Blog

October 1, 2020

SUBMANDIBULAR GLAND

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 submandibular
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.  Skin is closed with absorbable stiches for a finer scar and patient can travel back to their home town in two days ,post op.  At the end of theoperation a small tube is also placed through the skin intothe 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?

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.