Endoscopic Excision of the Submandibular Gland by an Intraoral Approach

Abstract

The recent advent of endoscopic procedures has compelled both plastic and neck and head surgeons to reconsider the conventional methods by which the excision of submandibular gland is classically achieved. An endoscopic intraoral approach for excision of the submandibular gland is described. This procedure is anatomically safe and can be made with minimal morbidity; a transcervical incision is avoided. Both specific instruments and solid anatomical knowledge are necessary to perform a safe and efficient glandular endoscopic excision. The essential surgical steps are as follows: 1) Careful identification of the Wharton duct and lingual nerve; 2) Retraction of the mylohyoid muscle; 3) Protection of the sublingual gland and lingual nerve; 4) Extraoral manipulation of the submandibular gland obtaining intraoral protrusion; and 5) Careful dissection of the posterior third of gland, avoiding injury on the facial artery and vein. Two patients were operated on with this technique and were very pleased with their results. No complications were registered. With advanced endoscopic instruments, new surgical technique, and surgeon experience, endoscopic intraoral excision of the submandibular gland can be the method of choice in benign neoplasia, sialolith, sialoadenitis and plunging ranula.

Robotic Surgery for Salivary Gland Disease

“…Endoscopic approaches have been incorporated into the transoral, submental and transcervical approaches and have been determined to be feasible in human patients [29,30,[33][34][35]49]. The retroauricular approach has been described and conducted endoscopically and with robotic assistance in humans [36, 37 • , 38], and an endo-robotic approach has also been described in a cadaver model [1].…”

“…Advantages of this approach include decreased risk of injury to the marginal mandibular nerve, avoidance of an external scar, minimal risk of postoperative sialocele formation and inflammation of Wharton's duct. Disadvantages include scar contracture in the floor of the mouth and injury to the lingual and hypoglossal nerves [33]. The endoscopic transoral approach has an additional advantage of improved visualization, magnification and illumination of the anatomical landmarks.…”

“…Disadvantages include the cost of endoscopic equipment, the learning curve of the surgeon and the need for increased operative and setup time [29]. Recent literature has confirmed the transoral endoscopic approach as a feasible means for SMG removal in cases of benign disease [33,43,49]. Due to the preliminary success of the endoscopic transoral procedure, there is a potential application of TORS for transoral SMG removal.…”

Revisiting the relationship between the submandibular duct, lingual nerve and hypoglossal nerve

“…It lies on the deep part of the submandibular gland and passes below the SD which crosses it from medial to lateral, then curves upward, forward and medially to enter the tongue. LN is the first key for the glandular excision by the endoscopic intraoral approach [1,8,16,19].…”

Modelo experimental de sialedenectomía submandibular con técnica endoscópica

“…Se ha descrito la aplicación de la cirugía minimamente invasiva para tiroidectomías, paratiroidectomías, exploraciones de cavidad orbitaria e incluso en cirugía plástica [5][6][7][8][9][10][11][12] . Para el caso de la glándula submandibular en la literatura se han reportado dos vías de abordaje, una cervical y la otra vía piso de boca [13][14][15][16][17] . Como hipótesis nos cuestionamos si acaso era posible hacer una sialedenectomía bajo técnica endoscópica en conejos, por vía cervical.…”