Minimally-invasive submandibular transfer (MIST) for prevention of radiation-induced xerostomia.

OBJECTIVE To develop a minimally invasive intraoral technique to transfer the submandibular gland into the submental space. STUDY DESIGN Experimental cadaver study. METHODS Five cephalus specimen, a total of 10 submandibular glands, underwent this intraoral approach. Primary outcome measures included operative time, length of gland transfer, adequate ligation of facial vessels, and preservation of lingual nerve, hypoglossal nerve, and submandibular duct. RESULTS All glands were successfully transferred. Operative times ranged from 60 to 120 minutes, mean time= 77 minutes. Length of gland repositioning ranged from 2.5 to 4 cm, mean length= 3.35 cm. Both nerves and the submandibular duct remained intact. Facial vessels were adequately visualized and ligated successfully if necessary for gland repositioning. CONCLUSIONS The submandibular gland can be transferred to the submental space through an intraoral incision without damaging the duct or neighboring nerves. The major advantage of this approach is the avoidance of an external neck scar and more rapid wound healing.