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

Complications of Submental Salivary Gland Neoplasm Excision Surgery

The most significant complications of submental salivary gland neoplasm excision surgery include nerve damage (particularly to the facial, hypoglossal, and lingual nerves), infection, and residual inflammation, with permanent neurological deficits occurring in up to 16% of cases. 1

Common Complications

Neurological Complications

• Facial nerve damage: Paralysis of the marginal branch occurs in approximately 6.8% of cases 2, with permanent facial nerve deficits in up to 7.7% of patients 1
• Hypoglossal nerve damage: Permanent deficits occur in approximately 2.9% of cases 1
• Lingual nerve damage: Permanent deficits occur in approximately 1.4% of cases 1
• Mylohyoid nerve damage: Can result in analgesia over the chin area while lip sensation remains normal 3

Wound-Related Complications

• Infection: One of the most common early postoperative complications, occurring more frequently in surgeries performed for inflammatory causes rather than neoplastic pathology 2, 1
• Hematoma/seroma: Can develop in the surgical bed
• Poor wound healing/scarring: Particularly relevant for cosmetic outcomes

Functional Complications

• Residual inflammation: Can persist in Wharton's duct in approximately 7.3% of cases 1
• Salivary function impairment: May occur if significant portions of functional gland tissue are removed
• Gustatory sweating (Frey's syndrome): Rare but documented complication 1

Risk Factors for Complications

1. Inflammatory vs. Neoplastic Pathology:

   • Complications are more common after gland excision due to inflammatory causes 2
   • Inflammatory conditions may create more adhesions and tissue distortion

2. Surgical Approach:

   • Complete excision of the gland (standard approach) carries higher risk of complications than gland-preserving techniques 4, 5
   • Nerves should not be conserved at the expense of tumor clearance 6

3. Tumor Characteristics:

   • Size and location of the tumor
   • Extension to vital structures
   • Histological grade and type

Prevention and Management Strategies

Surgical Technique Considerations

• Complete surgical excision is the standard treatment for salivary gland tumors 4, 6
• For low-grade, early-stage tumors, partial excision with adequate margins may be considered 6
• Gland-preserving surgery via submental approach has shown promising results with lower complication rates for certain benign tumors like pleomorphic adenoma 5

Postoperative Care

• Follow-up schedule:
  • Monthly surveillance during the first 6 months 6
  • For low-grade tumors: every 3 months initially, then 4-monthly, then 6-monthly for 3-4 years, then annually 6
  • Assessment should include chest X-ray (AP and lateral) every 6 months initially, then yearly 6

Management of Specific Complications

• Neurological deficits: Approximately 37.4% of nerve injuries resolve spontaneously within a mean period of 4 months 1
• Infection: Early identification and appropriate antibiotic therapy
• Residual inflammation: May require additional medical management

Prognostic Factors

• Hospital stay is typically short (median 2 days) 2
• Multiple nerve involvement occurs in approximately 3.4% of cases 1
• Recurrence rates depend on completeness of excision and tumor characteristics
• Gland-preserving techniques for appropriate cases have shown good functional and cosmetic outcomes with low recurrence rates (0.9% in one study) 5

In conclusion, while submental salivary gland neoplasm excision is generally considered a safe procedure, patients should be informed about the potential neurological complications, particularly facial nerve injury, which represents the most significant long-term morbidity risk. The surgical approach should be tailored based on tumor characteristics, with complete excision remaining the standard of care for most salivary gland tumors.