Transoral Submandibular Gland Excisions: Avoiding the Unsightly Neck Scar in Select Patient Populations

Introduction: There are various submandibular gland pathologies that warrant surgical intervention. The two surgical approaches to the submandibular gland include transcervical and transoral approaches, with the former being the most commonly performed. Though the transoral approach is considered more technically challenging, with proper understanding of anatomy, this approach provides improved aesthetic outcomes and avoids aberrant scar formation. Our objectives are to review surgical outcomes after transoral submandibular gland excision and describe the surgical technique.

Methods: This is a case series on transoral submandibular gland excisions and a descriptive step-wise surgical approach (background).

Results: Twenty-nine cases were performed by a single surgeon under general anesthesia and nasotracheal intubation. The ages ranged from 11-80 years old. All (100%) patients avoided a neck scar, corresponding to zero conversions to a transcervical approach. The average length of operative time was 95 minutes, with times ranging from 45 – 200 minutes. A total of 3 patients had transient tongue parathesis, 2 resolved without therapy by 3 weeks, and 1 resolved following a short course of gabapentin by 6 weeks. No patients had hypoglossal dysfunction or facial nerve dysfunction. The lack of facial nerve paralysis is significant compared to the transcervical approach, which is reported up to 7.7%, and is likely grossly underreported. No patients developed postoperative hematomas or seromas. This is attributed to the use of jaw bras placed intraoperatively and worn throughout the postoperative course. One patient with poorly controlled diabetes developed a delayed postoperative abscess at 3 weeks. The patient underwent transoral incision and drainage followed by hospitalization for intravenous antibiotics.

Conclusions: Transoral submandibular gland excision is a viable approach to the management of submandibular gland pathologies. This technique avoids an unsightly cervical neck scar and eliminates the risk of facial nerve paralysis.