Page 143 - New epidemiological and PSMA-expression based paradigms in salivary gland tumors

The tubarial glands paper: A starting point. A reply to comments
Dear Editor,
We thank the authors of the letters for their constructive comments and thereby their contribution to the interpretation of the glandular structure as described in the tubarial gland paper and the clinical consequences of its presence [3]. Their comments will be discussed by topic in this summarized reply. Our reply to the comments in a point-by-point response to each letter is provided in the Supplemental material.
The glands clustered in the mucosa of the auditory tube and regions adjacent to the
tubarius torus have been earlier described by anatomists
The words ‘‘new” and ‘‘organ” in the title seem to have been a trigger for massive
media attention[4]. This might have caused some distraction from the core
message of the manuscript. We therefore thank Mudry and Jackler for their view
on the focus of our paper: ‘‘reclassification of a well-known anatomical feature
rather than a striking discovery of an unrecognized structure somehow overlooked
by generations of anatomists”, and its possibly important role in preserving
salivary gland function in radiotherapy for head and neck cancer[5,6]. It is indeed
important to emphasize that clusters or a high density of seromucous glands in this
area have been described before. In the writing of the original paper, we realized
as authors that we were standing on the shoulders of giants in anatomy. For that
reason, we reviewed commonly used anatomical atlases and available papers in
English and non-English from the past two centuries. Some (but not all) of these
giants were mentioned in the references list of our paper and they referred to the 9 even older papers of e.g. Moos, in German, dating back to 1874[5–7]. We thank
the authors of the letter for adding more and even older references and anatomical interpretations.
The core of our message is the fact that the gland tissue in this area has not been considered as an organ at risk (OAR) in radiotherapy. One should realize that an OAR (as mentioned in the original title) is a radiotherapy term and does not only concern organs, but also comprises all tissues near the clinical target volume that can get damaged by radiation. In the original paper, we thus did not claim to have discovered a new organ, as suggested by Cohen Goldemberg et al., Narayan et al. and Schumann, but introduced a potential new organ at risk[8–
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