^99Tc^mO4^—显像评价唾液腺自体移植治疗角结膜干燥症疗效

目的 探讨^99Tc^mO4^-唾液腺显像在角结膜干燥症颌下腺自体移植术前患者选择和术后判断移植腺体的活力、分泌功能及导管通畅中的价值。方法 12例重症干燥角结膜炎患进行,均行^99Tc^mO4^-唾液腺显像,其中9例行单侧自体腺体移植手术,术后再行^99Tc^mO4^-唾液腺显像,其中5例于术后1周、1、3和6个月进行动态及静态显像,观察移植腺体的形态、摄取显像剂情况及排泄管通畅与否。结果 术前3例患者颌下腺显像不良,未行手术。9例自体颌下腺移植术患者中6例移植腺体摄取显像剂正常。但在早期（1～4周）除个别患者外,眼内均未见明显放射性分布;3个月后,6例患者眼内均有放射性分布,移植腺体功能均正常。3例患者术后无泪液排出,其中2例^99Tc^mO4^-唾液腺显像阴性,手术证实为腺体坏死,1例经超声检查证实腺体无血运。另1例移植腺体显像正常,但排泄导管不通,经冲洗导管后,眼内显影亦正常。结论 ^99Tc^mO4^-唾液腺显像可评估颌下腺功能,判断移植手术是否成功及有无并发症。     

系统性红斑狼疮继发干燥综合征的唾液腺功能定量分析

目的 探讨系统性红斑狼疮继发干燥综合征(SLE-SSS)患者的99TcmO4-唾液腺动态显像特点.方法 对42例SLE-SSS患者与10名健康对照者行常规99TcmO4-唾液腺动态显像,获得并比较腮腺与颌下腺的时间-放射性曲线(TAC)及功能参数:15 min摄锝率(UR)与酸反应泌锝率(SR).结果 在SLE-SSS组,21.4%的腮腺与59.5%(11.9%为单侧)的颌下腺TAC明显异常.SLE-SSS组的UR与SR均值均低于对照组(P＜0.01),且左侧腮腺UR均值低于右侧(P＜0.01).SLE-SSS组腮腺的UR及SR分别与颌下腺的UR及SR呈明显正相关(P＜0.05),腮腺及右侧颌下腺的UR与SR无明显相关性(P＞0.05),左侧颌下腺的UR与SR呈明显正相关(P＜0.01和＜0.05).结论 SLE-SSS时腮腺与颌下腺的摄取及分泌功能受损程度呈正相关,且颌下腺受损程度重于腮腺;腺体自身摄取与分泌功能受损程度无必然关联,且双侧腺体的功能受损程度不对称.     

唾液腺核素显像在诊断干燥综合症中的临床意义

目的探讨唾液腺核素^99mTcO4-显像的形态、功能等影像学特点，评判唾液腺显像对干燥综合症的诊断价值。方法对33例自身免疫普阳性的患者及10例健康体检者，行唾液腺核素^99mTcO4-显像，利用计算机感兴趣区（ROI）技术和自编软件获得腮腺时间-放射性曲线并分析计算摄取指数、相对摄取率、排泄率（MSR）及酸刺激后唾液腺放射性计数由高峰降至最低的时间，比较两组各功能指标所得数据行统计学处理。结果43例受检者顺利完成检查，一次显像可同时获得双侧唾液腺动态影像过程、时间一放射性曲线以及各功能参数半定量指标，正常组唾液腺各项功能指标明显高于干燥综合征组（P值〈0．01）。结论核素特征性显像是诊断干燥综合征的灵敏指标，动态显像定量分析省时、可行，该方法值得进一步推广。     

改良半定量唾液腺动态显像分析腮腺功能方法初探

目的:建立改良99mTcO4-唾液腺动态显像方法和腮腺半定量功能指标.材料和方法:对30例正常人和44例干燥综合征患者分别进行30min99mTcO4-动态显像,于第15min时舌下含服维生素C(Vit.C)o.1g,利用计算机感兴趣区(ROI)技术和自编软件获得腮腺时间-放射性曲线和各功能参数,比较两组各功能指标.结果:74例受检者顺利完成检查.患者和正常对照组双侧腮腺第15min摄取指数、相对摄取指数及排泄分数差异明显(P<0.05).结论:改良99mTcO4-唾液腺动态显像省时,其功能指标可直观、客观反映腮腺功能,值得进一步推广.     

