REMOVAL OF SUB MANDIBULAR SALIVARY GLAND

The submandibular gland is a salivary gland found under the lower jaw. There are two sub mandibular glands, one under the lower jaw on each side. Saliva drains from the gland through a tube, called the submandibular or Wharton’s duct, into the mouth. The duct opens the in the mouth under the tongue just behind the lower front teeth. The most common reason for removing a submandibular gland is as a result of repeated infection. This occurs if the duct becomes blocked, preventing drainage of the saliva. The blockage is usually caused by a stone.

The submandibular gland is removed under a general anaesthesia. The operation usually takes about 1 hour to perform, and the recovery is usually rapid. An incision around two inches long is made in the upper part of the neck just below the jaw line. Once the gland has been removed the incision is held together again with stitches. These stitches are removed at seven days. The scar will be noticeable immediately after the surgery; however it will usually fade and eventually it should blend into the natural folds of the skin. At the end of the operation a small tube (referred to as a drain) is also placed through the skin into the underlying wound to drain any blood which may collect. This is usually removed the following morning. Most patients are ambulatory the day of surgery, and most are discharged from hospital the following morning. Most are able to return to work without restriction within a week. The scar will be noticeable immediately after the surgery; however it will usually fade and eventually it should blend into the natural folds of the skin.

Bleeding from beneath the skin can collect and form a haematoma. This occurs in about 5% of patients. This is why a drain is left in for a number of hours after the operation. Infection is uncommon but if you are at an increased risk you may be prescribed a short course of antibiotics.

The removal of the submandibular gland will no effect on the amount of saliva that you produce as there are many other salivary glands left to keep the mouth moist.

There are three important nerves that lie very close to the submandibular gland that may be damaged during its removal. Most nerve damage occurs as a result of nerve bruising as the nerves are held out of the way and protected during the surgery. If nerve damage occurs it is usually temporary.

The marginal mandibular branch of the facial nerve is the nerve most likely to be bruised in the removal of a submandibular gland. If bruising of the nerve occurs there will be a slight weakness of your lower lip. There is a 1 in ten chance of having a temporary problem and less than 1 in a hundred of having a permanent problem.

The lingual nerve supplies sensation to the front 2/3rd of the side of the tongue. If bruised it causes numbness or tingly sensation on side of your tongue. There is a 1 in fifty chance of chance of having a temporary problem and less than 1 in a hundred of having a permanent problem.

The hypoglossal nerve makes the tongue move. If bruised during surgery may result in decrease of tongue movement. There is a 1 in fifty chance of chance of having a temporary problem and less than 1 in a hundred of having a permanent problem.

As in all surgery it is essential to see a surgeon who will be able to tell you whether your problem can be remedied by surgery, and what the risks are. Thereafter you will be in a position to decide whether you should go ahead or not.