下颌下腺转移手术的改良

Marzouki Hani Z, Elkhalidy Youness, Jha Naresh, Scrimger Rufus, Debenham Brock J, Harris Jeffrey R, O'Connell Daniel A, Seikaly Hadi

Department of Otolaryngology-Head and Neck Surgery, King Abdulaziz University, Jeddah, Saudi Arabia.

Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada.

Laryngoscope. 2016 Nov;126(11):2492-2496. doi: 10.1002/lary.26029. Epub 2016 May 12.

OBJECTIVES/HYPOTHESIS: The treatment for most advanced head and neck cancers (stage III and IV) usually includes radiation, and the most common side effect of this treatment modality is a permanent decrease in salivary production. Xerostomia is a devastating complication that significantly affects patients' quality of life by interfering with functions of taste, mastication, deglutition, and speech production. Treatment of xerostomia is varied, but one of the strategies developed by our group was to preserve one submandibular gland by surgically transferring it to the submental space and shielding it from the full dose of radiation. This procedure is proven to reduce the rate of radiation-induced xerostomia, but its main disadvantage is that it is contraindicated in oral cavity cancer. This study describes and evaluates a modification of the submandibular gland transfer (SGT) procedure, where the submandibular gland contralateral to the disease process is relocated to the parotid region. This modification has the potential of expanding the benefits of submandibular gland transfer procedures to patients with oral cavity cancers.

STUDY DESIGN

Prospective feasibility study.

METHODS

This study involved nine patients with a new diagnosis of advanced head and neck cancer undergoing major head and neck cancer resection with postoperative adjuvant radiation therapy. The new modified salivary gland transfer procedure was performed on all nine patients, and the glands total dose received with radiation therapy was assessed.

RESULTS

All the modified SGT procedures were successful with no post-operative complications. The radiation oncology team has been able to successfully localize the transferred submandibular glands and shield them from the radiation beam postoperatively.

CONCLUSIONS

We have successfully demonstrated that surgical transfer of a submandibular salivary gland to the parotid region is feasible, surgically viable, oncologically sound, and does not interfere with radiation therapy.

LEVEL OF EVIDENCE

4 Laryngoscope, 126:2492-2496, 2016.

目的/假设：大多数晚期头颈癌（III期和IV期）的治疗通常包括放疗，而这种治疗方式最常见的副作用是唾液分泌永久性减少。口干症是一种极具破坏性的并发症，通过干扰味觉、咀嚼、吞咽和言语功能，严重影响患者的生活质量。口干症的治疗方法多种多样，但我们团队开发的策略之一是通过手术将一个下颌下腺转移至颏下间隙并使其免受全剂量放疗，从而保留该腺体。这一手术已被证明可降低放射性口干症的发生率，但其主要缺点是在口腔癌中为禁忌。本研究描述并评估了一种改良的下颌下腺转移（SGT）手术，即将病变对侧的下颌下腺重新定位至腮腺区域。这种改良有可能将下颌下腺转移手术的益处扩展至口腔癌患者。