改良99Tcm-RBC显像对下消化道出血的定位诊断价值

目的探讨改良99Tcm-RBC显像对下消化道出血的定位诊断价值.方法常规静脉注射示踪剂,矩形探头取全腹部视野.待腹部出现异常放射性浓聚后,用核素在体表标记出血区,结合口服99TcmO-4 液,密切观察99TcmO-4 峰通过肠腔的情况和99TcmO-4 峰与异常放射性浓聚区的融合时间,必要时加侧位观察.结果 18例改良99Tcm-RBC显像中,5例小肠出血患者99TcmO-4 前峰迅速覆盖标记区内异常放射性浓聚灶,融合时间平均为(38.4±12.5) min;13例结肠出血患者可见顺次显示空回肠各部直至回盲部, 融合时间平均为(98.7±31.6) min.结论以99TcmO-4 峰融合时间60 min为参考标准,可区分大小肠出血,再结合观察回盲部显像位置初步确定出血位置.改良99Tcm-RBC显像较常规99Tcm-RBC显像对下消化道出血定位诊断有一定优势.     

99mTcO-4动态显像诊断异位甲状腺

99mTcO-4是核医学甲状腺显像常用显像剂,但由于唾液腺,口腔,鼻咽腔和胃等黏膜上皮细胞对99mTcO-4摄取和分泌,使99mTcO-4甲状腺显像的特异性不高,故普遍认为其对异位甲状腺的诊断价值有限[1～3].本研究通过回顾性分析临床疑似异位甲状腺的99mTcO-4动态显像结果及部分患者手术后的病理学资料,旨在探讨99mTcO-4动态显像在异位甲状腺诊断中的应用价值.     

动态显像定量评价唾液腺功能的探讨

目的用唾液腺动态显像定量分析方法评价唾液腺的摄取与排泄功能。方法用２种唾液腺定量分析软件,对３０例正常人和２０例干燥综合征患者的唾液腺功能进行分析,计算唾液腺１５ｍｉｎ摄取率和３０ｍｉｎ排泄率。结果正常人腮腺和颌下腺摄取率分别为（０２６±００９）％和（０１５±００８）％,而干燥综合征患者为（００７±００３）％和（００５±００４）％,两者比较差异有极显著意义,ｔ值分别为５３和４１,Ｐ均＜００１。不同定量方法评价唾液腺摄取功能的结果间呈显著正相关（ｒ＝０８５）。结论动态显像定量分析方法简单实用,能灵敏、可靠地评价唾液腺功能,有较重要的临床意义。     

唾液腺核素显像在干燥综合症中的临床意义

目的评判唾液腺99mTcmO4-显像的功能及影像学特点，探讨唾液腺99mTcmO4-显像对干燥综合症患者的临床价值。方法对33例干燥综合症组的患者及10例健康体检组患者，行唾液腺核素99mTcmO4-显像，利用计算机感兴趣区（ROI）技术及软件获得摄取指数（UR）、相对摄取率（S／I）、排泄率（MSR）及高峰时间（Tmin），比较两组上述指标并进行统计学分析。结果干燥综合症组与健康体检组患者腮腺UR、S／I、MSR及Tmin差异有统计学意义（P值〈0．01），在干燥综合症患者中唾液腺轻度受损组与严重受损组上述指标差异有统计学意义（P值〈0．01）。结论唾液腺99mTcmO4-显像利用ROI技术时干燥综合症患者的诊断有重要临床价值，可以区分唾液腺受损差异。     

Mikulicz病唾液腺SPECT显像1例

患者女, 42岁, 因"反复上眼睑肿块1年"入院。既往体健。体格检查:体温36.5 ℃;双侧泪腺对称性肿胀, 可触及肿块, 质软, 无压痛;双侧腮腺对称性肿大, 无触痛;无口干、眼干、皮疹、脱发、光过敏、关节疼痛。实验室检查:血尿常规、肝肾功能、肿瘤标志物未见异常。免疫指标:免疫球蛋白(immunoglobulins, Ig)G4>3.33(正常参考值范围:0.08～1.40) g/L, IgE 296(正常参考值范围:<100) kU/L。采用德国Siemens公司Symbia T16 SPECT/CT仪行唾液腺SPECT显像(图1):患者取仰卧位, "弹丸"式静脉注射99TcmO4-(北京原子高科股份有限公司), 行唾液腺动态显像, 20 min时口服维生素C, 继续采集10 min。显像示:(1)双侧腮腺摄取功能减低(左侧为著), 左侧腮腺排泌功能正常, 右侧腮腺排泌功能减低;(2)双侧颌下腺摄取及排泌功能正常。时间-放射性活度曲线示:右侧腮腺及左侧腮腺曲线斜率减低, 右侧颌下腺及左侧颌下腺曲线斜率大致正常;20 min时口服维生素C后, 右侧腮腺曲线未见下降, 余曲...     

