Endoscopic-assisted Transoral Removal of the Submandibular Gland
Kyonori Uehara DDS, Oral and Maxillofacial Surgery, Kobe City Medical Center General Hospital, Kobe, Japan
Toshihiko Takenobu DDS, Ph.D, Oral and Maxillofacial Surgery, Kobe City Medical Center General Hospital, Kobe, Japan
Masanobu Ohnishi DDS, PhD, Oral and Maxillofacial Surgery, Kobe City Medical Center General Hospital, Kobe, Japan
Naoki Taniike DDS, Ph.D, Oral and Maxillofacial Surgery, Kobe City Medical Center General Hospital, Kobe, Japan
Yuzo Hirai DDS, Oral and Maxillofacial Surgery, Kobe City Medical Center General Hospital, Kobe, Japan
Saori Ohtani DDS, Oral and Maxillofacial Surgery, Kobe City Medical Center General Hospital, Kobe, Japan
Background: Removal of the submandibular gland is traditionally performed via a transcervical incision. However, the transcervical approach has several complications, such as pathologic external scarring and the risk of injury to the marginal mandibular branch of the facial nerve. The transoral approach to the submandibular gland has been reported in some scientific literatures as a way to avoid or reduce visible scarring and nerve injury. However, the transoral approach has a restricted surgical field, so it requires a high degree of advanced technical skill. On the other hand, the recent advent of endoscopic procedures has provided head and neck surgeons with the option of minimally-invasive surgery. Endoscopic surgery provides a good view and a wider surgical field. Here we report the case of a patient who underwent endoscopic-assisted removal of the submandibular gland via a transoral incision.
Methods and Results: A 35-year-old female was referred to our department because of left submandibular swelling and pain. Radiographic examinations revealed a sialolithiasis of the left submandibular gland. Endoscopic-assisted transoral removal of the submandibular gland was planned. A linear incision was made in the floor of the mouth from the canine to the retromolar trigone, and then, the lingual nerve and Wharton’s duct were identified. The lingual nerve was retracted medially so as to be preserved during the surgery. The submandibular gland was exposed by anterior retraction of the mylohyoid muscle and by applying firm digital pressure on the exterior of the neck. The submandibular gland was bluntly dissected with a harmonic scalpel. The branches of the facial artery and vein were identified with endoscopic guidance and ligated with vessel clips. Finally, the submandibular gland was removed together with the divided Wharton’s duct. The hypoglossal nerve was confirmed in the wound. The wound was then loosely closed with interrupted sutures without drains. The postoperative course was good and uneventful.
Conclusion : We successfully performed endoscopic-assisted transoral removal of the submandibular gland by a minimally invasive procedure. The endoscopic technique permits magnification of anatomical landmarks on the monitor, which allows a wider surgical field.
