Transoral excision of the submandibular gland: techniques and results of nine cases.

OBJECTIVES/HYPOTHESIS: We will discuss the transoral surgical approach to excising the submandibular gland, the relevant anatomy, the indications, and the risks and benefits of the procedure. We will present our case series of nine patients.

STUDY

DESIGN

A retrospective review of a series of nine patients in which transoral submandibular gland excision was attempted over the past 10 years was performed.

METHODS

The series of nine patients who underwent transoral submandibular gland excision was examined for age, indication for operation, complications, length of stay, and postoperative pathology. Relevant indications, risks, and benefits are also discussed in conjunction with relevant surgical anatomy and approach utilized.

RESULTS

Of nine patients who underwent attempted transoral submandibular gland excision, eight operations were completed transorally. Only one operation was converted to a standard external approach due to severe scarring. Six of nine patients presented with chronic sialadenitis, three of nine having obstructing sialoliths. Three patients presented with other benign cystic lesions consistent with a ranula, an infected mucocele, and a cystic teratoma. There was only one patient with a complication of incision breakdown and delayed healing in an irradiated field. There were no long-term complications involving the lingual or hypoglossal nerves, and there were no hemostatic complications.

CONCLUSIONS

Transoral excision of the submandibular gland is a viable and safe approach to be utilized. There are no external scars caused, there is minimal risk to the marginal mandibular branch of the facial nerve, and skin incisions through irradiated fields are avoided. Although the surgical anatomy is somewhat novel, the transoral approach has been used effectively and without complication in removing benign submandibular gland pathology in our series.