Comparison of the intraoral and transcervical approach in submandibular gland excision

The purpose of this study is to evaluate the benefits of the intraoral approach for removal of the submandibular gland (SMG) by comparing it with the usual method of the transcervical approach. Sixteen patients who required SMG resection for benign disorders were divided into two surgical groups who underwent surgery via the intraoral (n = 8) or transcervical (n = 8) approach. The intraoral approach (IOA) consisted of an incision on the floor of mouth from the caruncle of Wharton's duct to the retromolar trigone while the transcervical approach (TCA) consisted of an incision along the natural skin crease overlying the gland. The operation time, hospital stay, complications, and cosmetic appearance were compared between groups. The mean operation time of the IOA group was significantly longer than that of the TCA group, but decreased gradually with surgical experience. The mean hospital stay of the IOA group was significantly shorter than that of the TCA group. Most patients (88 %) of the IOA group experienced sensory defects of the lingual nerve, but these symptoms were temporary. No lasting complications were noted in the IOA group; however, one patient of the TCA group had permanent paralysis of the marginal mandibular branch of the facial nerve. The incision scars were invisible owing to the location on the mouth floor in the IOA group, whereas they were apparent even on the natural skin crease of the neck in the TCA group. In conclusion, the SMG can be removed safely and effectively by IOA with the avoidance of an external scar and of injury to the marginal mandibular nerve. We suggest that the IOA be substituted for the TCA as the primary procedure for removal of the SMG in suitably selected patients.