Introduction:
The submandibular gland (SMG) lies deep to the platysma, encapsulated by
the investing layer of the deep cervical fascia. It is lined by a
capsule of connective tissue which harbours septi , subdividing
the gland in lobes, through which the vascular and nervous components
branch (figure 1).
Several benign disorders requiring a surgical excision (sialoadenectomy)
can affect the SMG, such as chronic sialadenitis, often deriving from
sialolithiasis, and benign tumours.
Different approaches to perform a submandibular sialoadenectomy have
been described, for all of them the most frequent and feared
complications are nerve injuries with obvious relevant functional and
cosmetic sequelae. In fact, three important nerves lie in proximity to
the gland: the marginal branch of the facial nerve (marginalis
mandibulae nerve, MMN), the hypoglossal nerve, and the lingual nerve.
In the standard transcervical technique, the gland is removed with a
layer of fascia over it and MMN is usually shielded by ligating the
facial vessels lying immediately deep to it and pulling up their distal
stumps (Hayes-Martin maneuver).
We recently described and demonstrated the submandibular degloving, an
alternative transcervical submandibular sialoadenectomy technique for
benign diseases, based on a supracapsular subfascial dissection (figure
2)1. The
fascia is incised over the inferior aspect of the gland, and carefully
dissected from the capsula . In this way the fascia is fully
preserved along with facial vessels and MMN lying within it, without any
need for a traumatic dissection of the branch. At the same time the
degloving leaves a further fascial layer also on the hypoglossal nerve
(whose direct exposure is not mandatory) and on the lingual nerve which
is anyway easily visualised and preserved.
In the present work, we evaluate surgical endpoints, postoperative
complications and clinical outcomes of the technique, and compare them
with other experiences in the literature.