Quality of salivary tears following autologous submandibular gland transplantation for severe dry eye

Abstract

Salivary tears resulting from SMG-transplantation represent condensed SMG saliva. Thus their quality is intermediate between normal tears and normal SMG saliva. High levels of secretory proteins demonstrate that the gland maintains an active function. Surgical denervation and residual tear components from the ocular surface are the most likely factors to cause the complex differences between normal SMG saliva and SMG-salivary tears. The effects of this secretion on the ocular surface are currently being evaluated in a clinical and laboratory study.

Innervation and Secretory Function of Transplanted Human Submandibular Salivary Glands

“…Then, after a period of 6 weeks without clinically obvious flow, secretion gradually builds up to peak at about 1 year. In the fully secreting transplant, the flow always appears to be less than in a normal submandibular gland, but protein concentration of its secretionincluding secretory immunoglobulin (Ig) A-is increased (6). While successfully transplanted patients report no gustatory reflex secretion, due to the surgical denervation of the gland, sympathetic activity from physical exercise or local hyperthermia can increase the flow substantially (4,5,7).…”

Novel Technique to Control Hypersecretion From a Transplanted Autologous Submandibular Salivary Gland for Keratoconjunctivitis Sicca

“…3 It is believed that the low osmolality is the main cause of microcystic epithelial edema and keratopathy that is observed in some cases. 2 Hypersecretion was described in approximately 20% of transplanted cases.…”

“…O ne of the newly introduced surgical modalities in treating severe cases of keratoconjunctivitis sicca (KCS) is transplanting an autologous submandibular gland (SMG) into the temporal fossa, creating microvascular anastomoses there, and connecting the excretory glandular duct (Wharton duct) to the upper conjunctival fornix. [1][2][3] Although this procedure showed favorable effects in reducing the ocular symptoms of patients with KCS, some cases of hypersecretion have been reported to result in corneal epithelial edema and visual deterioration. 2,3 The management of these cases is usually based on surgical reduction of the transplanted gland.…”

“…[1][2][3] Although this procedure showed favorable effects in reducing the ocular symptoms of patients with KCS, some cases of hypersecretion have been reported to result in corneal epithelial edema and visual deterioration. 2,3 The management of these cases is usually based on surgical reduction of the transplanted gland.…”

Differenzierte Therapie der Keratokonjunctivitis sicca beim Sjögren-Syndrom

“…Eine freie Transposition der Glandula submandibularis mit mikrochirurgischer Revaskularisation wurde bei einigen Patienten mit Autoimmunerkrankungen (z. B. Stevens-Johnson-Syndrom, vernarbendes Schleimhautpemphigoid) erfolgreich durchgeführt[14,43]. Für Patienten mit Sjögren-Syndrom kommt dieses Verfahren aufgrund der Mitbeteiligung der Speicheldrüsen nicht in Frage.…”