A Modified Submandibular Approach - Assessment of Outcome

Abstract

The submandibular approach has been an integral tool in facial surgery since 1934. The technique is indicated in different clinical scenarios. This approach is governed by two key determinants; namely the skin tension lines and the course of the marginal mandibular branch.Aim of study: this study suggests that moving the incision further into the neck while respecting the course of the facial nerve would help achieving both optimal esthetic outcome as well as less nerve injuries.Materials and methods: eight patients requiring facial surgery, where the submandibular approach was indicated, were recruited and the modified submandibular incision was applied. The function of the facial nerve was followed up for six months using the Houseman-Brackman test. The esthetic result was assessed by two panels; consultant maxillofacial surgeons, and lay persons mainly concerned with the esthetics. The panel reviewed the cases through a power point presentation. A questionnaire customized to each panel's expertise was then provided.Results: Surgeons grading intra-class correlation coefficient (ICC) showed that there was an excellent agreement in questions 1, 4, 5 and 7 (ICC=0.672, ICC=0.647, ICC=0.753 and ICC=0.679 respectively). The 5 different maxillofacial surgeons had excellent agreement on that the incision utilized accurately facilitated accessibility, good healing and pleasant esthetic outcome. Regarding lay persons grading, intra-class correlation coefficient (ICC) showed that there was an almost perfect inter-observer agreement on the success of the technique esthetically (ICC=0.826 and 0.838 respectively).Conclusion: the modified submandibular approach provided better aesthetic results and lower risk of facial nerve injury.

Transcervical Submandibular Approach: A Patient and Observer Scar Objective Score appraisal

“…The scar assessment session was set at 12-month postoperative. Similar period was reported by Ghanem et al (2021) and Delsing et al (2016) (6,13). Following an initial healing period and a 6 to 18 weeks period of epithelization, scars are usually developed after linear surgical incision closed by primary intention (17,18).…”

“…In this study, various maxillofacial applications were chosen to fully evaluate the procedure's adaptability. Similar approach was taken by Ghanem et al (2021) (6). This study on the other hand included more mandibular-trauma patients.…”

“…In this study the functional performance of the utilized modified incision was superb, where none of the cases developed permanent nerve damage or any functional and aesthetical asymmetry. The fact that Resting Skin Tension Line (RSTLs) gets more transverse away from the boundary of the mandibular bone, taking the incision in the skin crease towards the midline will have a more inferior position than that near the ramus and angle of the mandible (5,6). This orientation gives the famous mastoid to hyoid transcervical incision placement, which was utilized in cases with mandibular resection in this study.…”

“…These lines owe a transverse orientation, that gets more diagonal further away from the mandibular boundary. Adhering to the skin crease is the best way to conceal the incision line and to have an inconspicuous postoperative surgical mark and minimal scar formation (5,6). The result of any surgical incision is a scar.…”

“…Itching and soreness are usually experienced by the patient, especially if the scar has hypertrophied (3)(4)(5). The etiology, size, location, suturing method, wound care, as well as a person's age, race, and genetic susceptibility, all affect the scar's characteristics (6). Evidence-based scar evaluation research are utilized to eventually improve scar therapy and prevention.…”