Introduction: Submandibular salivary glands are a pair of major mucoid salivary gland. They lie just below the angle of the mandible. These glands are responsible for about 70% of basal salivary secretion.
Indications of submandibular salivary gland excision:
1. Chronic salivary gland infections
2. Salivary gland calculi
3. Suspected submandibular neoplasm
4. As an adjunct of surgical treatment for drooling
1. The surgery is performed under general anesthesia.
2. The patient is positioned on a shoulder roll with the head hyperextended and turned to the opposite side. This manuver brings the gland more supeficial.
3. After painting the field of surgery with betadine lotion, 1% xylocaine with 1 in 100,000 adrenaline is used to infiltrate the surgical field. This infiltration helps to reduce bleeding from small blood vessels. The infiltration should be made about 3 cm below the ramus of the mandible inorder to avoid the marginal mandibular nerve.
4. Incision : is made in the skin crease 5 cm below the ramus of the mandible starting from the angle of the mandible. The incision is deepened through the platysma muscle and the flap is elevated immediatly beneath it. This procedure helps to avoid injury to the mandibular nerve.
The lower border of the submandibular gland is identified. The gland can be identified by its characteristic lobulations and yellow color. Lateral surface of the gland is freed by dissecting it free of its attachments by cutting close to the gland. Facial artery branches need to be ligated here. Branches of the facial vein will have to be ligated. The facial artery may be seen running close to the posterior border of the gland.
The dissection is now extended superiorly keeping close to the gland. The hypoglossal nerve will be retracted by this maneuver and the lingual nerve which lie deeper is not at risk. The superficial portion of the gland is freed and traced up to the mylohyoid groove where it comes into contact with the deep lobe of submandibular gland. The deep lobe of the gland can be freed by retracting the mylohyoid muscle. The gland is thus resected in toto.
After securing complete hemostasis, the cervical fascia and skin flaps are sutured back in position.