Geerling Gerd, Raus Peter, Murube Juan
Department of Ophthalmology, University of Würzburg, Würzburg, Germany.
Dev Ophthalmol. 2008;41:243-254. doi: 10.1159/000131093.
Minor oral salivary glands exist in large numbers in the labial, buccal and palatal mucosa, and account for approximately half of the baseline secretion of saliva. They can be transplanted together with the overlying mucosa as a complex graft to the posterior lamella of the eyelids to increase ocular surface lubrication and reduce discomfort in dry eyes.
The surgical methods and the results of this technique in 17 patients are described. All patients had been retractive to medical treatment. The recipient bed over the lower or upper lid retractors and a donor tissue of lower labial mucosa with its submucosal minor salivary glands of approximately 2.5 x 2 cm were prepared by means of a surgical knife or Ellman Surgitron high-frequency/low-temperature radiosurgical device. The graft was cut in two strips of approximately 2.5 x 1 cm size and sutured to the recipient site with interrupted or running sutures. The labial wound was left open for second intention healing.
All grafts remained viable and vascularised within 1 week. Vascularisation of the graft was associated with an improvement of symptoms and increased ocular surface lubrication. Complications included temporary labial hypaesthesia, partial necrosis of the graft (n = 1), herpes simplex virus keratitis (n = 1) and epiphora (n = 1). Viable glandular tissue was found in specimens taken 18 and 36 months postoperatively. Other reported complications include lid malpositioning such as ptosis and entropium.
Transplantation of minor salivary glands is a promising new treatment option for severe dry eyes. The procedure is simple with minimal surgical risks. These grafts remain viable in over 90% and seem to be capable of sustaining a basal secretion for up to 36 months. Since experience with this technique is still very limited, prospective controlled studies have to be performed to establish the long-term survival of the glands and to characterise the salivary tear film and its impact on the ocular surface.
小唾液腺大量存在于唇、颊和腭黏膜中，约占唾液基础分泌量的一半。它们可与覆盖其上的黏膜作为一个复合移植物移植到眼睑后层，以增加眼表润滑并减轻干眼不适。
描述了该技术在17例患者中的手术方法及结果。所有患者对药物治疗均无效。使用手术刀或Ellman Surgitron高频/低温放射外科设备准备下睑或上睑牵开器上方的受区床以及一块约2.5×2 cm大小的下唇黏膜及其黏膜下小唾液腺的供体组织。将移植物切成两条约2.5×1 cm大小的条带，用间断或连续缝线缝合到受区部位。唇部伤口敞开，二期愈合。
所有移植物在1周内均存活并血管化。移植物血管化与症状改善及眼表润滑增加相关。并发症包括暂时性唇部感觉减退、移植物部分坏死（n = 1）、单纯疱疹病毒性角膜炎（n = 1）和溢泪（n = 1）。术后18个月和36个月采集的标本中发现有存活的腺组织。其他报道的并发症包括睑位异常，如睑下垂和睑内翻。
小唾液腺移植是重度干眼一种有前景的新治疗选择。该手术操作简单，手术风险极小。这些移植物存活率超过90%，似乎能够维持基础分泌长达36个月。由于该技术的经验仍非常有限，必须进行前瞻性对照研究以确定腺体的长期存活情况，并明确唾液泪膜及其对眼表的影响。
