Surgical Morbidity of Intraoral Removal of the Submandibular Gland

Hong, Ki Hwan; Kim, Chang Hyun; Moon, Seung Young; Kim, Byum Kyu; Lee, Sang Hyun; Lim, Hyun Sil; Choi, Seung Choul

Abstract

BACKGROUND AND OBJECTIVES: For surgery of chronically inflamed submandibular gland, most head and neck surgeons carry out skin incision on the neck, but several clinical problems after surgery has been mentioned. An intraoral approach as an alternative to the standard transcervical approach has been reported. To evaluate a postoperative morbidity in the intraoral approach for excision of submandibular gland.
SUBJECTS AND METHODS
A total of 62 surgery cases for chronic submandibular sialoadenitis with or without stone, including those resulting from benign tumor of submandibular gland, were carried out via intraoral approach during a 3-year period.
RESULTS
Most patients (85.5%) had sialoadenitis with or without stone. Early postoperative complications developed in 87.1% of the temporary lingual sensory paresis, followed by temporary limitation of tongue movement in 67.7% and 2 cases of postoperative bleeding and 1 case of abscess formation. The tongue paresis resolved spontaneously in all patients in a mean period of 3-4 weeks, whereas late complications developed in 3 cases of residual salivary gland and abnormal sense of mouth floor and one case of gustatory sweating syndrome. No residual inflammation in Wharton's duct was noted. Neurological complications of hypoglossal and marginal mandibular nerves were not observed at all.
CONCLUSION
The major advantages of this approach are no external scar, no injury to the marginal mandibular nerve or to the hypoglossal nerve, and no residual Whartons duct inflammation. The disadvantage is a more difficult dissection to transcervical approach before proper expert due to narrow surgical field, especially in the severe adhesion of salivary gland to surrounding tissue. However, with experience, the intraoral dissection of submandibular gland should be easier.