Autologous submandibular gland (SMG) transplantation has been proved to ameliorate the discomforts in patients with severe keratoconjunctivitis sicca. The transplanted glands underwent a hypofunctional period and then restored secretion spontaneously. This study aims to investigate whether autonomic nerves reinnervate the grafts and contribute to the functional recovery, and further determine the origin of these nerves. Parts of the transplanted SMGs were collected from the epiphora patients, and a rabbit SMG transplantation model was established to fulfill the serial observation on the transplanted glands with time. The results showed that autonomic nerves distributed in the transplanted SMGs and parasympathetic ganglionic cells were observed in the stroma of the glands. Low-dense and unevenly distributed cholinergic axons, severe acinar atrophy and fibrosis were visible in the patients' glands 4-6 months post-transplantation, whereas the cholinergic axon density and acinar area were increased with time. The acinar area or the secretory flow rate of the transplanted glands was statistically correlated with the cholinergic axon density in the rabbit model, respectively. Meanwhile, large cholinergic nerve trunks were found to locate in the temporal fascia lower to the gland, and sympathetic plexus concomitant with the arteries was observed both in the adjacent fascia and in the stroma of the glands. In summary, the transplanted SMGs are reinnervated by autonomic nerves and the cholinergic nerves play a role in the morphological and functional restoration of the glands. Moreover, these autonomic nerves might originate from the auriculotemporal nerve and the sympathetic plexus around the supplying arteries.
Animals ; Autonomic Pathways ; growth & development ; Fascia ; innervation ; Female ; Humans ; Keratoconjunctivitis Sicca ; surgery ; Male ; Models, Animal ; Rabbits ; Recovery of Function ; Secretory Rate ; Submandibular Gland ; innervation ; transplantation ; Transplantation, Autologous

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.
Humans ; Lacrimal Apparatus Diseases/therapy* ; Salivary Ducts ; Submandibular Gland/transplantation* ; Tears ; Transplantation, Autologous

Xerostomia is a severe side effect of radiation therapy in head and neck cancer patients. To date, no satisfactory treatment option has been established. Because mesenchymal stem cells (MSCs) have been identified as a potential treatment modality, we aimed to evaluate stem cell distribution following intravenous and intraglandular injections using a surgical model of salivary gland damage and to analyse the effects of MSC injections on the recruitment of immune cells. The submandibular gland ducts of rats were surgically ligated. Syngeneic adult MSCs were isolated, immortalised by simian virus 40 (SV40) large T antigen and characterized by flow cytometry. MSCs were injected intravenously and intraglandularly. After 1, 3 and 7 days, the organs of interest were analysed for stem cell recruitment. Inflammation was analysed by immunohistochemical staining. We were able to demonstrate that, after intravenous injection, MSCs were recruited to normal and damaged submandibular glands on days 1, 3 and 7. Unexpectedly, stem cells were recruited to ligated and non-ligated glands in a comparable manner. After intraglandular injection of MSCs into ligated glands, the presence of MSCs, leucocytes and macrophages was enhanced, compared to intravenous injection of stem cells. Our data suggest that injected MSCs were retained within the inflamed glands, could become activated and subsequently recruited leucocytes to the sites of tissue damage.
Animals ; Antigens, Polyomavirus Transforming ; immunology ; Cell Culture Techniques ; Cell Movement ; physiology ; Cell Transformation, Viral ; Clone Cells ; physiology ; Flow Cytometry ; Immunohistochemistry ; Injections, Intralesional ; Injections, Intravenous ; Leukocytes ; pathology ; Macrophages ; pathology ; Mesenchymal Stem Cell Transplantation ; methods ; Mesenchymal Stromal Cells ; pathology ; physiology ; Necrosis ; Rats, Wistar ; Salivary Ducts ; pathology ; Sialadenitis ; pathology ; therapy ; Simian virus 40 ; immunology ; Submandibular Gland ; pathology ; Submandibular Gland Diseases ; pathology ; therapy ; Time Factors

