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CC BY-NC-ND 4.0 · Indian J Plast Surg 2022; 55(04): 400-405
DOI: 10.1055/s-0042-1759551
Case Report

Bilateral Microvascular Submandibular Gland Transfer with Implantation of Wharton's Duct in Superior Conjunctival Fornix: A Vision-Saving Procedure for Severe Dry Eye Disease

Mohit Sharma
1   Department of Plastic and Reconstructive Surgery, Amrita Institute of Medical Sciences, Kochi, Kerala, India
,
Anil Radhakrishnan
2   Department of Ophthalmology, Amrita Institute of Medical Sciences, Kochi, Kerala, India
,
Shravan Rai
1   Department of Plastic and Reconstructive Surgery, Amrita Institute of Medical Sciences, Kochi, Kerala, India
,
Gopal S. Pillai
2   Department of Ophthalmology, Amrita Institute of Medical Sciences, Kochi, Kerala, India
,
Deepak Balasubramanian
3   Department of Head and Neck Surgery, Amrita Institute of Medical Sciences, Kochi, Kerala, India
,
Krishnakumar Thankappan 
3   Department of Head and Neck Surgery, Amrita Institute of Medical Sciences, Kochi, Kerala, India
,
Srilekha Reddy G.
1   Department of Plastic and Reconstructive Surgery, Amrita Institute of Medical Sciences, Kochi, Kerala, India
,
Vasundhra Jain
1   Department of Plastic and Reconstructive Surgery, Amrita Institute of Medical Sciences, Kochi, Kerala, India
,
Abhinandan Badam
1   Department of Plastic and Reconstructive Surgery, Amrita Institute of Medical Sciences, Kochi, Kerala, India
,
Kannisha Shah
2   Department of Ophthalmology, Amrita Institute of Medical Sciences, Kochi, Kerala, India
,
Amritha V. Rajan
2   Department of Ophthalmology, Amrita Institute of Medical Sciences, Kochi, Kerala, India
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Abstract

Dry eye can initially cause mild symptoms of irritation and may rapidly progress to corneal scarring and blindness. Tear substitutes can only help for mild cases. With the advancement in microsurgical techniques, an option of transferring vascularized salivary glands has shown positive results. We present a case of a 5-year-old boy with congenital alacrimia with ocular surface damage. Vascularized autologous submandibular gland transfer was considered as a viable option for this patient. We performed the gland transfer in two separate stages for the two eyes (1 year 5 months apart). The patient was evaluated for up to 2 years for the right eye and for 7 months for the left eye. Dry eye workup showed drastic improvement (right > left). Biochemical analysis showed gradual transition to resemble that of natural tears. This procedure can result in significant symptomatic improvement and can be a promising treatment option for cases of severe dry eye.

Keywords

microvascular submandibular gland transfer - salivary gland - dry eyes - keratoconjunctivitis sicca


Publication History

Article published online:
22 December 2022

© 2022. Association of Plastic Surgeons of India. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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