What are the potential complications of submental salivary gland excision surgery?

Complications of Submental Salivary Gland Excision Surgery

The most common complications of submental salivary gland excision surgery include temporary facial nerve paresis (particularly the marginal mandibular branch), lingual nerve damage, and wound healing issues, with permanent nerve damage occurring in approximately 2.5% of cases with normal preoperative function.

Nerve-Related Complications

Facial Nerve Complications

• Marginal mandibular branch injury: Most frequent nerve complication, typically presenting as temporary paresis 1
• Risk factors include:
  • Extensive inflammation or scarring from previous infections
  • Tumor proximity to nerve
  • Surgeon inexperience with minimal-access techniques 2
• Temporary facial weakness occurs in approximately 27% of cases, while permanent facial weakness occurs in about 2.5% of patients with normal preoperative function 3

Other Nerve Injuries

• Mylohyoid nerve damage: Can result in sensory deficit over the chin area with normal sensation to the lip 4
• Lingual nerve paresthesia: Particularly common with intraoral approaches (74% temporary sensory paresis) 5
• Greater auricular nerve numbness: Results in sensory deficit in the earlobe and adjacent skin 6

Wound Complications

• Hematoma formation: Can occur due to inadequate hemostasis during surgery 3
• Salivary fistula: Abnormal connection between salivary tissue and skin surface 6
• Sialocoele: Collection of saliva in the surgical site 6
• Infection/abscess formation: Reported in approximately 1.3% of cases 5
• Wound dehiscence: Particularly in cases with poor tissue handling or infection

Functional Complications

• Temporary limitation of tongue movement: Reported in 70.1% of cases with intraoral approach, typically resolves spontaneously 5
• Residual salivary tissue: Can occur if excision is incomplete, reported in approximately 5% of cases 5
• Frey's syndrome (gustatory sweating): Rare in submandibular gland surgery compared to parotidectomy, but has been reported 5
• Abnormal sensation of mouth floor: Can persist after surgery 5

Risk Reduction Strategies

1. Proper surgical technique:

   • Meticulous hemostasis and layered wound closure 3
   • Careful identification and preservation of vital structures
   • Appropriate drain placement to minimize fluid collection 3

2. Surgeon experience:

   • Completion of at least 10 supervised procedures before performing independently 2
   • Understanding of regional anatomy and theoretical aspects of the procedure

3. Surgical approach selection:

   • Transcervical approach is standard for most cases
   • Intraoral approach may avoid external scarring and marginal mandibular nerve injury but has higher rates of temporary lingual nerve issues 5

4. Intraoperative considerations:

   • Avoid decisions resulting in major harm (such as nerve sacrifice) based on indeterminate intraoperative findings 2
   • Use of careful tissue handling techniques

Special Considerations

• In cases of malignancy, more extensive surgery may be required, potentially increasing complication risks 2
• For high-grade or advanced tumors, consideration should be given to neck dissection which carries additional risks 2
• Recurrent disease requiring revision surgery carries higher complication rates due to scarring and altered anatomy 2

The overall complication rate can be significantly reduced with appropriate surgical technique, careful patient selection, and surgeon experience. Most complications are temporary and resolve spontaneously with proper postoperative care.