How to treat submaxillary salivary gland pathologies through surgery (submaxillectomy)
Submaxillectomy (or submandibulectomy) is the ablation of the submaxillary gland (or sub-mandibular gland), which is the salivary gland located under the horizontal part of the jaw (or mandible). Such surgery is proposed in two cases:
- the presence of a tumour whose benign or malignant nature must be defined through a RIM (medical imaging radiology), a cytopuncture, then a postoperative histological study under a microscope,
- inflammation or chronic infection, often of lithiasic origin (stone).
The surgery is performed under general anaesthesia in the operating room, usually as an outpatient.
The ablation of the submaxillary gland is done by dissection, gradually releasing the gland to bind its evacuating canal, which ends in the oral cavity under the tongue.
The procedure requires a 4 to 5 cm long incision located in a fold of the neck, about two fingers width under the edge of the mandible. According to the cases concerned, it will check the presence of:
- Lithiasis: ensures the absence of stones in the evacuator canal of the gland; a small oral incision under the tongue may be necessary.
- Tumour: a highly suspected tumour may justify an extemporaneous anatomic pathology examination that is to say during the procedure, whose result will be confirmed by the postoperative check. If the tumour is malignant, it will be necessary to remove the ganglia around the gland to be analysed and make a larger incision in order to perform a ganglion curettage. In the case of a benign tumour, there is no complementary gesture.
The incision is sutured with resorbable thread, usually a suction drain is placed, to reduce the risk of postoperative cervical hematoma.
The duration of the intervention depends on the complexity of the procedure.
The pain in the operated area is relatively slight.
In the immediate postoperative recovery, haemorrhagic complications requiring a new operation are exceptional.
At the removal of the dressing, a slight depression under the edge of the jaw may remain but will gradually reduce over time.
The most common complication is an injury of a branch of the facial nerve, which leads to an impossibility of lowering the mouth, and the lingual nerve, responsible for the sensitivity of the tip of the tongue and of the floor of the mouth, and finally of the hypoglossal nerve that allows to push your tongue out of the mouth.
The lingual nerve and the hypoglossal nerve are easy to spot because they are thick. On the other hand, the mandibular branch of the facial nerve is difficult to locate because it is very thin. To increase the chances of preserving it, a rather low incision will have to be made and go deeply towards the gland. A paralysis, which fortunately is transitory most of the time, can however occur in a significant number of cases.
Coverage of submaxillectomy by social security.
This surgery is covered by social security, but your ENT head and neck surgeon may request an additional fee according to his degree of experience.
Dr. Stéphane Hervé is an ENT specialist and head and neck surgeon who graduated from some of the best universities in France. He has over 20 years pf experience and a solid training, acquired in renowned hospitals and clinics.