Surgical removal of the submandibular gland, known as submandibulectomy, is a surgical therapeutic procedure used mainly as a treatment measure for recurrent inflammatory processes in the presence of calculus disease. This salivary stone disease, that is also called sialolithiasis, represents an obstruction of salivary outflow, so that sialadenitis (salivary gland inflammation) is favored.
Indications (areas of application)
- Sialolithiasis – the use of submandibulectomy in the present pathologic process is indicated because inadequate treatment may result in ascending inflammation, which may be associated with sequelae – such as phlegmon (purulent, diffusely spreading infectious disease of soft tissues), necrosis (tissue death), sepsis (blood poisoning), and endocarditis (meningitis). Furthermore, the formation of fistulas (connection between the salivary gland and the body surface), which are difficult to treat, may also occur. In particular, the submaxillary salivary gland is affected by sialolithiasis in the majority of cases. Due to the occurring calcium stones in the submaxillary salivary gland area, necrosis (dying tissue) can also occur here.
- Sialadenitis – inflammation of the submaxillary parotid gland can occur not only as a result of a present stone disease. Accordingly, in the case of chronic recurrent infections of the gland, submandibulectomy is also indicated.
- Tumors of the submandibular gland – in the presence of a tumor of benign or malignant (benign or malignant) genesis, the submandibular gland should be removed.
- Neck dissection – as part of the removal of all lymph nodes in the neck area, the removal of the submaxillary parotid gland is also indicated. The use of neck dissection is necessary in the presence of a tumor with metastatic potential. In the procedure can be distinguished prophylactic and directly therapeutic variant.
Contraindications
- Severe general disease – if there is too high a risk of surgery, surgery should either be replaced by a less invasive procedure or a conservative treatment option should be considered.
- Phlegmonous sialadenitis – in the presence of a pathologic process characterized by a deep necrotizing inflammatory reaction, surgery should not be performed because the risk of spread of the inflammatory reaction should be considered too high. However, surgical intervention before submandibulectomy makes the procedure indicated.
Before surgery
- Discontinuation of anticoagulants (anticoagulants) – in consultation with the attending physician, medications such as Marcumar or acetylsalicylic acid (ASA) must usually be temporarily discontinued to minimize the risk of bleeding during surgery. The re-taking of the drugs may only take place under medical instruction.
- Anesthesia – the procedure is usually performed under general anesthesia.
The surgical procedures
Conventional submandibulectomy
- This surgical method ensures safe removal of the submandibular gland. During the procedure, the submandibular tissue is first cut and the glandular capsule is exposed. After severing the facial artery (vessel carrying oxygenated blood) and closing the other vessels leading to the gland and draining it, the gland is removed.
- After removal, sufficient hemostatic measures and the creation of a wound drainage are necessary.
- In the case of stone disease, ensure that a check of the posterior excretory duct for calcium stones is performed and, in the presence of possible calculi, complete stone removal is performed.
Endoscopic submandibulectomy
- The endoscopic surgical method currently represents the gold standard in the treatment of sialolithiasis. With the help of endoscopy, optimal localization of the submandibular gland is possible, so that endoscopic removal is also an excellent therapeutic option.
- The use of endoscopic surgery allows the removal of stones up to four millimeters in size, so that the use of the conventional method is necessary relatively rarely.Furthermore, there is the possibility to crush larger stones with the help of a laser.
- A small wire basket is used to remove the stones.
After the operation
- Antibiotics – postoperative antibiotic infusion is given to minimize the risk of infection of the wound and, if necessary, the spread of an inflammatory process.
- Sparing – after the procedure, the patient must take it easy to allow optimal wound healing.
- Follow-up examinations – to avoid complications, the patient should take the necessary follow-up examinations to have the healing process and possible complications assessed.
Possible complications
- Wound healing disorders
- Bleeding – as a result of vascular injury or inadequate hemostasis, bleeding may occur.
- Hematomas (bruises)
- Scarring – excessive scarring is a possible adverse reaction of the body, which is difficult to control therapeutically.
- Nerve lesions – due to the location of the surgical site, the risk of surgery-related nerve damage with temporary or manifest paralysis is relatively high. In particular, the laryngeal nerve is at risk. If this nerve is damaged, the ability to speak may be reduced.
- Frey syndrome (synonyms: Auriculotemporal syndrome; Gustatory sweating; Gustatory hyperhidrosis) – abnormally pronounced sweating in circumscribed skin areas of the face-neck area (here as a consequence of surgery), which is triggered during the consumption of any food or gustatory (ie, taste) stimuli such as sucking candy, biting, chewing, tasting.