干燥综合征腮腺~(99)Tc~mO_4-核素动态显像与唇腺活检的对比研究

目的:与唇腺活检相对比,评价核素动态显像在诊断干燥综合征(SS)中的作用和价值。方法:对143例干燥综合征患者和22例正常人分别进行核素动态显像,所有病例均经唇腺活检病理证实。结果:正常对照组99TcmO4-摄取率为5.12±3.17,最大浓聚时间为(22.5±3.01)min,排泄率为(52.4±5.62)%;SS组患者99TcmO4-摄取率为2.02±1.02,最大浓聚时间(17.8±4.53)min,排泄率为(10.6±6.04)%,两组差异有统计学意义(P0.05)。与唇腺活检结果对比,核素动态显像的灵敏度为94.4%,特异性为95.5%。结论:对于临床怀疑为SS的患者,99TcmO4-唾液腺显像是一种值得推广应用的首选筛查方法。     

99TcmO4-动态显像在颌下腺移位术中的临床应用

目的探讨颌下腺动态显像在鼻咽癌颌下腺移位术中的临床价值。方法70例鼻咽癌初诊患者，分为试验组36例，非试验组（对照组）34例。对照组直接行常规放疗；试验组于术前1天行颌下腺^99Tc^mO4^-动态显像，根据结果选取功能较好一侧颌下腺于第2天行颌下腺移位术，术后复查颌下腺功能及择期行常规放疗。放疗后皆行颌下腺^99Tc^mO4^-动态显像及记录患者口腔干燥症状的程度，结果采用非参数秩和检验进行统计分析。结果移位侧颌下腺功能于术后、放疗后损伤明显减轻，与非移位侧颌下腺差异有显著性（P〈0．01）；试验组中度以上口腔干燥症率为13．9％，对照组为76．5％，差异有显著性（P〈0．01）。结论^99Tc^mO4^-颌下腺动态显像可准确、灵敏地评估颌下腺功能。     

Effects of gender and age on the quantitative parameters of [99mTc]pertechnetate salivary gland scintigraphy in normal subjects

AIM: To assess the effect of gender and age on [99mTc]pertechnetate salivary gland scintigraphy (SGS) in healthy subjects. METHODS: The study population consisted of 93 normal subjects (46 women, 47 men; age range 20-59 years). The subjects were categorized into eight (four female and four male) subgroups according to age decades. Dynamic SGS was performed after intravenous injection of 370 MBq [99mTc]pertechnetate. Anterior salivary gland images were acquired for 30 min. On the basis of the time-activity curves, three functional parameters were calculated for the parotid and submandibular salivary glands: (1) the first minute uptake ratio, (2) the maximum uptake ratio, and (3) the maximum secretion percentage. RESULTS: For women, all parotid and submandibular functional parameters had a peak in the fourth decade group. The comparison of four age groups in the female subjects showed significant differences, except for the third versus the fifth decades, at least for one parameter. The number of significant differences was highest in the comparison between the second versus the fourth decades. Among men, the highest values for all parotid and submandibular parameters were in the second decade, except for the first minute uptake ratio in the submandibular gland. The number of parameters that were significantly different among the four age groups in men was lower than in women. The first minute uptake ratio of the submandibular gland had the most significant differences among the groups of male subjects. CONCLUSION: Age and gender differences have a significant effect on salivary gland functions which is more apparent in women than in men.     

