The submandibular glands are the second largest of the major salivary glands and are located deep to the skin under the jaw. There is one on each side. They divided into a superficial and deep lobe by the mylohyoid muscle which bridges the gap between the jaw and the hyoid bone in front of the trachea (windpipe) in the neck. Each submandibular gland produces saliva that enters the mouth via a duct whose opening can be located beneath the tongue. The submandibular gland is intimately related to the hypoglossal nerve that gives supply to the muscles of the tongue and the lingual nerve that supply sensation and taste to the tongue.
The most common reason for submandibular gland surgery is a stone in the submandibular gland duct. This causes obstruction of the gland leading to acute and then chronic inflammation. This condition causes pain, particularly during salivation. The next most common reason for surgery are tumours which can be benign or malignant. These usually present as painless submandibular masses. Occasionally they affect the nerves to the tongue causing numbness and/or paralysis, or as a lump in the lymph nodes of the neck.
Submandibular gland excision is removal of the submandibular gland. The gland is removed via a skin incision under the jaw. The gland is usually removed whole taking care not to disturb the nerve to the corner of the mouth or the nerve that supply movement and sensation to the tongue.
Prior to your operation you may need to attend a Preadmissions Clinic. Your fitness for surgery will be assessed, tests may be ordered and referrals to other specialists arranged if required.
You cannot eat for 6 hours prior to your operation. You may sip water for up to 2 hours prior to your operation. Fasting decreases the risk of vomiting and aspiration during induction of anaesthesia. Aspiration can cause pneumonia and a prolonged stay in hospital.
Parotidectomy is done under general anaesthesia. You will be asleep during the whole procedure. The anaesthetist will discuss the anaesthetic with you prior to your operation. They will see you in the pre-operative area and accompany you to the operating theatre.
Following general anaesthesia, you are positioned on the operating table, your neck is marked, and local anaesthetic is injected to decrease post-operative discomfort. An incision is made beneath the jaw. To get access to the gland, the facial vein is usually divided and retracted which acts to protect the nerve supplying the muscles to the corner of your mouth. The superficial lobe of the gland is dissected out, followed by the deep lobe and the gland is removed in continuity.
If the operation is for a submandibular gland duct stone or a benign tumour, usually only the gland is removed. If the operation is for a malignant tumour, a variable amount of tissue around the gland may also need removal.
At the end of the operation, the skin is closed with absorbable stitches and dressed with a waterproof dressing.
Following the operation, you will wake up in the recovery area. You will feel a little disoriented and may feel a little nauseous. The staff in recovery are equipped to help you. Immediate post-operative pain is usually minimal. Once you are awake and oriented, you will be taken to a ward bed. After a few hours, and once the nurses are satisfied that it is safe, you can get out of bed.
There are no dietary restrictions or special dietary supplements that are required after submandibular gland surgery. You may eat whatever you choose. Oral analgesia including paracetamol is usually all that is required for pain relief. You may bathe and shower. The wound is waterproof and can get wet.
You should avoid strenuous physical activity for two weeks after your operation. It increases the risk of post-operative bleeding which could result in a trip back to the operating theatre. Once this period has passed and you feel that you have recovered, you may return to your normal physical activities.
There is no specific law covering surgery and driving. It is not advisable to drive immediately after surgery. In general, in order to return to driving, you must:
Post-operative swelling around the wound is normal and usually resolves within a month or so. No specific wound management is needed in the first two weeks while the dressings are on. After this, gentle scar massage is advisable for 10 minutes two or three time a day for 6 months. You may use whatever moisturising lotion you like (e.g. sorbolene, bio-oil etc.) but creams with Vitamin E should be avoided for the first post-operative month. Alternatively, you can keep the scar covered with a silicon strip for 12 hours a day for 6 months. These strips are available from the chemist but are quite costly.
Initially the scar will be pink. Over 6-12 months, the scar will fade until it becomes pale.
This occurs in <5% patients and is usually self-limiting. Occasionally a return to theatre is required for evacuation of blood clot from the wound.
These can complicate any type of surgery and can usually be treated with a short course of oral antibiotics. Uncommonly, IV antibiotics or further surgery is required.
These are uncommon, except if your surgery is for a malignant tumour.
A follow-up appointment should be arranged in rooms 2 weeks after your operation for a discussion regarding pathology. Another appointment will be required 4-6 weeks after surgery for a post-operative check-up. At this appointment, your wounds will be assessed, and any further investigations and management arranged. Please call to arrange a convenient time.
This pamphlet is intended to provide you with information and does not contain all known facts about submandibular gland surgery. Treatment may have uncommon risks not discussed in this pamphlet. Please do not hesitate to ask any questions you may have.