Submandibular gland transfer into the temporal fossa in patients with oral squamous cell carcinoma: A viable option to prevent radiation-induced xerostomia





Highlights





  • Preservation of submandibular gland during lymph node dissection is oncologically safe in selected patients with OSCC.



  • Temporal fossa is an anatomical site receiving very low dose of radiation in patients with OSCC treated by radiotherapy.



  • SMG transfer into the temporal fossa could help for reducing radiation-induced xerostomia in patients with OSCC.



Abstract


Oral squamous cell carcinoma (OSCC) is associated with an important mortality and morbidity related to surgery and radiotherapy. In particular, radiation-induced xerostomia has a major impact on patient’s quality of life. Although intensity-modulated radiation therapy allowed mean dose reduction to the spared submandibular gland (SMG) in patients with head and neck squamous cell carcinoma, xerostomia is still an important sequela for patients treated for an OSCC. SMG surgical transfer into anatomical subsite receiving very low radiation doses is a promising approach to prevent xerostomia. Based on a literature review and data from our institutional cohort, we analyzed the oncological safety of SMG preservation. Then, we discussed the feasibility and relevance of SMG transfer into the temporal fossa, in order to prevent radiation-induced xerostomia in patients with OSCC.


Introduction


Oral squamous cell carcinoma is associated with a substantial morbidity and mortality, which is mainly due to a high risk of loco-regional recurrence. Because of the incidence of lymph node metastasis, a rigorous neck node management is crucial for patients suffering from OSCC. However, de-escalation strategies have been recently proposed for neck management of those patients. In particular, in patients with early OSCC (cT1-T2N0), recent randomized clinical trials demonstrated the oncologic equivalence of the sentinel node biopsy (SN) and neck lymph node dissection (ND) with lower morbidity in the SN arm. Moreover, preservation of submandibular gland during ND could also be considered regarding the low incidence of invasion of the SMG in patients with OSCC . In patients with advanced OSCC requiring adjuvant radiation therapy, the SMG preservation could allow its transposition into a poorly irradiated area in order to prevent radiation-induced xerostomia . Although SMG transfer into the temporal fossa has not been yet performed in patients with OSCC, the purpose is to review the literature and our institutional cohort data in order to discuss its safety and feasibility to prevent radiation-induced xerostomia in this clinical setting.


Oncological safety of submandibular gland preservation


Literature review


A previous systematic review and meta -analysis, based on a total of 4458 patients and 5037 glands analyzed, showed a SMG involvement rate of 1.8 % when considered per patient, and 1.6 % when considered per gland . We updated the literature review using Pubmed database on June 12th, 2024 to retrieve studies for submandibular gland involvement in patients with oral squamous cell carcinoma. We excluded case reports and studies including less than 10 patients. A total of 31 studies were identified ( Table 1 ), with six studies including more than 300 patients . In total 5665 patients and 6309 submandibular glands were analyzed. The incidence of SMG invasion is low according to previous retrospective (27/31) and prospective (4/31) studies reporting a rate between 0 to 9.5 % per gland and 10 % per patients. The rate of involvement of the submandibular gland was 2.2 % per gland (138/6309) and 2.4 % (138/5665) per patient. Even if most of the articles were retrospective studies, this review suggests the feasibility of the SMG preservation in patients with oral squamous cell carcinoma. Notably, a non-randomized prospective cohort study showed that the 5-year locoregional control as well as the disease-specific survival rates were not different between the SMG-sparing and SMG-excision groups .



Table 1

Literature review of submandibular gland (SMG) invasion.













































































































































































































































































































Pubmed
ID
Year Data collection Total patients Total SMG Nb of involved SMG % invasion per gland % invasion per patient
15,459,920 2004 retrospective 169 196 9 4,6 5,3
19,360,744 2009 retrospective 342 383 7 1,8 2,0
18,607,927 2009 retrospective 201 316 2 0,6 0.9
19,881,371 2009 retrospective 130 171 6 3,5 4,6
19,475,546 2009 retrospective 132 253 1 0,4 0,7
20,737,484 2011 prospective 20 33 0 0 0
21,729,447 2011 retrospective 52 52 1 1,9 1,9
22,017,858 2012 retrospective 69 69 2 2,9 2,9
22,944,141 2012 retrospective 194 229 3 1,3 1,5
23,853,397 2013 retrospective 236 294 13 4,4 5,5
25,149,835 2014 retrospective 110 110 2 1,8 1,8
25,621,270 2015 retrospective 94 98 3 3,1 3,2
25,724,734 2015 retrospective 175 163 6 3,7 3,4
27,508,132 2016 retrospective 112 112 0 0 0
27,232,643 2016 prospective 137 152 0 0 0
27,450,469 2017 retrospective 176 NA 2 NA 1,1
29,720,283 2018 retrospective 155 183 2 1,1 1,3
30,401,471 2018 retrospective 586 622 26 4,2 4,4
31,864,860 2019 retrospective 95 116 4 3,4 4,4
31,876,743 2019 prospective 330 363 7 1,9 2,1
31,866,411 2020 retrospective 302 355 1 0,3 0,3
33,968,233 2020 retrospective 149 157 7 4,5 4,7
33,940,532 2020 retrospective 303 366 4 1,1 1,3
33,109,130 2021 prospective 106 106 0 0 0
34,900,678 2021 retrospective 145 173 1 0,6 0,7
33,654,687 2021 retrospective 131 NA 1 NA 0,7
34,972,007 2021 retrospective 60 60 0 0 0
35,110,897 2021 prospective
60 63 6 9,5 10
36,742,853 2022 retrospective
83 83 6 7,2 7,2
37,280,380 2023 retrospective 642 852 12 1,4 1,8
37,871,650 2024 retrospective 173 179 4 2,2 2,3
Total 5665 6309 138 2,2 2,4

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Jun 2, 2025 | Posted by in ONCOLOGY | Comments Off on Submandibular gland transfer into the temporal fossa in patients with oral squamous cell carcinoma: A viable option to prevent radiation-induced xerostomia

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