Salivary gland scintigraphy using technetium-99m-pertechnetate after autotransplantation of the submandibular salivary gland in the correction of dry eye

The aim of the study was to determine whether salivary gland scintigraphy using technetium-99m pertechnetate is suitable for checking the vitality and function after autotransplantation of the submandibular salivary gland in patients with dry eye syndrome. To this end, 56 scintigraphic studies in 20 patients have so far been performed. In addition, these scans were evaluated by a region of interest (ROI) technique in order to examine tracer uptake in the early and late stages after surgery. We have been able to prove that in this special respect, too, the salivary gland scintigraphy is suitable for assessing reliably the vitality and function of the transplanted gland. The secretion into the eye and thus the patency of the efferent duct can also be displayed. This proved to be particularly valuable in those cases in which at first no secretion could be seen in the clinical examination. In patients with uncertain excretory function, we were able to distinguish between non-vitality and lack of patency of the secretory duct. Using ROI evaluation, no significant decrease in the salivary function has been detected in long-term follow-up, now extending to 1 year after surgery. Received 21 August and in revised form 25 October 1997     

Evidence for early and persistent impairment of salivary gland excretion after irradiation of head and neck tumours

Salivary gland scintigraphy with technetium-99m pertechnetate was used to follow changes in the excretion and uptake function of the major salivary glands until 1 year after irradiation. Twenty-five patients who received radiotherapy for head and neck tumours were included in the study. Seventy-nine salivary glands (39 parotid and 40 submandibular) were evaluated in relation to the average received radiation dose. Salivary gland scintigraphy was performed before and 1, 6 and 12 months after radiotherapy. For each gland the excretion response to carbachol, evaluated by calculation of the salivary excretion fraction (SEF), the cumulative gland uptake (CGU) and the absolute excreted activity (AEA) at various intervals after radiotherapy were compared with the baseline values. The excretion response decreased in 20 of 25 patients at 1 month after radiotherapy. One month after radiotherapy both SEF and AEA decreased significantly in relation to the radiation dose. These decreases in excretion parameters persisted during the follow-up period. Parotid excretion was affected significantly more than submandibular excretion. CGU values did not change significantly until 6 months after radiotherapy, but at 12 months a significant decrease related to radiation dose was observed. Xerostomia was assessed during radiotherapy and on the days of the scintigraphic tests. The incidence of xerostomia did not correspond to the effects observed in the scintigraphy studies. It is concluded that radiotherapy induces early and persistent impairment of salivary gland excretion, related to the radiation dose. This impairment is stronger in parotid glands than in submandibular glands.     

Salivary gland scintigraphy: the use of semiquantitative analysis for uptake and clearance

OBJECTIVE: Quantitative analysis of (99m)Tc-pertechnetate salivary gland scintigraphy has been used in the evaluation of salivary gland function, but so far no one method can be considered optimal for this task. In this study, a semiquantitative method providing 2 functional parameters for objective assessment of salivary gland function by scintillation camera imaging was tested. METHODS: Twenty-one patients referred for (99m)Tc-pertechnetate thyroid scanning were studied. Two patients with salivary complaints were also included. Dynamic imaging of the anterior head using a scintillation camera was started after a bolus intravenous injection of 185 MBq (5 mCi) (99m)Tc-pertechnetate at 1 frame per 30 s for 30 min. At 15 min after injection, diluted lemon juice was administered orally. Analysis of the dynamic study included time-activity curves of 4 salivary glands (right and left parotid and right and left submandibular). Two parameters of function were defined: uptake rate, taken as the value of the initial slope of the time-activity curve, and washout fraction, which was the relative mobilizable radioactivity from each salivary gland after ingestion of the sialogogue. A parametric image of the washout fraction was also generated. RESULTS: The images showed gradual uptake in the parotid and submandibular glands. Washout was noted immediately after ingestion of the lemon juice. The pattern of the time-activity curve in all glands showed an early fast-rising part followed by a slow-rising component to nearly a plateau within 6-10 min after injection. The mean value of the uptake rate parameter was 0.10 +/- 0.09 cps/s. There was no significant difference between the parotid and submandibular glands or the right and left sides. Uptake in the parotid gland was 1.5-2 times that in the submandibular gland. The washout fraction was 1.40 +/- 1.60 for the parotid glands and 0.77 +/- 0.41 for the submandibular glands (P = 0.005). CONCLUSION: The quantitative analysis method including the uptake rate and the washout fraction parameters would enable objective assessment of salivary function and provide a reproducible means for follow-up of functional impairment in certain diseases.     

Sj?gren's syndrome: comparison of assessments with quantitative salivary gland scintigraphy and contrast sialography.

