Submandibular gland excision

Abstract

Results: Results: 117 patients were studied, aged 12-89 years (mean 48), 70 women and 47 men. Thirty-nine patients (33.3%) were affected by inflammatory diseases (28 patients with lithiasis), 70 had benign tumors, and malignant tumors, eight. Regarding FNA, the sensitivity and specificity were 85.7% and 100%, respectively. Nine patients (7.7%) had temporary paralysis of the marginal mandibular nerve and one had permanent paralysis. Conclusion:Conclusion: Conclusion: Conclusion: Conclusion: resection of the submandibular gland is a safe procedure, with low complication rates. . The most found benign tumor is the pleomorphic adenoma. Total resection of the affected gland is the standard treatment proposed for all tumors.The surgical transcervical lateral access is considered standard for approach the submandibular gland 4 . Although other open and endoscopic approaches have been proposed 5 , the lateral transcervical remains the only one used in our Department.The report of operative complications in the submandibular gland excision for benign lesions ranges from 0 to 14% for hematoma and infection. However, the need of reoperation is rarely reported 3,6,7 . Subjective complaints are also reported by some patients. Permanent damage to the marginal mandibular branch of the facial nerve accounts for 0 to 8%, the lingual nerve, 0 to 12%, and the hypoglossal, 0 to 1.4% 1,[6][7][8] . The objective of this study is to analyze the value of fine needle aspiration and the rates of postoperative complications in patients undergoing resection of the submandibular gland. METHODS METHODS METHODS METHODS METHODSWe reviewed the records of unselected cases of patients treated with resection of the submandibular gland in the Head and Neck Surgery Service at the Hospital Ana Costa and at the Irmandade da Santa Casa da Misericór-dia de Santos, São Paulo -SP, Brazil, from January 1995 to December 2008. The data analyzed were age, gender, findings on clinical history, results of FNA, indication for surgery, surgical procedure, histological diagnosis and complications. Clinical examination was performed with bimanual palpation to differentiate between glandular tissue and lymph node.The evaluated postoperative complications were hematoma, wound infection, salivary fistula and paralysis of the hypoglossal, marginal mandibular and lingual nerves. The physiological function of each involved nerve was clinically assessed before and after surgery by observing the movements of the facial muscles and the appearance, movement and tactile sensation of the tongue. We performed the postoperative evaluation at the time of skin suture removal, and if there were nerve changes, we carried out periodic reviews until complete resolution of paresthesia.Ultrasonography was performed routinely as a complementary imaging study to clinical findings. The fine needle aspiration with frozen specimen was performed in patients with nodular disease of the submandibular gland to clarify the benign or malignant nature of the lesion, not being indicated for patients...

Recurrent Submandibular Sialolithiasis in a Child

“…More invasive modalities include submandibular gland excision. Submandibular gland excision is mainly reserved for recurrent cases or intraparenchymal sialolithiasis which can be achieved either by means of transcervical or intraoral approach [ 10 ]. Intraoral submandibular gland excision has been described previously, such an approach has an advantage of external scar avoidance and a lowered risk of hypoglossal and marginal mandibular nerve injury [ 11 ].…”

3D Reconstruction and Prediction of Sialolith Surgery

“…A lateral transcervical approach was used, and according to De Carvalho et al, it is considered the standard surgical access for submandibular gland [9]. …”

“…For sialoliths located in the anterior half of the duct, surgical intervention is required for the removal of sialoliths, mainly by intraoral surgery [4, 9]. In cases when the calculus is located in the posterior portion of the duct or inside the gland, the approach is always surgical and may be associated with the total removal of the gland, such as in our case, where the treatment of choice was to remove the sialoliths, followed by excision of the gland (indicated on volumetric analysis) [9]. Caution is necessary for surgical treatment, as it can lead to complications such as fibrosis in the ductus, salivary fistula, paralysis, and paresthesia.…”

“…Caution is necessary for surgical treatment, as it can lead to complications such as fibrosis in the ductus, salivary fistula, paralysis, and paresthesia. There are two more recent methods that can also be used as a form of treatment: endoscopy, which is used for massive salivary calculus, such as the region near the lingual nerve, and lithotripsy, which consists of a focused, extracorporeal shock wave through the skin to the calculus and which fragments the calculus and decreases its size [8, 9]. …”

“…However, depending on the location of sialolith (e.g., mainly in the duct of the submandibular gland), occlusal radiograph can be used for its visualisation [3, 8] if it is located in the glandular parenchyma; otherwise, other imaging examinations allow a better visualisation. In this latter case, complete resection of the gland is necessary because there is a high rate of relapse and the calcified mass cannot pass through the duct, which requires a lateral transcervical approach for removal of the submandibular gland [2–4, 8, 9]. …”