Submandibular gland removal
Submandibular gland removal is usually carried out for recurrent infections or stones unsuitable for minimally invasive removal, or for tumours within the gland.
This is carried out under a short general anaesthetic and patients stay overnight for observation.
A small cut is made in the neck. This is usually approximately a 5cm incision placed in a neck crease a few centimetres under the jaw.
The submandibular gland is then exposed. The marginal mandibular nerve – responsible for lower lip movement, important in smiling, is found on top of the gland and protected.
The gland is then carefully removed taking care to preserve all of its neighbouring structures, which include the lingual nerve (responsible for feeling to the side of the tongue) and the hypoglossal nerve (responsible for tongue movement).
Next, the wound is washed and then closed in several layers. A drain is placed so that any fluid that may accumulate in the space created is drained out. This reduces the chance of developing a haematology and infection. The drain is secured to the skin with a small stitch. The drain is usually taken out the next day.
The deeper part of the wound is closed with dissolving stitches. Your team will explain what the skin part was closed with and give specific advice over removal etc.
Your surgeon will come and review you the next day prior to discharge and explain follow up arrangements.
There will be a small scar in the neck. This will be placed in a neck crease where possible and over time these usually fade to be very inconspicuous and in fact hard to notice. Great care will be taken by your surgeons to ensure that the scar is the best it can be. Specific management advice will be given.
Lower lip weakness
The nerve which gives movement to the lower lip is at risk during submandibular gland removal. It is not uncommon to have some mild temporary weakness to the lower lip after surgery for a few weeks. This is because we carefully move the nerve out of the way. This reduces the risk of permanent injury but nerves tend to not like being handled and so go on strike for a short while.
Permanent weakness is very rare especially in benign tumour or stone surgery. It is more common in surgery for malignant tumours and your surgeons will offer specific advice.
Tongue numbness / altered sensation
The nerve which gives feeling to the tongue (Lingual nerve) loops down and sends some attachments to the submandibular gland which have to be divided at surgery. If injured, the side of the tongue may feel ‘tingly’ (this is called paraesthesia), or completely numb (anaesthesia). These are very rare but sometimes occur for a short period after surgery.
This can be more of an issue when patients have suffered with recurrent gland infections for a long period of time, which causes scarring or fibrosis and makes it more difficult to separate he gland from the structures around it.
The hypoglossal nerve is responsible for tongue movement and is at potential risk from submandibular gland surgery. This would present with reduced tongue movement on the injured side. This over time is compensated for by the other side and so the function usually recovers to a decent extent.
The hypoglossal nerve is actually tucked away and is very rarely injured by submandibular gland removal.
Sometimes patients can experience wound infections in keeping with all surgical procedures. The surgery is conducted in a sterile manner and all precautions are taken, specifically: sterile drapes, prophylactic antibiotics and antibacterial skin preparations.
Wound infections are rare for submandibular gland removal and usually mild.
During surgery usually long acting Local Anaesthetic is infiltrated, and strong analgesics are given. Usually patients are discharged from hospital the next day only requiring mild analgesia.
Bruising / Swelling
Patients may experience some mild bruising and swelling which usually resolves within 5-7 days of surgery.