[New knowledge on endo-oral submandibular sialoadenectomy].

The present work reports personal modifications to the classical endo-oral surgical technique used to remove the submaxillary gland (Bourguet and Branchu surgery). The top of the tongue is transfixed with a silk thread and drawn out of the mouth laterally. An incision from the outlet of the Wharton duct to the base of the anterior palatine arch makes possible a full view of the sublingual extension of the submaxillary gland and the point where the lingual nerve crosses the Wharton duct. The sublingual gland may be removed to broaden access to the muscular hiatus of the mylohyoideus and hyoglossus muscles. The edges of the submaxillary gland are then identified and dissected from the muscle plane. At this point the sublingual extension of the submaxillary gland is detached from the lingual nerve which is medialized and shifted backward. The branches of the submental artery feeding the gland are isolated and pinched off so that the submaxillary gland can be removed from behind its anterior pole. Draining forward the gland can now be seen. At this point, if there is any adherence with the gland, a silk-catgut thread can be pulled back and forth as a saw in order separate the two. Once the glandular branch of the facial artery has been separated and detached from the gland, the submaxillary gland is fully removed. A small drainage is positioned in the surgical cavity sutured with Dexon thread and medicated with an external "Tensoplast" compress stretched from the jaw bone to the mastoid on the opposite side. The authors feel that the above surgical technique may prove advantageous and effective when a satisfactory esthetic result is required in benign submaxillary gland pathology.