Malignant salivary gland tumors only represent 0.08% of all childhood tumors and mucoepidermoid carcinoma (MEC) is the most common histologic type. Although there are many reports describing second malignant neoplasm (SMN) in patients treated for childhood cancer, salivary gland tumors rarely appears. In Korea, there has been no report about MEC that developed in children as a SMN. We report a MEC in a 4 years and 8 months old female child that developed after completing treatment for yolk sac tumor of lower abdomen. The primary tumor presented with metastasis at the time of diagnosis, and therefore, the child underwent high-dose chemotherapy with autologous peripheral blood stem cell transplantation along with surgery and radiotherapy. Three years and five months after completing treatment, MEC developed in her submandibular gland. She was treated with surgery and radiotherapy and is in disease free state for 5 months at the time of this writing.
Abdomen ; Carcinoma, Mucoepidermoid ; Child ; Diagnosis ; Drug Therapy ; Endodermal Sinus Tumor ; Female ; Humans ; Korea ; Neoplasm Metastasis ; Peripheral Blood Stem Cell Transplantation ; Radiotherapy ; Salivary Gland Neoplasms ; Salivary Glands ; Submandibular Gland ; Writing

Animals ; Botulinum Toxins, Type A ; pharmacology ; Capsaicin ; pharmacology ; Carbachol ; pharmacology ; Humans ; Keratoconjunctivitis ; surgery ; Phenylephrine ; pharmacology ; Saliva ; drug effects ; Submandibular Gland ; drug effects ; transplantation ; Translational Medical Research

OBJECTIVETo summarize the cooperative measures on circulation restore during the operation of microvascular submandibular gland transfer.

METHODSFifty-six cases of microvascular submandibular gland transfer were performed in Peking University School & Hospital of Stomatology from January 2005 to March 2009. The related data was collected retrospectively and the cooperative measures on circulation restore during the operation were summarized.

RESULTSThe circulation restore of transferred glands were satisfied in all 56 cases when the submandibular gland transfer operation finished. Thrombosis happened in 7 cases within the postoperative 48 hours and the secondary emergency operations were done. At last 6 glands were salvaged and the final successful rate was 98.21%.

CONCLUSIONSuccessful circulation restore was one of the key points on microvascular submandibular gland transfer. The most important mission of the nursing during the operation was the prevention of vascular crisis. The main measures include persistent wet packing using narceine, fomentation using warm saline and special nursing on postoperative complications. Our experience proves that it is beneficial to the success of operation.

Adult ; Female ; Humans ; Postoperative Complications ; Retrospective Studies ; Submandibular Gland ; Tissue Transplantation

Humans ; Practice Guidelines as Topic ; Submandibular Gland ; transplantation ; Transplantation, Autologous

Adult ; Dentist-Patient Relations ; Dentistry ; Dentists ; legislation & jurisprudence ; Dissent and Disputes ; legislation & jurisprudence ; Female ; Humans ; Keratoconjunctivitis Sicca ; surgery ; Liability, Legal ; Malpractice ; legislation & jurisprudence ; Submandibular Gland ; transplantation

Amifostine ; therapeutic use ; Animals ; Head and Neck Neoplasms ; radiotherapy ; Humans ; Oral Health ; Radiation Injuries ; etiology ; prevention & control ; therapy ; Radiation-Protective Agents ; therapeutic use ; Radiotherapy ; adverse effects ; Radiotherapy, Conformal ; Salivary Glands ; radiation effects ; Salivation ; radiation effects ; Submandibular Gland ; surgery ; transplantation ; Xerostomia ; etiology ; prevention & control ; therapy

OBJECTIVETo observe the effect of capsaicin on the secretion of the transferred gland in "latent period".

METHODSForty-two patients (45 sides of eye), who received the microvascular autologous submandibular gland transfer in our hospital, were treated with two different types of capsaicin stimulations. The secretion function of the transferred glands was evaluated by Schirmer's test. The effect of capsaicin and its time-variation regularity were observed. In the meantime, the results of capsaicin were compared with some other stimulation methods, such as acid, chewing and physiotherapy with infrared rays.

RESULTSThe capsaicin gargle, capsaicin cream and physiotherapy could all promote the secretion of the transferred gland, while the effects of the capsaicin stimulation were more obvious. The other two stimulations (acid and chewing) had no effect on the secretion of the transferred gland.

CONCLUSIONSThe capsaicin stimulation can be taken as one of the effective means to promote the secretion of the transferred glands in "latent period" and to prevent the obstruction of the ducts. Because of its convenience and blandness, the capsaicin cream is the first choice of the clinical application options for the transferred submandibular gland in "latent period".

Adolescent ; Adult ; Capsaicin ; pharmacology ; Child ; Female ; Humans ; Keratoconjunctivitis Sicca ; surgery ; Male ; Middle Aged ; Saliva ; secretion ; Submandibular Gland ; secretion ; transplantation ; Transplantation, Autologous ; Young Adult