ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Submandibular Gland Transfer For The Prevention Of Post-Radiation Xerostomia
Clinical Question In a patient with xerostomia is Submandibular gland transfer compared to no treatment an effective method for xerostomia relief?
Clinical Bottom Line Compared to no treatment, submandibular gland transfer is an effective method of decreasing the effects of xerostomia, although it does not fully restore submandibular gland function.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 20629074Xue-Kui/ 201170 patientsCase Control
Key resultsPrior to treatment patients showed no significant difference in the trapping and excretion of the submandibular. 70 patients were divided into two groups; a test group (36 patients) and a control group(34 patients). At 3 and 60 months post operation, these patients were evaluated for xerostomia. The test group showed significantly better submandibular trapping and excretion.
#2) 15313866Seikaly/200438 patients Cohort
Key resultsTotal of 96 patients were enrolled in the study and only 38 of the patients had a minimum of a 2 year follow up. Of the 38 patients, 26 received the surgery while the remaining 12 did not receive the surgery. With regards to patient demographics there were no differences. 2 years post-op, 83% of patients that received the surgical treatment reported normal salivary flow as opposed to none that did not receive the treatment.
#3) 12742268Jha N/200376 patientsCohort
Key resultsIn this study 76 patients were evaluable, 59 were men and 17 women with ages ranging from 36 to 79. 60 patients received the surgery to transfer the submandibular gland into the submental space. In eight of these 60 patients, although the transfer was made, the submandibular gland was not protected from the radiation due to close proximity of pathology. Another 9 patients did not require the radiation therapy, 3 patients refused the radiation, and 2 patients died before the treatment begun. There fore, there were a total of 43 patients that received the gland transfer and proceeded with the radiation therapy (protecting the submandibular gland). The percentage of none or minimal xerostomia post op was 81%, 65% at 2 month follow up, and 71% at 6 month follow up. The patients that received gland transfer but were not protected from the radiation(16 patients), 48% developed moderate to severe xerostomia which increased to 71% at a 6 month follow up.
Evidence Search Search (("Submandibular Gland"[Mesh])) AND "Xerostomia"[Mesh] Search "Xerostomia"[Mesh]#14Search "Submandibular Gland"[Mesh] 19:08:22 9367
Comments on
The Evidence
A total of 12 articles were evaluated, 3 were chosen for review. These included 2 cohort studies and a case control. The Case control trial offered good comparison between treatment and no treatment(control). Also the patient pool was large (70 patients). The other 2 cohort studies were of valuable interest because they offered a long term follow up (60 months) of the treatment and offered more detail on the results obtained post operation.
Applicability Based on the studies evaluated above I believe the use of submandibular gland therapy as a method of xerostomia relief is both effective and efficient. Patients that are willing should be evaluated as possible candidates to receive this treatment prior to radiation therapy for cancer.
Specialty/Discipline (General Dentistry) (Oral Surgery)
Keywords Gland transfer, submandibular, Xerostomia, dry mouth
ID# 858
Date of submission: 04/01/2011spacer
E-mail rahgozarr@livemail.uthscsa.edu
Author Reza Rahgozar
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Vidya Sankar, DMD, MHS
Faculty mentor/Co-author e-mail SankarV@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
post a rationale
None available
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Comments on the CAT
(FOR PRACTICING DENTISTS' and/or FACULTY COMMENTS ON PUBLISHED CATs)
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by Gurbani Makkar, Matthew Alonzo (San Antonio) on 11/28/2017
A PubMed database search was conducted on November 2017 with the same search criteria from the CAT. Two more recent systematic reviews and meta analyses done by Wu in 2015 (pmid# 25823449) and Sood in 2014 (24189058) supported the CATs finding that a submandibular gland transfer can preserve salivary function; therefore, preventing Xerostomia.
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