Exodontia.Info
Submandibular Gland Removal
This leaflet has been designed to improve your
understanding of your forthcoming treatment and contains
answers to many of the common questions.  If you have
any other questions that the leaflet does not answer or
would like further explanation please ask a member of the
medical or nursing staff.
What is the Submandibular Gland?

The submandibular gland is a salivary gland about the size of a plum that lies
immediately below the lower jaw.  Saliva drains from it through a tube that opens on
the inside of the mouth under the tongue immediately behind the lower front teeth.

The most common reason for removing a s
ubmandibular gland is as a result of
infection that occurs if the tubes that drain saliva become blocked.  Blockages
usually arise as a result of stones.  The saliva secreted by the
submandibular
gland
is a bit thicker than that produced by other salivary glands.  Due to its
thickness, this saliva can sometimes form little
stones in the salivary glands and
their ducts similar to those that form in the kidneys.  Other indications for surgery
include benign “lumps”, such as
pleomorphic adenomas.

What does the operation involve?

The submandibular gland is removed under a general anæsthesia.  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.  Once
the gland has been removed the incision is held together again with stitches.  These
usually need to be removed around a week after surgery.  At the end of the
operation a small tube is also placed through the skin into the underlying wound to
drain any blood which may collect.  This is usually removed on the morning following
surgery.

If your gland is being removed because of infection that is caused by a stone it may
also be necessary to make a cut inside the mouth to remove that stone.

How long will the operation take?

The length of time partly depends upon the degree of difficulty, the size of the
gland, (the nature of the “lump”) and how scarred down to surrounding tissues the
gland is.  In an uncomplicated procedure, it can take approximately 45 minutes to
remove the
submandibular gland.

What can I expect after the operation?

You usually need a night in hospital following the surgery.  It is unlikely to be very
sore but regular painkillers will be arranged for you.  There is relatively little swelling
following
submandibular gland removal.

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.

Do I need any time off work?

It is usually advisable to take 1 week off from work to recover from the surgery.  
During this time you should avoid strenuous activity.

Is there anything that I need to do when I get 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.

Will I have a scar?

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.  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?

This list of warnings might seem excessive to some however the legal ruling in the
case of
Chester vs Afshar (2004) would suggest that it is quite prudent / necessary
to list them.  Others might say that there isn't enough information but where do you
stop?

The following list of warnings regarding
submandibular gland excision is neither
exhaustive nor is it predictive.  The most pertinent warnings have been included
here.

Infections.  Infection is uncommon but can happen if the submandibular gland was
badly infected.  Wound infection will require antibiotic treatment.  Pus collected
under the skin may need to be drained.

Bleeding.  Bleeding 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.

Hæmatoma.  A blood clot can collect beneath the skin (hæmatoma).  This occurs in
about 5% of patients and it is sometimes necessary to return to the operating
theatre and remove the clot and replace the drain.

Lower Lip Weakness.  The Facial Nerve passes under the chin close to the
submandibular gland.  It makes the lower lip move.  If it is damaged during the
surgery, it can lead to a weakness of the lower lip, resulting in a slightly crooked
smile.  In most cases, the
Facial Nerve works normally after the surgery however
in some cases, weakness of the lower lip can occur, particularly when the gland is
badly inflamed or if the
Facial Nerve is stuck to a lump.  This weakness is usually
temporary and can last for 6 - 12 weeks.

Occasionally, there is a permanent weakness of the lower lip following this surgery.

Numbness around the Operation Scar.  The skin around the wound may be numb
after the operation.  If that happens, the numbness will usually improve over the
next three months.

Numbness of Tongue.  The Lingual Nerve, which gives sensation and taste to one
half of the tongue, runs close to the duct of the gland.  It very rarely gets injured.  
However, if the
Lingual Nerve is damaged, your tongue may feel numb immediately
after the operation.  This will usually go and permanent numbness of the tongue is
rare.

Restricted Tongue Movement.  The Hypoglossal Nerve is only very rarely bruised.  
It is a nerve that makes the tongue move.  If it were to occur, it is unlikely to
produce any noticeable disability.

Frey’s Syndrome / Gustatory Sweating.  This is very rare.  Some patients find that
after this surgery the skin overlying where the gland was becomes flushed and
sweaty whilst eating.  This is because the nerve supply to the gland can re-grow to
supply the sweat glands of the overlying skin, instead of the
submandibular gland.  
This can usually be treated easily by the application of a roll-on antiperspirant or
other simple non-surgical treatments.

Scar / Keloid.  Although rare in submandibular surgery, some patients (those with
darker skin) may develop a thick scar (
hypertrophic scar) or keloid.

Recurrence.  Dependent on what was removed, there is always a small chance of
recurrence.  Hence, the need for regular reviews over several years.

Amputation / Traumatic Neuroma.  After healing, there is a chance that one of the
nerves in the area may have been cut and on healing, be scarred.  They are often
sensitive or painful on pressure.  If particularly painful, these have to be surgically
removed.

Will I need further appointments?

A review appointment will be arranged before you leave hospital.  We will keep a
close eye on you for several months following treatment to make sure that nothing
recurs and your symptoms settle.


Websites:

Ear, Nose & Throat UK

British Association of Oral & Maxillofacial Surgeons
Last Updated 13th July 2011