Saving saliva function during treatment for head and neck cancer

Two Edmonton doctors have pioneered a new surgical procedure that significantly boosts quality of life for patients with head and neck cancer by preserving saliva functioning.

The novel method, developed by Drs. Naresh Jha and Hadi Seikaly of the University of Alberta, involves permanently moving 1 of the 6 main (submandibular) saliva glands from under the jaw to beneath the chin, where it is more easily shielded from radiation during treatment. This rerouting of blood flow, nerve supply, and saliva drainage to the relocated gland, which adds only 45 minutes to initial cancer surgery, is performed before radiation therapy starts.

Preliminary results of the team's prospective trial (Int J Radiat Oncol Biol Phys 2000;46[1]:7-11) confirm that the approximately 300 mL of saliva produced daily by a single gland is enough to prevent dry mouth. "We all know that patients can function with one kidney or one lung," says Jha, an associate professor in the U of A's Department of Oncology. "Our hope was that if we were able to save one major salivary gland, it would produce enough saliva to take care of the dryness problem."

Cancer of the head or neck is typically managed with some combination of surgery, radiation treatment and chemotherapy. The radiation component, however, destroys all of the patients' saliva glands, leaving patients with a permanent dry mouth (xerostomia). Besides causing problems with speech, chewing, tasting and swallowing, this condition also leads to loss of appetite and body weight, and to tooth decay.

Jha estimates that the new procedure could benefit up to three-quarters of all patients with head and neck cancer. The remaining 25% of patients with cancer of the nasopharynx or oral cavity, or with bilateral neck nodes, are not eligible for the operation.

Since getting the green light for their prospective trial from the Alberta Cancer Board in June 1999, Seikaly has successfully performed 30 of the operations through Edmonton's Cross Cancer Institute. While they won't have long-term follow-up results for at least another year, the pair is continuing to do the procedure outside of the trial. "Based on the very favourable preliminary results," says Seikaly, assistant clinical professor in the Department of Otolaryngology, Head and Neck Surgery, "we feel it is unethical not to offer it to patients." FIGURE

Figure. Diagram shows how the relocated salivary gland is shielded from radiation: 1) area affected by radiation (radiation field); 2) wire defining posterior border of salivary gland relocated to below the chin; 3) area shielded from radiation during therapy.