Salivary Gland Surgery – Minimizing Radiation

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Salivary Gland Surgery – Minimizing Radiation




Guest:  Dr. Joshua Hornig - Otolaryngology

Host:  Dr. Linda Austin – Psychiatry


Dr. Linda Austin:  This is Dr. Linda Austin.  I’m talking with Dr. Joshua Hornig who is Assistant Professor of Ear, Nose & Throat, Otolaryngology, here at MUSC. 

Dr. Hornig, I know you’ve been doing a procedure here, at the medical university, which you learned in Canada, which, actually, is unusual here in the United States.  It helps prevent a very common side effect after radiation for head and neck cancer.  Can you describe that procedure, please?


Dr. Joshua Hornig:  Sure.  The biggest side effect of people having radiation is that you get a very dry mouth afterwards.  Saliva is critically important in swallowing ability and in hygiene for your teeth, and also for speech.  If you’re not convinced of this, all you have to do is eat a whole bunch of crackers and then try to talk and swallow and whistle.  It’s just impossible to do.


So, when you get the radiation, all the saliva glands become atrophied and no longer function properly.  So, the new procedure that we’re doing is transferring one of the glands underneath the jaw line to underneath the front part of the chin.  By moving it from that one area to the area of the chin, the radiation therapist can actually target his radiation to avoid that gland.  By doing so, surprisingly, but convincingly, people will have near normal saliva after these treatments.  The effect for the patient is that you swallow better, talk better, and you’re often able to keep your own teeth.  Often, after you’ve had radiation treatments, over time, all your teeth have to be pulled because they get very bad cavities.


Dr. Linda Austin:  That sounds really important.  Why is that procedure not routinely done throughout the United States?


Dr. Joshua Hornig:  Surgeons are creatures of habit.  They like to do it the way they were taught.  This is a very new procedure and we were the leading site in the United States for the clinical trial.  This clinical trial just closed this week.  The evidence from the trial will show that these people that had this procedure had much better saliva, were able to keep their teeth, and swallow much more effectively than those that did not.  The initial studies showing this came out of Canada.  And this international trial, that we just finished, was trying to show that we could replicate these results in other centers.


Dr. Linda Austin:  How long does this surgery take?


Dr. Joshua Hornig:  The surgery takes about 45 minutes, and that’s in addition to any other surgery you have at that time.  It’s part of, almost, a normal treatment of head and neck cancer, so there’s hardly any additional surgery that you need to have for it. 


Dr. Linda Austin:  So it just gets rolled into the procedure that a patient would expect to have, but then end up with a much better outcome?


Dr. Joshua Hornig:  That’s correct.  That’s very well said.


Dr. Linda Austin:  Are there any other areas in the southeast that are currently doing this procedure? 


Dr. Joshua Hornig:  I think we are one of the few centers in the entire United States doing it.  We, typically, in the last six months, have had people come from California, Florida, Georgia and Minnesota for this particular procedure.


Dr. Linda Austin:  Now, we keep referring to it as this surgery and this procedure.  It has a name, I presume.


Dr. Joshua Hornig:  We call it the submandibular gland transfer.


Dr. Linda Austin:  Because the mandible is the jaw?


Dr. Joshua Hornig:  Yes.


Dr. Linda Austin:  Right.  And you’re transferring that gland?


Dr. Joshua Hornig:  Right.


Dr.  Linda Austin:  Dr. Hornig, thank you very much.


Dr. Joshua Hornig:  You’re very welcome.


If you have any questions about the services or programs offered at the Medical University of South Carolina or if you would like to schedule an appointment with one of our physicians, please call MUSC Health Connection:  (843) 792-1414.

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