Salivary gland scintigraphy in patients suffering from severe kerato conjunctivitis sicca

Summary

Low tear production or elevated tear evaporation can lead to severe keratoconjunctivitis sicca. In patients with this disease, the transfer of an autologous submandibular gland into the temporal fossa is currently the most common surgical lacrimal gland substituting procedure. Aim: We compared the pre- and postoperative viability of transferred submandibular glands. Patients, methods: Altogether 16 submandibular glands had been transferred in 12 patients. The graft's viability was evaluated before and 0.5–1, 1–6 and 8–12 months after transplantation by dynamic salivary gland scintigraphies after application of 40–50 MBq ^99mTc-pertechnetate. Quantitative analysis was performed by calculation and comparison of the glandula submandibularis-to-background-ratio (SBR) and the transplant-tobackground-ratio (TBR). The scintigraphic results were correlated with the clinical follow-up. Results: All grafts remained viable during clinical follow-up. Salivary gland scintigraphy yielded 15 true positive results and 1 falsenegative result. Comparison of presurgical SBR and postsurgical TBR showed good correlation with the clinical course. In 10 patients at least one transplant-reduction was necessary due to excessive epiphora occurring averagely 8 months after transplantation. Conclusion: Our results show that salivary gland scintigraphy very exactly reflects the morphological and biochemical postsurgical changes in a transferred submandibular gland. Thus, it is a reliable tool to exactly and objectively evaluate the viability of the grafts in the postsurgical course.

Zusammenfassung

Verringerte Tränenproduktion oder erhöhte Tränenverdunstung kann zu schwerer Keratokonjunktivitis sicca führen. Bei Patienten mit dieser Erkrankung ist der Transfer einer autologen Glandula submandibularis in die Fossa temporalis das übliche chirurgische Verfahren zum Ersatz einer Glandula lacrimalis. Ziel: Wir verglichen die prä- und postoperative Funktionsfähigkeit transferierter Glandulae submandibulares. Patienten, Methodik: Insgesamt 16 Glandulae submandibulares wurden bei 12 Patienten transferiert. Die Funktionsfähigkeit des Transplantates wurde vor und 0,5–1, 1–6 und 8–12 Monate nach Transplantation mittels Speicheldrüsenszintigraphie nach Applikation von 40–50 MBq ^99mTc-Pertechnetat evaluiert. Die quantitative Analyse wurde mittels Berechnung und Vergleich der glandula submandibularis-to-background-ratio (SBR) und der transplant-to-backgroundratio (TBR) durchgeführt. Die Ergebnisse der Szintigraphie wurden mit dem klinischen Follow-up korreliert. Ergebnisse: Alle Transplantate blieben während des klinischen Follow-Up funktionsfähig. Die Speicheldrüsenszintigraphie ergab 15 richtig positive Befunde und einen falsch negative Befund. Der Vergleich der präoperativen SBR und der postoperativen TBR korrelierte gut mit dem klinischen Verlauf. Bei 10 Patienten war mindestens eine Transplantatverkleinerung aufgrund einer exzessiven Epiphora notwendig, die durchschnittlich acht Monate nach Transplantation auftrat. Schlussfolgerung: Unsere Ergebnisse zeigen, dass die Speicheldrüsenszintigraphie die morphologischen und biochemischen postoperativen Veränderungen sehr gut abbildet. Folglich handelt es sich um ein zuverlässiges Verfahren, um die postoperative Funktionsfähigkeit der Transplantate zu evaluierten.

Keywords

Keratoconjunctivitis sicca - transplantation - salivary gland scintigraphy - viability - epiphora

Schlüsselwörter

Keratokonjunktivitis sicca - Transplantation - Speicheldrüsenszintigraphie - Funktionsfähigkeit - Epiphora

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