LESSON 1: Eye, Ear, Nose, and Throat (EENT) Surgery

Section IV: THROAT, TONGUE, AND NECK SURGERY

1-39

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1-39. EXCISION OF THE SUBMAXILLARY GLAND

a. General. This operation involves the removal of the gland and tumor through an incision made in the neck, just beneath the chin. It is performed to remove mixed tumors and multiple calculi associated with extensive chronic inflammation.

b. Preparation of the Patient. The patient is placed on the table in a dorsal recumbent position, with the affected side uppermost, and prepared as for neck surgery.

c. Operative Procedure.

(1) A small skin incision is made below and parallel to the mandible, extending forward to beneath the chin. The platysma is incised with scissors; the skin flaps and undersurface of the platysma and cervical fascia covering the gland are undermined, using fine hooks, tissue forceps, and Metzenbaum scissors.

 

(2) The mandibular branch of the facial nerve is retracted away with a small loop retractor.

 

(3) The submaxillary gland is elevated from the mylohyoid muscle. The edge of the muscle is retracted to expose the lingual veins and nerve and the hypoglossal nerve.

 

(4) The gland is freed by blunt dissection, and the submaxillary (Wharton's) duct is clamped, ligated, and divided.

 

(5) The external maxillary artery is clamped, ligated, and divided. The submaxillary gland is removed.

 

(6) The wound is closed with interrupted fine silk or chromic gut sutures. The skin edges are approximated with nylon sutures. A Penrose drain is inserted in the submaxillary bed and secured to the skin. Dressings are applied.

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