This study compared the quantitative parameters of salivary gland scintigraphy and the sialographic stages in patients with Sj?gren's syndrome. METHODS: One hundred sixteen patients suspected of having Sj?gren's syndrome were examined with salivary gland scintigraphy and contrast sialography. When contrast sialography was used as the gold standard, Sj?gren's syndrome was diagnosed in 50 of these 116 patients; Sj?gren's syndrome was not seen in the other 66 patients. After injection of 370 MBq 99mTc-sodium pertechnetate, dynamic salivary gland scintigraphy with lemon juice stimulation was performed for 50 min. Functional parameters for the parotid and submandibular glands were calculated, and scintigraphic and sialographic results were compared. RESULTS: With the progression of sialographic stages from 0 to 4, the quantity of tracer accumulation decreased in the submandibular gland (P < 0.0001), and the quantity of tracer secretion decreased in the parotid gland (P < 0.0001). The sialographic stage in patients with Sj?gren's syndrome was correlated with these scintigraphic parameters (P < 0.0001): sialographic stage = 3.243 - 0.337 x (submandibular gland uptake ratio) - 0.026 x (parotid gland maximum secretion). CONCLUSION: The decreased accumulation in the submandibular gland and the decreased secretion in the parotid gland were highly sensitive indicators of salivary gland disease in Sj?gren's syndrome. The sialographic stage was correlated with these scintigraphic parameters.     

综合干预措施下评估首次131I清甲治疗对分化型甲状腺癌患者唾液腺的慢性损伤

目的研究探讨分化型甲状腺癌（DTC）患者在采取综合干预措施后首次131I清甲治疗对唾液腺功能的慢性损伤情况。方法选取2016年8月至2017年9月在攀枝花市中心医院核医学科首次行131I（4200.24±604.21）MBq清甲治疗的DTC患者52例,所有患者均在131I清甲治疗后立即采取综合干预措施（饮食护理、心理护理、物理护理、口腔卫生护理、健康宣教及药物治疗等）,并分别于131I清甲前和治疗后6个月行99TcmO₄-唾液腺动态显像,计算其摄取峰值和排泌分数,所得数据采用自身配对t检验分析,同时联合口干评分法评估唾液腺功能的损伤情况。结果（1）左侧腮腺摄取峰值在131I清甲前为45.157±19.421,治疗后6个月为52.600±21.716,差异有统计学意义（t=2.470,P=0.018）。（2）右侧腮腺、双侧颌下腺的摄取峰值及双侧腮腺、双侧颌下腺的排泌分数之间的差异均无统计学意义（t=0.784、0.524、0.514、0.362、0.731、0.596、0.507,均P>0.05）。（3）对52例患者行问卷调查和口干评分法分析,其中,50例（96.2%）患者无口干症状,仅有2例（3.8%）出现轻度口干症状。结论（1）首次131I清甲治疗可引起DTC患者唾液腺功能受损,损伤主要以单侧腮腺摄取功能为主,呈非对称性损伤。双侧颌下腺的摄取和排泌功能则未受到明显影响。（2）症状上,在综合干预保护措施下,绝大部分患者在接受首次131I清甲治疗后6个月无明显口干情况,生活质量无明显影响。     

Rosai Dorfman disease of the parotid and submandibular glands: salivary gland scintigraphy and oral findings in two siblings

Rosai-Dorfman disease (RDD) is an unusual clinical entity characterized by benign pseudolymphomatous proliferation with significant histiocytic infiltration. In the present paper, extranodal RDD of the major salivary glands causing salivary hypofunction and the results of salivary gland scintigraphy and ultrasound are presented in two siblings. Case 1: a 10-year-old boy with bilateral painless masses around the parotid and submandibular glands was referred. Ultrasound examination showed bilateral, well-defined, hypoechoic solid mass lesions within both parotid glands with minimal normal parenchyma in the upper poles. Both submandibular glands were markedly hypoechoic and heterogeneous. Mass lesions within the parotid glands appeared as cold lesions with regular contours on scintigraphy. Dynamic images showed normal uptake and normal response to secretion in the upper poles of the parotid glands, corresponding with ultrasonographically normal parenchyma. Both submandibular glands showed markedly diminished uptake and secretion. Case 2: a 9-year-old boy presented with mass lesions around the submandibular glands. Ultrasound examination showed normal parotid glands and markedly hypoechoic and heterogeneous submandibular glands. Salivary gland scintigraphy showed normal uptake and secretion of parotid glands with markedly diminished uptake and secretion in both submandibular glands. There were severe carious lesions in both patients due to salivary hypofunction. Treatments of the two patients' teeth were performed. Major salivary gland involvement of RDD is important for dentists as it may cause xerostomia and can mimic dental abscess. Functional evaluation of salivary glands with scintigraphy, besides radiological and pathological techniques, will help to explain whether salivary glands are affected or not and improve the diagnostic effectiveness.     

