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.