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Submandibular Gland Surgery; Transoral Versus Conventional Transcervical Approach
Secaattin Gülşen1, Saffet Ulutaş2
1Department of Otorhinolaryngology, Dr Ersin Arslan Training and Research Hospital.
Introduction:
Transcervical approach (TCA) is a widely accepted method of surgery in submandibular gland (SMG) excision. The main purpose of the present study is to compare the surgical and functional outcomes of TCA and transoral approach (TOA) in SMG excision.
Methods:
The participants of this prospective study are 31 consecutive patients in whom SMG excision was performed via TOA (n = 14) and TCA (n = 17). Operative time, complications, hospitalization time, postoperative morbidities, and histopathological results were noted and compared between the groups. The numerical rating scale was used to grade the postoperative morbidities including, pain, eating and swallowing difficulty, and abnormal sense of tongue.
Results:
The number of females (n = 10) was higher than males (n = 4) in the TOA group due to aesthetic concerns. The average operative time of TOA group (85.3 ± 17.8 minutes) was significantly longer than the TCA group (40.8 ± 7.3 minutes), whereas the mean hospitalization time in TOA group (28.5 ± 4.6 hours) was remarkably shorter than TCA group (49.4 ± 6.9 hours). The mean pain scores were significantly less in the TOA group than the TCA group during the first 3 days postoperatively (P < 0.001). The mean numerical rating scale scores of eating and swallowing difficulty and abnormal sense of tongue were significantly higher in the TOA group compared to the TCA group postoperatively. There was no postoperative marginal mandibular nerve (MMN) dysfunction seen in the TAO group, whereas temporary dysfunction of MMN was observed in 3 (17.6%) patients in the TCA group.
Conclusion:
In selected patients, transoral SMG excision is an indisputable superior method in terms of MMN inadvertent injury risk, cosmetic results and postoperative pain compared to the conventional method of TCA in selected cases. Especially in young female patients with serious aesthetic concerns, excision of SMG via a TOA without any visible incision provides cosmetically excellent satisfactory results.