Normal values of [99mTc]pertechnetate uptake and excretion fraction by major salivary glands

The assessment of the functional status of the salivary glands has been used in the scintigraphic evaluation of xerostomia. Several quantitative methods derived from standard dynamic scintigraphy have been suggested. However, the indices proposed are quite variable and unlikely to be useful in clinical practice.The objectives of this study were to obtain reference values of major salivary glands uptake and excretion fraction in healthy subjects and to obtain normal ratios of Tc-pertechnetate uptake by the major salivary glands in comparison to the thyroid gland uptake. The standardization of these values has the purpose of making this evaluation faster and more objective.Fifty volunteers without clinical evidence of xerostomia or thyroid disease underwent static salivary glands scintigraphy with Tc-pertechnetate. Static images were obtained at 20 minutes and then at 3 minutes after oral stimulation with lemon juice. Percent uptake, excretion fraction and salivary gland to thyroid ratio rates were calculated for the parotid and the submandibular glands.The mean of the uptake values at 20 minutes for the right and left parotid glands were respectively 0.31% and 0.26%, and for the submandibular glands 0.15%. The excretion fraction of the tracer after the lemon juice stimulation was 70% for the parotids glands, 50% for the right and 49% for the left submandibular glands. The mean+/-SD salivary gland to thyroid count ratio was 0.79+/-0.45 for the right parotid, 0.78+/-0.5 for the left parotid, 0.67+/-0.33 and 0.66+/-0.34 for the right and left submandibular glands, respectively.Salivary glands scintigraphy with uptake and excretion fraction calculation is an easy to perform, non-invasive and objective method to investigate salivary glands function. These findings help the nuclear physician to interpret salivary gland scintigraphy more objectively, even in patients with thyroid gland dysfunction in whom Tc-pertechnetate thyroid uptake may be abnormal.     

Application of 99mTc-pertechnetate scintigraphy to microvascular autologous transplantation of the submandibular gland in patients with severe keratoconjunctivitis sicca.

Our objective was to evaluate the role of (99m)Tc-pertechnetate scintigraphy on microvascular autologous transplantation of the submandibular gland in patients with severe keratoconjunctivitis sicca (KCS). METHODS: (99m)Tc-Pertechnetate scintigraphy was performed on 106 patients with severe KCS. The patients were examined before surgery and at 1 wk and 3 mo afterward using a standardized protocol that included static scintigrams, time-activity curves, and delayed scintigrams to check the function and secretion of the major salivary glands. The scintigraphic findings were assessed visually. When possible, the scintigraphic findings were compared with the clinical appearance of the transplanted gland. RESULTS: The function of all 4 major salivary glands was almost completely lost in 10 patients, indicating that these patients were not suitable for transplantation. The other 96 patients were treated by autologous transplantation of the submandibular gland. In 14 patients, the function of the major salivary glands was below normal. One patient's scintigram, obtained on the second day after surgery, showed no uptake of (99m)Tc-pertechnetate in the transplanted gland. Surgical exploration showed embolism of the artery of the transplanted gland. Scintigraphy was performed 1 wk after surgery in 90 patients. There was no uptake of (99m)Tc-pertechnetate in the temporal region in 8 patients, indicating that the glands were not revascularized. Scintigraphy showed obvious uptake of (99m)Tc-pertechnetate in the temporal region of the other 82 patients, indicating that the transplanted glands were viable. At more than 3 mo after surgery, scintigraphy was again performed on 30 patients. Scintigraphy after a 120-min delay showed that (99m)Tc-pertechnetate drained into the orbit through the duct of the transplanted gland in 26 patients. However, no secretion into the orbit was found in 4 patients, indicating obstruction of the duct. CONCLUSION: Scintigraphy plays an important role in microvascular autologous transplantation of the submandibular gland in patients with severe KCS. Scintigraphy can be used to select patients and donor glands, to evaluate the viability of the graft, and to check the patency of Wharton's duct of the transplanted gland.