Minimally invasive video-assisted submandibular sialoadenectomy: a preliminary report

Full endoscopic submandibular gland excision through the retroauricular hairline approach: A cohort study

INTRODUCTION

Submandibular gland (SMG) excision can be achieved by conventional approach (Conv) through a cervical incision or endoscopic surgery (Endo). The aim of this study was to propose a new concept and technique of full endoscopic SMG excision through the retroauricular hairline incision and investigate its safety and feasibility.

MATERIALS AND METHODS

A total of 141 patients with SMG diseases treated at our department from 2021 to 2024 were retrospectively enrolled in the Endo group (n = 74) and the Conv group (n = 67). Interested variables included age, sex, pathological diagnosis, incision length, intraoperative bleeding, operation duration, hospitalization stay, complications, and aesthetic satisfaction score. SPSS software 26.0 and G power 3.1.9 were used for analysis.

RESULTS

There were no significant differences between the two groups in age, sex, follow-up period, pathological type, incision length or postoperative complications. Significant differences were found for the amount of bleeding [Endo: 12.5 (10.0) mL; Conv: 20.0 (20.0) mL, P < 0.001] and aesthetic satisfaction score [Endo: 8.8 ± 1.3; Conv: 7.5 ± 1.8, P < 0.001]. The operation duration of the Endo group was longer for early cases [Endo: 110.0 (27.5) min; Conv: 87.0 (40.0) min, P < 0.001], yet there was no significant difference from the thirtieth case [Endo: 85.0 (20.0) min; Conv: 89.0 (52.5) min, P = 0.894]. No recurrence of SMG diseases occurred during the follow-up period.

DISCUSSION

Full endoscopic SMG excision through the retroauricular hairline approach results in less intraoperative bleeding, invisible scars, and greater patient satisfaction, achieving ideal clinical and cosmetic outcomes.

Gasless Endoscopic Submandibular Gland Excision Through Hairline Approach

BACKGROUND

The aim of this study was to evaluate the therapeutic effect of gasless endoscopic submandibular gland excision through hairline approach and the safety, feasibility and practicability of this technique.

METHODS

Twenty-five patients with submandibular gland lesions who underwent gasless endoscopic submandibular gland excision through hairline approach at the Department of Head and Neck Oncology of the West China Hospital of Stomatology from May 1 st 2021 to May 31 st 2022 were included in this prospective study. The variables were analyzed statistically with SPSS software version 23.0 (IBM Corp, Armonk, New York, USA).

RESULTS

There was a female predominance (72%), female to male ratio was 2.6. The mean age was 30.6±10.2 years (range: 11 to 52 year). All 25 cases of endoscopic submandibular gland excision through hairline approach were done without conversion to conventional approach. This approach was indicated in 14 cases (56%) for pleomorphic adenoma, 8 cases (32%) for chronic sialadenitis, 2 cases (8%) for adenoid cystic carcinoma, and 1 case (4%) for lymphadenitis. The incision length mean was 4.8±0.4 mm (range: 4 to 5 mm); the operation duration mean was 100.6±39.7 min (range: 51 to 197 min); the intraoperative bleeding mean was 13.2±5.7 ml (range: 5 to 20 ml); the hospital length of stay mean was 4.5±0.8 days (range: 3 to 6 days). The follow-up mean was 10±3.4 months (range: 5 to 16 months). The patients were very satisfied with postoperative cosmetic result (score mean: 9.2±1). No recurrence of disease and complications such as postoperative bleeding, hematoma, nerve damage, skin necrosis, infection, and hair loss occurred.

CONCLUSIONS

Gasless endoscopic submandibular gland excision through hairline approach is safe, feasible and practicable, resulting in a very satisfied cosmetic result without significant complications; the intraoperative bleeding is less, the operative field is clear, the operation duration decreases with accumulation of experience.

Contemporary Review of Submandibular Gland Sialolithiasis and Surgical Management Options

One of the most common disorders of the salivary glands is obstructive sialolithiasis. Salivary gland obstruction is important to address, as it can significantly impact patient quality of life and can progress to extensive cellulitis and abscess formation if left untreated. For small and accessible stones, conservative therapies often produce satisfactory outcomes. Operative management should be considered when stones are inaccessible or larger in size, and options include sialendoscopy, laser lithotripsy, extracorporeal shockwave lithotripsy, transoral surgery, and submandibular gland adenectomy. Robotic approaches are also becoming increasingly used for submandibular stone management. The purpose of this review is to summarize the modern-day management of submandibular gland obstructive sialolithiasis with an emphasis on operative treatment modalities. A total of 77 articles were reviewed from PubMed and Embase databases, specifically looking at the pathophysiology, clinical presentation, diagnosis, and management of submandibular sialolithiasis.

