Surgeons in the Institute of Medical Sciences and SUM Hospital, faculty of the SOA Deemed to be University here, have successfully removed the submandibular gland (SMG) in two persons using a new technique which spared the patients from living with big scars on the face for the rest of their lives.
“The recent advent of endoscopic procedures has prompted both ENT and head and neck surgeons to reconsider the conventional methods by which the removal of the submandibular gland is classically achieved,” Dr. Radhamadhab Sahu, an expert in ENT and Skull Base Surgery, said.
Dr. Sahu, who conducted the surgery for the first time in Odisha, said humans have one pair of submandibular gland in their body which lay just below and in front of the lower jaw. The main function of this particular gland is to secrete saliva which helps to moisten and digest food.
If the saliva flow is obstructed due to formation of stone in duct, it leads to enlargement of the gland and infection. Conventionally, the submandibular gland is removed by transcervical approach which leaves a big scar on face and sometime leads to lower lip weakness.
“This latest technique is anatomically safe and can be done with minimal morbidity while a transcervical incision is avoided,” he said adding specific instruments and anatomical knowledge with skills are needed to perform such a tricky endoscopic excision.
The surgical steps essential for the procedure included careful identification of the Wharton duct and lingual nerve, retraction of the mylohyoid muscle, protection of the sublingual gland and lingual nerve, extraoral manipulation of the submandibular gland obtaining intraoral protrusion and careful dissection of the posterior third of the gland while avoiding injury to the facial artery and vein. The patients, who underwent the new surgery, were very pleased with the results while no complications had surfaced, Dr. Sahu said adding with availability of advanced endoscopic instruments, and new surgical technique and experience of the surgeon, endoscopic intraoral excision of the submandibular gland could be the method of choice in a variety of ailments.