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Journal of Peking University (Health Sciences) ›› 2022, Vol. 54 ›› Issue (5): 842-845. doi: 10.19723/j.issn.1671-167X.2022.05.011

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Establishment and application of new techniques for submandibular gland preservation

Guang-yan YU1,2,*(),Jia-zeng SU1,2,Deng-gao LIU1,3,Li-ling WU1,4,Xin CONG1,4   

  1. 1. Research Center of Salivary Gland Diseases, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
    2. Department of Oral & Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
    3. Department of Oral Radiology, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
    4. Department of Physiology and Pathophysiology, Peking University School of Basic Medical Sciences, Beijing 100191, China
  • Received:2022-04-07 Online:2022-10-18 Published:2022-10-14
  • Contact: Guang-yan YU E-mail:gyyu@263.net
  • Supported by:
    the National Natural Science Foundation of China(81974151);the National Natural Science Foundation of China(81671005);the National Natural Science Foundation of China(81470756);the National Natural Science Foundation of China(81271161);the National Natural Science Foundation of China(81070847)

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Abstract:

The saliva secreted from submandibular gland (SMG) accounts for 60%-65%. It plays an important role in maintaining the human function of swallow, digestion, testing, speech, protection of oral mucosa, and prevention from dental carries. The SMG is frequently resected during the treatment for various kinds of oral and maxillofacial diseases, resulting in xerostomia and decreased quality of life. During the past 15 years, Research Center of Salivary Gland Diseases in Peking University School and Hospital of Stomatology conducted a series of studies on new techniques for preservation of SMG and achieved remarkable results. The clinicopathologic and imaging characteristics of IgG4-related sialadenitis (IgG4-RS) were clarified based on systematic studies. The results of studies on the pathogenesis of IgG4-RS showed that unbalance of inflammatory factors mediated the abnormality of secretion of SMG. IL-4 participates in occurring and development of glandular fibrosis of SMG. Regulation of tumor necrosis factor α (TNF-α) and cleaning of senescent cells might be taken as the targets for treatment of IgG4-RS. The combination of glucocorticoid and steroid-sparing agents showed effective results for treating IgG4-RS, clinical remission was achieved in all the patients, serum IgG4 levels decreased, and salivary gland secretion significantly increased. Sialoendoscopy-assisted sialolithectomy was applied in the treatment of about 1 000 cases with submandibular hilar calculi with a success rate of more than 90%. Transfer of SMG was used for prevention from radiation-induced xerostomia in the patients with head and neck carcinoma. SMG was transferred to the submental region before radiotherapy and was kept away from the ra-diation field. The results of prospective clinical controlled study showed this technique could effectively preserve the function of SMG and prevent from xerostomia. Based on the micro-anatomical study on the blood vessels and ducts of SMG, partial sialoadenectomy was applied for treatment of benign tumors in the SMG. A clinical controlled study confirmed its safety for control of the tumors and its advantage of preservation of SMG function. The studies on the involvement of SMG in oral squamous cell carcinoma (OSCC) provided the anatomical and histopathological basis for preservation of SMG during neck dissection for early cases with OSCC. A innovated surgical modality "four preservations including SMG" was used during the neck dissection for the early cases with OSCC. A prospective randomized clinical controlled study confirmed its safety, feasibility, effectiveness for control of the carcinoma, and advantages of preservation of SMG function.

Key words: Immunoglobulin G4-related sialadenitis, Submandibular gland calculi, Submandibular gland transfer, Partial submandibular gland resection, Neck dissection

CLC Number: 

  • R782.7
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