Satisfaction with Quality of Life in Patients with Minimum Cicatricial Damage of the Face and Neck

Satisfaction with quality of life and self-attitude in patients operated by «traditional» (conventional surgical methods) and endoscopically assisted methods are considered in the article. Differences in the quality of life in patients, self-attitude to ones appearance are described. 65 patients were surgically operated and examined. Control group – patients operated by «traditional» techniques (35 patients), the average age of patients was 38 ± 11,1 years. The comparison group – patients operated using endoscopically assisted methods (30 patients), the average age of patients was 44 ± 17,7 years. Psychodiagnostic methods: 1. N. E. Vodopyanova`s scale of life quality; 2. The Short Form-36; 3. S.R. Panteleev`s Assessment of self-relationship. Complaints of paresthesia and pain experienced by patients who underwent a “traditional” operation were revealed as a result of the examination. Operated on with an endoscopically assisted method patients did not present any complaints. Differences between the assessment of the life quality and self-relationship in examined groups were found. Operated on with an endoscopically assisted method patients evaluated life quality, satisfaction with their appearance and physical condition higher than patients operated on with a “traditional” method.

Minimally invasive video-assisted submandibular sialadenectomy: surgical technique and results from two institutions

BACKGROUND

Submandibular gland excision is traditionally performed using a transcervical approach. However, innovative surgical trials have recently been conducted to investigate techniques that can prevent or reduce visible scarring and nerve injury. The aim of the present study was to evaluate the feasibility of a new approach to submandibular gland excision that is based on the use of a minimally invasive video-assisted technique and an ultrasound scalpel in an endoscopic neck surgery program with a low annual flow of procedures.

METHODS

We retrospectively studied 15 patients with submandibular gland disease who underwent minimally invasive video-assisted submandibular sialadenectomy performed by two surgeons at two institutions. Eight patients had proximally located salivary calculi, three had chronic sialadenitis, and four had benign neoplasms. All dissections were carried out by a single-port gasless approach, using the Miccoli technique, involving endoscope magnification and an ultrasonic scalpel.

RESULTS

All 15 submandibular gland resections were performed successfully, with no conversions to conventional open resection. The operative time ranged from 45 to 125 min (median 84 min). A total of 67 % of patients were discharged the day after surgery, and the maximum length of stay was 3 days. One patient experienced postoperative bleeding, and one experienced postoperative infection. There was no neural injury. The incision scar healed well in all cases, and all patients reported excellent cosmetic results.

CONCLUSIONS

Endoscopic submandibular gland resection using a minimally invasive video-assisted technique, endoscopic magnification, and ultrasonic scalpel was feasible and resulted in excellent surgical outcomes.

Perioperative difficulties and early postoperative complications of transoral approach in mouth base surgery

OBJECTIVE

The aim of this study was to discuss perioperative difficulties and temporary or permanent complications that can be seen at early postoperative period in cases undergoing transoral surgical approach for disorders of mouth base.

STUDY DESIGN

The study included 19 patients undergoing transoral surgical approach between September 2011 and January 2013 who were retrospectively evaluated. Exclusion criteria were patients with malign submandibular gland tumor or other suspected tumors at mouth base, those with a benign solid mass larger than 10 × 10 cm, and those who did not accept the transoral approach.

RESULTS

Mean age was 28.47 ± 17.89 years (range, 8-76 years) in 19 patients included (9 male and 10 female subjects). Of these, submandibular gland excision was performed in 9 cases, whereas thyroglossal duct cyst excision was performed in 3 (2 transfrenulum approach and 1 lateral lingual approach), lymphangioma excision in 1, diagnostic lymph node excision at the posterior of submandibular gland in 3 cases, and dermoid cyst excision (2 with midline and 1 with left submandibular localization) in 3 cases. Perioperative difficulties included dissection problems due to adhesion, partial adhesion between Wharton canal and lingual nerve, fragmented dissection of the gland, capsule rupture of submandibular adenoma, and facial artery rupture. While visualization of surgical field and retraction of mouth base muscles are an important issue in midline approaches, resection of hyoid bone corpus is challenging in lateral approaches. Early postoperative complications included edema at mouth base, lingual ecchymosis, and postoperative temporary abnormal tongue sensation.

CONCLUSIONS

Transoral mouth base surgery is a safe approach in selected patients. Permanent injuries of neural structures are rarely encountered, which is considered as a concern by head and neck surgeons. Temporary complications are at a level that can be tolerated by patients.

Preoperative fine needle cytology and imaging facilitates the management of submandibular salivary gland lesions

BACKGROUND

  Lesions of the submandibular gland represent a pleomorphically diverse group in which benign and malignant pathologies are difficult to differentiate from each other. Accurate diagnosis and surgical intervention relies upon clinical presentation, examination and investigations to guide appropriate management. The current series aimed to identify the roles of preoperative cytology and imaging with subsequent histopathology in the management of these lesions.

METHODS

Between 1998 and 2008, 54 patients of median age 54 years (range 25-94), with a male : female ratio of 1:3.5 were identified, of which, 50 patients underwent 52 excisions of the submandibular gland. Demographic data were recorded. The utility of imaging and cytology were analysed, and the accuracy of cytology correlated with histology.

