the transplanted SMG to lubricate the ocular surface. In our study, the surgical techniques of blood vessel management were continuously modified to increase the survival rate of the transplanted SMG. A novel surgical modality of partial transplantation of SMG was established to prevent postoperative epiphora. A clinical study with the largest case number in the world was conducted and the effectiveness of transplantation of SMG for severe dry eye was fully confirmed. In order to resolve two main clinical problems including ductal obstruction resulted from low secretion rate during the latent period, and epiphora due to over secretion of the transplanted SMG in the later term of transplantation, the regulation of the secretion mechanism of the normal and transplanted SMG were investigated. New opinions on mechanisms of saliva secretion were provided. Based on the priniciple of translational medicine, the results of related basic research were applied in the clinic. The clinical guidelines for secretion regulation of transplanted SMG were established. A concept of chronic obstructive sialadenitis of transplanted SMG was provided and its diagnostic criteria, diagnostic technique of sialography, and therapeutic regimen were established. As a result, the surgical success rate was obviously elevated, the surgical complications were decreased, and life quality of the patients was greatly improved.
