Submandibular gland excision by retroauricular approach – S.B. Butsan, G.G. Chkhaidze, A.A. Danilenko

Aim of the study: to improve the effectiveness of surgical treatment of patients with benign neoplasms of the submandibular salivary glands by applying a new surgical approach using endoscopic assistance. Material and methods. From May 2021 to November 2022 in the hospital of the Central Research Institute of Dentistry and Maxillofacial Surgery, surgical treatment was performed in 15 patients with indications for removal of the submandibular salivary gland due to the following conditions: pleomorphic adenoma of the salivary gland (13 patients), Warthin’s tumor (2 patients). The age of the patients ranged from 23 to 63 years old (mean age 39). Most patients did not suffer from any comorbidities, one third of patients were diagnosed with hypertension and gastrointestinal diseases. Patient selection was based on the absence of previous surgical interventions in the submandibular region. Preoperatively, all patients underwent fine needle aspiration of the tumor to verify the diagnosis, MSCT and MRI of the head and neck to clarify the size and location of the mass, visualize the course of facial vessels and assess the area of surgical intervention. Results. Gland removal was performed via retroauricular (behind the ear) access using endoscopic assistance The mean duration of the surgical intervention was 180 minutes. In two cases, the facial vein was ligated and dissected because the course of the facial vessels did not allow full access to the tumor. In other cases, the vessels were successfully isolated from the surrounding tissues and detached from the mass. During the first three days, the wound was managed under pressure dressing with the use of active and passive drains. The mean duration of hospital stay was 8 days. The patients were followed up for 8 months. According to the survey, all patients were satisfied with the quality of treatment, functional and aesthetic aspects. Paresis of the mimic muscles innervated by the marginal and cervical branches of the facial nerve was not noted in any case. Postoperative complications consisted of earlobe paresthesia manifested as numbness and tingling during the first month after surgery. Full restoration of sensitivity was registered in all patients within 3 to 8 months. Conclusion. Retroauricular approach is a technique that allows the surgeon to successfully remove tumors of the submandibular salivary glands while preserving the integrity of the platysma muscle, avoiding paresis of facial muscles and rough raised scars on the lateral surface of the neck. The technique of submandibular salivary gland removal using retroauricular approach can be applied in maxillofacial surgery departments if endoscopic equipment is available. Keywords: submandibular salivary gland; pleomorphic adenoma; sialolithiasis; chronic sialadenitis; retroauricular approach; video-endoscopic assistance; maxillofacial surgery; submandibular gland excision, platysma Conflicts of interest. The authors have no conflicts of interest to declare. Funding. There was no funding for this study