RESULTS

Pathologies of resected specimens were sialadenitis 17 (32%), pleomorphic adenomas nine (17%), calculi eight (15%), lymphoma five (10%), squamous cell carcinoma two (4%), adenoid cystic carcinoma one (2%) and other 10 (20%). Twenty-eight patients (52%) underwent fine-needle aspiration cytology/core biopsies, of which 25 (89%) were correlated with histology. The accuracy, sensitivity and specificity of the fine-needle aspiration cytology correlation with histology were 88.0%, 71.4% and 94.4%, respectively. Overall, the complication rate was 9.6%; involving five temporary nerve palsies of the marginal mandibular branch of the facial nerve, including one temporary lingual nerve palsy.

CONCLUSION

This series demonstrates histological outcomes in patients specific to the submandibular salivary gland. The malignancy rate was low compared to current published literature. The transcervical surgical approach to submandibular gland pathology is a safe and effective method with minimal morbidity when performed by experienced surgeons. No single investigative modality can be solely aligned with diagnosing a specific lesion of the submandibular gland.

The endoscopic approach to the neck: a review of the literature, and overview of the various techniques

BACKGROUND

The endoscopic surgical approach to the neck has reached the head and neck surgeons' view with a certain delay, compared to other fields of endoscopic procedures. This may be attributed to the tight work space and plenty of vital structures in the operating field. Since study groups described first attempts with endoscopic or video assisted removals of thyroid glands in the late nineties, selective neck dissections on animal models or cadaveric dissections were performed in 2003.

METHOD

The review consists of a Medline Search regarding the terms of endoscopic, video- assisted neck dissections, excision of neck lesions, thyroidectomy and submandibular resection and minimal access surgery. The three main procedures (selective neck dissection, submandibular resection and thyroidectomy) are described and reviewed in the following test.

RESULTS

Various techniques have been performed successfully and led to good clinical results. The studies described in literature other than for thyroidectomy often do not exceed the level of small series or case-reports.

CONCLUSION

With a good proof of indication gasless lifting techniques, video assisted endoscopical techniques and subcutaneous approaches with gas filling procedures are feasible in neck surgery. All methods depending on the surgeons' experience describe no significantly extended operation times, a better and faster wound-healing and an optimized cosmetic outcome, compared to open approaches. Surgeons should always be aware of the limitations of the minimal invasive techniques regarding the complications or modifications during neck dissection/thyroidectomy.

Endoscopic resection of the submandibular gland via a hairline incision: a new surgical approach

OBJECTIVES/HYPOTHESIS

Submandibular gland excision is traditionally performed by the transcervical approach. To avoid or reduce visible scarring and nerve injury, diverse innovative surgical trials have been reported. Here we report a patient who had an endoscopic submandibular gland resection via a hairline incision.

METHODS

A 36-year-old woman presented with a right submandibular gland tumor that was found on a routine check-up. The submandibular gland was resected under endoscopic assistance via a posterior hairline incision using an ultrasonic scalpel.

RESULTS

The resection was successful, causing no acute complications, such as neural injury, hematoma, or seroma formation. The incision scar healed with an excellent cosmetic result.

CONCLUSIONS

Endoscopic submandibular gland resection via a hairline incision was feasible and resulted in an excellent surgical and cosmetic outcome. Laryngoscope, 2010.

Video-assisted submandibular resection: two-step technique

BACKGROUND

The relative delay in the development of endoscopic neck surgery has been attributed to the relatively narrow operative field and to the presence of many vital structures in it. For endoscopic neck surgery to be feasible, it is essential to create a comfortable working space. A method of creating a working space is the gasless skin-lifting technique. To date, there have been only few reports on the transcervical endoscopic approach to the submandibular gland.

AIM

Assessment of a new modification in the technique of video-assisted submandibular sialadenectomy aiming at improving the visibility and safety of the operation.

METHODS

The study included 12 adult patients indicated for sialadenectomy. Patients having large, hard or fixed submandibular gland were excluded. Laboratory work-up and ultrasound of the neck were obtained in all patients. All patients had video-assisted submandibular sialadenectomy, using a "two-step resection" technique: A 15-20-m skin incision was performed. The superficial part of the submandibular gland down to the plane of the mylohyoid muscle was dissected free and excised, leaving behind a roomy working space and a clearer view to the deeper part (step 1). The remaining deep part of the gland was then dissected and removed (step 2). A gasless skin lifting was adopted using Army-Navy retractors. Dissection was performed using ultrasonic sealing device.

RESULTS

Mean operative time was 89.67 ± 37.97 min. Mean blood loss was 45 ± 19.78 ml. There was no permanent nerve injury.

CONCLUSION

The two-step submandibular sialadenectomy using skin-lifting gasless technique offers good visibility and good working space that allow safer dissection.