Part 2 book “Operative oral and maxillofacial surgery” has contents: Submandibular, sublingual and minor salivary gland surgery, management of stones and strictures and interventional sialography, facial nerve dissection and formal parotid surgery, extracapsular dissection, mandibular fractures, orbital trauma, and other contents. | Section V SALIVARY GLAND AND THYROID SURGERY 44 Submandibular, sublingual and minor salivary gland surgery JOHN D LANGDON CONTENTS Principles and justification Surgical removal of stones in the distal submandibular duct Surgical removal of stones in the proximal submandibular duct Submandibular gland excision Sublingual gland excision for ranula or excision biopsy Sublingual gland excision for malignant tumour Surgery of the minor salivary glands Operation for excision of benign tumours Operation for low-grade malignant tumours Surgery for high-grade malignant tumours Suggested readings PRINCIPLES AND JUSTIFICATION The most frequent indications for excision of the submandibular gland are when a calculus is present within the gland hilum and cannot be retrieved endoscopically or when the gland is the site of chronic infection or when a benign or malignant tumour is present. Only 10% of salivary tumours arise in the submandibular gland and 60% of these will be pleomorphic adenomas. The remaining 40% will be malignant. Except in advanced malignancy, the tumours rarely extend beyond the capsule of the gland and so excision of the submandibular gland is the definitive surgical treatment. For advanced malignant tumours with spread beyond the capsule, more radical clearance of the submandibular triangle is required, often in continuity with a neck dissection. When a pre-operative diagnosis of a benign tumour can be reasonably and confidently established by computed tomography (CT) and ultrasound-guided fine needle aspiration cytology or preferably fine needle core biopsy and the tumour is in the superficial part of the submandibular gland partial excision of the gland is possible. This has the merit of preserving gland function and reduces the risk of damage to the lingual and hypoglossal nerves. 441 442 443 445 447 448 449 450 451 452 453 There are only two indications for the removal of the sublingual gland. The first is in the management of a .
