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Submandibular Gland

General Background

The submandibular gland in located below the jaw on either side of the face. Its primary function is the production of saliva in your mouth. Both benign and malignant (cancerous) tumors can affect the gland. Other inflammatory or autoimmune diseases, such as chronic submandibular inflammation (sialoadenitis) or submandibular stones (sialolithiasis), can also affect the gland. Often your surgeon will have performed a needle biopsy of a suspected tumor in the gland. If the biopsy shows a malignant lesion, an aggressive benign lesion, or a lesion highly suspicious for malignancy, submandibular gland excision may be needed. Processes such as siloadenitis or sialolithiasis may also necessitate excision of the gland.

The Procedure

This procedure takes place under general anesthesia and lasts about 1 hour. A small incision is made on the side of the neck approximately one inch below the jawbone. This incision is typically very well masked within an existing skin crease, and the resulting scar usually heals to the point of being imperceptible to the naked eye. The gland is carefully dissected away from surrounding structures, and once removed, the deeper layers of the wound and the skin are then sutured closed. Occasionally a small drain is placed in the wound- this drain is typically removed in one to two days after surgery.

After Surgery

After spending several hours in the recovery area, you will be discharged home. Pain associated with the procedure is typically mild. Most patients often state the worst sensation after surgery is a sore throat, which is caused by the breathing tube placed in the airway during surgery. This sensation usually resolves after several days. If a drain has been placed during surgery, you will return to the office the next day to have it removed. Approximately one week after surgery, the skin sutures are removed.

Risks of Surgery

There are several risks with submandibular gland excision. Several important nerves travel closely to the gland, including the nerve for tongue movement (hypoglossal nerve), the nerve for tongue sensation (lingual nerve), and the branch of the facial nerve responsible for movement of the corner of the lower lip. The risk of damage to either the lingual or hypoglossal nerve is very minimal, and the damage is almost always temporary. The risk of facial nerve injury leading to permanent paralysis of the lower lip is less than 1-2%. Permanent weakness or paralysis may require further adjunctive procedures. Some temporary weakness of the lower can occur after surgery due to manipulation of the nerve while dissecting the tumor away from it. This weakness typically resolves over the span of a few weeks. Another risk is recurrence of the tumor. Though every necessary step is taken during surgery to remove the entirety of the tumor, certain tumor types have a predisposition for recurrence and may require additional surgery. The risk of bleeding after surgery is very low, typically less than 1%. If any sudden swelling associated with pain is noted, immediate evaluation is required. This risk is minimized by the avoidance of any heavy lifting, strenuous activity, straining, or the use of blood-thinning products such as aspirin or NSAIDS for two weeks after surgery. Infection after surgery is a rare complication and is managed by oral antibiotics. Scarring from the surgery is very minimal; often the scar is so well hidden in skin creases that they are virtually unnoticeable. If you have prior history of keloids or hypertrophic scars, however, you may be at risk for larger-than-normal scar formation.