What is Submandibular Gland Removal?
Submandibular gland removal is a surgical procedure to excise (take out or remove) one or both of the salivary glands located just below the jaw.
The submandibular gland is a salivary gland about the size of a plum that lies on either side of the upper neck region immediately under the lower jaw. Saliva drains from it through a tube that opens on the inside of the mouth under the tongue immediately behind the lower front teeth.
Indications for Submandibular Gland Removal
Submandibular gland removal is most commonly recommended for recurrent sialadenitis (infection/ inflammation of the salivary gland) that occurs if the tubes that drain saliva become obstructed or blocked. Obstruction typically occurs as a result of salivary stones.
The saliva produced by the submandibular gland is fairly thicker than that secreted by other salivary glands. As a result of its thickness, the saliva can at times form little stones in the salivary glands and their ducts similar to those that form in the kidneys. Other indications for surgery include managing a condition called sialorrhea (excessive salivation or drooling) and for removal of benign or malignant tumors such as pleomorphic adenoma (benign salivary gland tumors).
Preparation for Submandibular Gland Removal
Preparation for submandibular gland removal may involve the following steps:
- A review of your medical history and a physical examination is performed to check for any medical issues that need to be addressed prior to the surgery.
- You may need to undergo basic lab tests and studies such as blood tests and biochemistry evaluation, and imaging such as head and neck CT and ultrasound to help detect any abnormalities that could compromise the safety of the surgery.
- You will be asked if you have allergies to medications, anesthesia, or latex.
- You should inform your doctor of any medications or supplements that you are taking or any conditions you have such as lung or heart disease.
- You may be asked to stop taking certain medications, such as blood thinners, anti-inflammatories, aspirin, or other supplements for a week or two.
- You should not consume any solids or liquids at least 8 hours prior to the surgery.
- Arrange for a friend or family member to drive you to and from the hospital on the day of your surgery.
- A signed informed consent form will be obtained from you or your family after the pros and cons of the surgery have been explained.
Procedure for Submandibular Gland Removal
Submandibular gland removal surgery takes about an hour and a half and may involve the following steps:
- You will be asked to lie down on the procedure table in a position that is best suited for your surgeon to access the gland.
- You will be administered general or local anesthesia to ensure you remain calm and comfortable or asleep throughout the surgery.
- Your surgeon will then make an incision around 5 cm or 2 inches long in the upper portion of the neck just under the jaw line.
- Next, your surgeon and the team locate the salivary gland and meticulously free it from its surrounding tissues and structures.
- Then, the gland is excised, and the wound is closed with stitches. These stitches are typically removed after a week’s time during a follow-up visit.
- At the end of the surgery, a small drain tube is also placed through the skin into the underlying wound to drain any blood which may collect. This is normally removed on the morning following the operation.
- In addition, an incision may also be made inside the mouth to remove salivary stones if your gland is being removed because of an infection that is caused by a stone.
Postoperative Care and Recovery
In general, postoperative care instructions and recovery after submandibular gland removal will involve the following steps:
- You will be transferred to the recovery area where your nurse will closely observe you for any allergic/anesthetic reactions and monitor your vital signs as you recover from the effects of anesthesia.
- You will typically require an overnight stay in the hospital following the surgery and be discharged home the next day.
- You may experience pain and discomfort in the operated area, as well as a sore throat. Medications are provided as needed to alleviate these symptoms.
- Antibiotics may also be prescribed to address the risk of surgery-related infection.
- Refrain from smoking and alcohol for a specific period of time as it can hinder the healing process.
- Instruction on wound care will also be provided to keep the surgical wound clean and dry.
- You should avoid strenuous exercise, lifting heavy objects, or hard chewing for a defined period to facilitate recovery and provide comfort to the operated area.
- It is typically advised to take off from school/work for at least a week to recover from the surgery.
- A follow-up appointment will be scheduled a week after the surgery to remove stitches and to check your overall progress.
Risks and Complications
Submandibular gland removal is a relatively safe procedure; however, as with any surgery, the following risks and complications can occur:
- Infection
- Bleeding
- Pain
- Seroma (fluid build-up under the skin)
- Scarring
- Injury to nerve
- A pulmonary embolus or deep vein thrombosis (DVT)
- Adverse reactions to anesthesia
