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Submandibular gland surgery

There are two submandibular glands which lie just under the jaw bone. They produce saliva which drains along a duct into the mouth under the tongue. The saliva from these glands is quite thick and small stones can develop in the gland and block the drainage. This causes a painful swelling of the gland when eating.  Sometimes the swelling settles down on its own. When the blockage is severe, it can lead to chronic inflammation of the gland.
 
Occasionally, a painless lump may develop within the submandibular gland. Although these lumps are often benign they should be investigated, as up to half of them may be or become cancerous.

What investigation are you likely to have?

An X-ray or ultrasound scan of the submandibular gland may be carried out to see if there are stones  inside the gland or the duct. An MR (magnetic resonance) sialogram may be arranged to look at the duct system. Occasionally a fine needle aspiration (needle biopsy) may be needed to find out the nature of the lump.

Operations on the submandibular gland

If the drainage duct of the gland becomes blocked by stones or narrowed, the gland may swell up when eating. These stones can be removed either  through the mouth under a local or general anaesthetic or by removing the whole gland. The gland may also be removed  if a suspicious lump has developed in it.

Removal of the submandibular gland

The operation is carried out under general anaesthetic, which means that you will be asleep throughout. The incision is made in the neck below the jaw where the submandibular gland lies. The operation will take about an hour and at the end of the operation a drain (plastic tube) is inserted through the skin to prevent blood clots collecting.
Most patients will require 24-48 hours in hospital after the operation and about 2 weeks off work.

Possible complications

Blood clot: A blood clot can collect beneath the skin in a small number of patients. This may require a return to the operating theatre.

Wound infection: This is uncommon in the neck but can happen if the submandibular gland was badly infected. Wound infection will require antibiotic treatment. Pus collecting under the skin may need to be drained.

Facial weakness: A branch of an important nerve passes under the chin close to the submandibular gland. It makes the lower lip move and if damaged or bruised during surgery it can lead to a weakness of the lower lip. In most cases this nerve works normally after the surgery but a weakness can occur which is usually temporary.

Numbness of tongue: The nerve which gives sensation and taste to one half of the tongue runs close to the duct of the gland. Rarely, this nerve gets injured leading to numbness of the tongue immediately after the operation. This will usually go, and permanent numbness of the tongue is rare.

Will my mouth be dry?

Removal of one salivary gland does not cause a dry mouth as there are many other similar glands which continue to work normally.


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