Functional gland-preserving surgery for submandibular gland pleomorphic adenoma

Abstract

Purpose: Conventional surgery for submandibular gland tumour is total excision of the gland affected by the tumour. Gland-preserving surgery is commonly used for benign tumours arising in the parotid gland but not in the submandibular gland. This study evaluated long-term oncological and functional outcomes after gland-preserving surgery in patients with pleomorphic adenoma of the submandibular gland via the submental approach.

Methods: This longitudinal study included 105 consecutive patients with submandibular gland pleomorphic adenoma who underwent the gland-preserving surgery combined with the en-bloc resection of tumours via the submental approach. Salivary scintigraphy was performed 6 months after surgery, and ultrasonography was regularly followed. Intraoperative findings, postoperative complications, cosmetic and salivary functions, and tumour recurrence were assessed in these patients.

Results: Median tumour size and submental incision length were 2.0 and 3.3 cm, respectively. Median operation time and amount of blood loss were 25 min and 18.5 mL, respectively. None had marginal or lingual nerve paralysis and most patients were satisfied with incision scar and facial contour. The salivary function of the affected gland was equal to that of the unaffected gland. One patient (0.9%) had single nodular recurrence 54 months after surgery and others had no recurrence for follow-up of median 96 months.

Conclusions: Pleomorphic adenoma of the submandibular gland can be safely removed by the gland-preserving surgery via the submental approach which has operation time, cosmetic and functional benefits with compromising oncological outcomes.

Keywords: Pleomorphic adenoma; Preservation; Recurrence; Salivation; Submandibular gland.

Fig. 1

Flow chart of the study cohort with functional gland-preserving surgery for pleomorphic adenoma (PA) of the submandibular gland (SMG)

Fig. 2

Submandibular gland-preserving surgery via a submental approach. A Axial computed tomography showing a 2.5 cm-sized well-defined mass in the submandibular gland. B–C The gland and mass (asterisk) were accessed after a submental incision and skin lifting. D–F The mass was carefully dissected from the surrounding tissues and removed with small portions of normal gland tissues. G The patient had an invisible scar in a natural position and no sunken defect on the operated submandibular triangle