Establishing a standardized endoscopic-assisted transoral approach for submandibular gland pleomorphic adenomas

Transcervical excision is the conventional treatment for submandibular gland pleomorphic adenomas (SMG PA), but it may result in visible cervical scarring and marginal mandibular nerve injury. This study aimed to establish a standardized endoscopic-assisted transoral surgical protocol and evaluate its feasibility and early outcomes.

This study included 120 consecutive patients with cytologically diagnosed SMG PA who underwent standardized endoscopic-assisted transoral resection between February 2023 and May 2025. The primary outcome was procedural feasibility, defined as successful completion of gland and tumor resection through the transoral route without conversion to a transcervical approach. Secondary outcomes included operative time, length of hospital stay, postoperative complications, recurrence, cosmetic satisfaction, and the learning curve. Operative time was analyzed using cumulative sum analysis to evaluate procedural proficiency.

All procedures were completed transorally without conversion to a transcervical approach. The mean operative time was 57.6 ± 28.1 min, and cumulative sum analysis showed a learning-curve inflection point at case 34. The mean hospital stay was 4.5 ± 1.2 days, ranging from 2 to 7 days.During a mean follow-up of 17.9 ± 7.9 months, no recurrence was observed. Complications were transient and included lingual numbness in 112 patients(93.3%), temporary tongue movement limitation in 5 patients(4.2%), abscess in 9 patients(7.5%), and hematoma in 1 patient(0.8%).Cosmetic satisfaction was high.

The standardized endoscopic-assisted transoral approach appears feasible and potentially safe in selected patients with SMG PA. Longer follow-up and comparative studies are required to confirm its long-term surgical reliability and relative clinical benefits.

Chinese Clinical Trial Registry ChiCTR2500096609; Registration date: January 26, 2025; Retrospectively registered.