Submandibulectomia

Submandibulectomia, or submandibular gland excision, is a surgical procedure to remove the submandibular gland. It is performed for benign or malignant glandular disease or for recurrent inflammatory conditions such as chronic sialadenitis and sialolithiasis involving the gland.

Anatomy and indications

The submandibular gland sits in the submandibular triangle along the lower border of the mandible. It has superficial and deep lobes, with the Wharton duct draining into the floor of the mouth. The procedure requires careful identification and protection of nearby structures, including the marginal mandibular branch of the facial nerve and the lingual nerve. The facial artery frequently courses near or through the gland.

Technique

The operation is commonly performed through a transcervical incision placed below the mandible. After dissection to expose the gland, the surgeon mobilizes and removes the gland en bloc while preserving the facial nerve branches. The duct and vessel pedicles are ligated and divided as needed. A drain may be placed, and the specimen is sent for histopathological examination. The goal is complete gland removal with minimal injury to surrounding tissues.

Outcomes and complications

Submandibulectomy has a high success rate for appropriate indications. Most patients recover without major sequelae. Potential complications include temporary or permanent weakness of the marginal mandibular nerve, numbness of the lower lip, sensory changes of the tongue if the lingual nerve is affected, hematoma, infection, salivary fistula, xerostomia, and scarring. Recurrence or the need for additional surgery is uncommon when the gland is completely excised, especially for benign tumors.