Case Report
Hyposalivation after undergoing stapedectomy

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ABSTRACT

Background

Treatment for otosclerosis involves patients' undergoing stapedectomy. Inadvertent damage to the chorda tympani nerve's (CTN's) secretory fibers during stapedectomy can result in inadequate secretory stimulation of the submandibular salivary glands (SMSGs) and sublingual salivary glands (SLSGs). Because most saliva originates from these glands, hyposalivation and subjective xerostomia manifest during resting periods when parotid gland secretions are minimal. Stimulation with food increases parotid gland salivation enough to overcome the subjective sense of dryness.

Case Description

The author examined a 52-year-old man who had undergone bilateral stapedectomy because of hearing loss; his rheumatologist referred him to the Salivary Gland Center (New York City) because of a complaint of dry mouth. After the author examined the patient, he concluded that the patient had decreased SMSG and SLSG secretion and recommended that the patient use sugarless chewing gum or sour candy frequently to stimulate his parotid glands and use oral lubricants and sip water as needed.

Clinical Implications

Stimulation of parotid gland secretion is independent of SMSG and SLSG activation. Therefore, the dental practitioner must become aware of the innervation of the salivary glands and each gland's secretory production during periods of oral stimulation and of rest.

Section snippets

CASE REPORT

In May 2010, a 52-year-old man's rheumatologist referred him to the SGC because of a complaint of dry mouth. The patient's medical history indicated that he had received a diagnosis of ankylosing spondylitis many years previously and a prescription for etanercept. Because he had developed noticeable hearing loss two years previous, he decided to seek medical attention. He underwent bilateral stapedectomy (on the right side in May 2008 and on the left side in May 2009). The procedures

DISCUSSION

Injury to the CTN during middle-ear surgery is not rare. In 1965, Bull12 studied 126 patients in whom the CTN was sectioned during middle-ear surgery. Oral dryness occurred in 37 of the patients, and one year later it was still present in 31 patients.

Hyposalivation after CTN injury has been reported several times since 1965,2, 4, 13, 14, 15 with diminished SMSG activity persisting.14 The results of a scintigraphic study indicated that there was minimal residual SMSG secretory hypofunction

CONCLUSIONS

When the oral cavity is at rest, most saliva originates from the SMSG/SLSG complex. Injury to the CTNis not unusual during stapedectomy. Because the CTN supplies secretomotor fibers to the SMSGs and SLSGs, inadequate mucosal moistening as a result of CTN injury occurs when the oral cavity is at rest and the salivary glands are not being stimulated. During stimulation, parotid gland secretions become more active and moisten the oral mucosa adequately to negate a subjective sensation of

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Disclosure. Dr. Mandel did not report any disclosures.

1

Dr. Mandel is the director, Salivary Gland Center, and the associate dean and a clinical professor, Division of Oral and Maxillofacial Surgery, Columbia University College of Dental Medicine, New York City. Address reprint requests to Dr. Mandel at Division of Oral and Maxillofacial Surgery, Columbia University College of Dental Medicine, 630 W. 168th St., New York, N.Y. 10032

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