Excision of the submandibular gland: minimizing the risk of nerve damage

Surgical texts do not clearly advise whether the ramus mandibularis should be identified in excision of the submandibular salivary gland for benign disease. An analysis of 74 patients was undertaken to assess the subsequent nerve function after submandibular salivary gland excision. Both glands were removed in two patients, making the total number of glands excised 76. In five cases the nerve was identified, in five patients the operative record did not clearly state whether the nerve was identified, and in the remaining 66 a non-identification technique was used. The subsequent analysis was unable to follow-up six patients fully. Seven patients had mild to moderate weakness in the early postoperative period, but all recovered, some taking up to 3 months to do so. Other complications were minor, except for two patients who had postoperative haemorrhage, one requiring a tracheostomy. As the majority of these patients had a non-identification technique, and because searching for the nerve is tedious and time-consuming, the former approach is recommended when operating for benign disease of the submandibular salivary gland.