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Submandibular Gland Transfer for Prevention of Xerostomia After Radiation Therapy
Swallowing Outcomes
Jana Rieger, PhD;
Hadi Seikaly, MD;
Naresh Jha, MBBS;
Jeffrey Harris, MD;
David Williams, MD;
Richard Liu, MD;
Tim McGaw, DDS;
John Wolfaardt, PhD
Arch Otolaryngol Head Neck Surg. 2005;131:140-145.
Objective To assess swallowing outcomes in patients with oropharyngeal carcinoma in relation to the Seikaly-Jha procedure for submandibular gland transfer (SJP). The SJP has recently been described as beneficial in the prevention of xerostomia induced by radiation therapy in patients with head and neck cancer.
Design Inception cohort.
Setting University-affiliated primary care center.
Patients A phase 2 clinical trial was conducted from February 1, 1999, through February 28, 2002, to evaluate SJP in patients with head and neck cancer. During that period, a consecutive sample of 51 patients who underwent surgical resection and reconstruction with a radial forearm free flap for oropharyngeal carcinoma were referred for functional assessment of swallowing after completion of adjuvant radiation therapy. At 6 months after surgery, swallowing assessments for 24 patients were available.
Intervention The cohort of 24 patients included 13 who had preservation of 1 submandibular gland (SJP group) and 11 who did not (control group).
Main Outcome Measures Quantitative and qualitative aspects of swallowing were obtained to determine whether patients in the SJP group performed more optimally than those in the control group.
Results Baseline and stimulated salivary flow rates were significantly different between groups. Patients in the SJP group were able to move the bolus through the oral cavity and into the pharynx faster than those in the control group. In addition, patients in the SJP group swallowed less often per bolus than patients in the control group. The complete swallowing sequence was twice as long in controls.
Conclusions The SJP for submandibular gland transfer appears to be beneficial in promoting more time-efficient swallowing behaviors. This efficiency has implications for the overall well-being and nutritional status of patients with head and neck cancer.
Author Affiliations: Craniofacial Osseointegration and Maxillofacial Prosthetic Rehabilitation Unit, Caritas Health Group (Drs Rieger, Seikaly, and Wolfaardt), Faculty of Rehabilitation Medicine (Dr Rieger), Division of Otolaryngology Head and Neck Surgery (Drs Seikaly, Harris, and Liu), Division of General Surgery (Dr Williams), and Department of Dentistry (Drs McGaw and Wolfaardt), University of Alberta; Division of Surgical Oncology (Dr Seikaly) and Department of Radiation Oncology (Dr Jha), Cross Cancer Institute, Edmonton, Alberta.
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