What is the submandibular gland?
The submandibular gland (also called submaxillary gland) is a salivary gland about the size of a plum that lies immediately below the lower jaw. Saliva drains from it through a duct that opens on the inside of the mouth under the tongue immediately behind the lower front teeth. Calcium deposits in the salivary glands and their ducts can form stones similar to those that form in the kidneys. The most common reason for removing a submandibular gland is chronic infection that occurs if the ducts that drain saliva become blocked with a stone. Other indications for surgery include benign tumors, such as pleomorphic adenomas. Whereas 80% of parotid gland tumors are benign, in the submandibular gland, 66% of tumors are malignant.
How is surgery done?
The submandibular gland is resected under a general anesthetia. A cut around two inches long is made in the upper part of the neck just below the lower jaw. The gland is dissected away from the surrounding muscles, vessels and nerves. Great care is taken to identify and dissect the nerve that makes the corner of the lip move (the marginal mandibular branch of the facial nerve). An electric stimulator is used to map the course of this nerve. Once the gland is removed, a small drain tube is placed through the skin into the underlying wound to drain any blood which may collect. The drain is usually removed on the morning after surgery. Sometimes, it may be necessary to cut in the floor of the mouth to remove a stone from the submandibular duct. The wound is generally closed with subcuticular sutures and sealed with a layer of Dermabond, an acrylic substance that resembles Crazy Glue.
How long will the operation take?
The operation usually takes about an hour, but may take much longer, depending on the size of the gland, the nature of the tumor and the amount of scar tissue.
Do I need to stay in the hospital?
Most patients are discharged home the same day, however, if there is excessive vomiting or pain, you may be admitted overnight for observation.
Do I need any time off work?
It is usually advisable to take a week off from work to recover from the surgery. During this time you should avoid strenuous activity.
What care do I need at home?
It is important to keep the wound dry for the first week following surgery. This obviously means you need to take care when washing or shaving. If your wound is sealed with Dermabond, you may be able to take a shower and wash with no special precautions. The Dermabond peels off slowly over a period of 2-3 weeks.
If you have a drain, kink the tube before emptying the bulb, to prevent air or fluid from getting sucked back into the wound. Write down the amount of fluid discarded and the time this was done.
You will receive prescriptions for a pain killer (Vicodin or similar product). These medications cause drowsiness and nausea. Please take them with food (a piece of toast or crackers would do if you are unable to eat much). Also, Vicodin and codeine products cause constipation. You will also receive a prescription for antibiotics. Please take them as directed. Finally, you will receive a prescription for Phenergan suppositories to control nausea and vomiting.
Will I have a scar?
Yes. All cuts made through the skin leave a scar but the majority of these fade with time and are difficult to see when they are fully healed. We will do our best to hide the scar in a natural crease of the neck and to close the wound with fine sutures that do not leave cross tracks. It may take several months for your scar to fade but eventually it should blend into the natural folds and contours of your face.
What are the possible problems?
•Bleeding from the wound is unlikely to be a problem. If it occurs it usually does so within the first 12 hours of surgery which is why you need to stay in hospital overnight. •Infection is uncommon but if your surgeon thinks it may happen to you a short course of antibiotics will be prescribed. •Very rarely, a salivary fistula may occur in instances where the gland was partially removed. •Weakness of the corner of the mouth and lower lip may occur. •Bruising of the neck around and below the wound, especially, in the elderly.
What does nerve damage mean?
There are three nerves that lie close to the submandibular gland that can be damaged during its removal. Most nerve damage occurs as a result of bruising of the nerves since they are held out of the way and protected during surgery. If nerve damage occurs it is usually temporary. The following three nerves can be damaged all with varying results: •Weakness of the lower lip - a lower branch of the facial nerve (the marginal mandibular branch) is the nerve most likely to be bruised in the removal of a submandibular gland. If bruising occurs it affects the movement of your lower lip, leading to a slightly crooked smile. •Numbness of the tongue - the lingual nerve is rarely bruised. Since it is the nerve that supplies feeling to the side of the tongue bruising results in a tingly or numb feeling in the tongue, similar to the sensation after having an injection at the dentist. Loss of taste could also result from this injury. •Restricted tongue movement - the hypoglossal nerve is only very rarely bruised. It is a nerve that makes the tongue move and damage can therefore result in decrease of tongue movement.
Is permanent nerve damage possible?
In general, nerve damage is temporary, although it can take several months for them to recover. Permanent damage is possible and usually occurs in only the most difficult cases.
If a salivary gland is removed will I be left with a dry mouth?
The removal of one submandibular gland will not have an impact on the amount of saliva that you produce. There are many other salivary glands left in and around the mouth that will still keep it moist.