Endoscopic submandibular gland resection preserving great auricular nerve and periaural sensation

Abstract

Objective

The preservation of periaural sensation is one of the most important things to improve the postoperative quality of life after performing the surgical procedures via retroauricular approach. The aim of this study is to describe the surgical technique of endoscopic submandibular gland (SMG) resection through the potential plane between great auricular nerve (GAN) and sternocleidomastoid muscle (sub-GAN dissection) and to evaluate its technical feasibility and advantage.

Methods

The present study enrolled 22 patients who underwent endoscopic SMG resection through linear hairline incision and sub-GAN dissection. The assessment was performed on the following: the cosmetic satisfaction after surgery and surgery-related variables.

Results

There was one case of a postoperative hematoma, which resolved with conservative management via a compression dressing, and one case of transient numbness at the surgical site, which spontaneously resolved within two months. In all other patients, no complications, such as seroma, skin necrosis, or marginal mandibular nerve palsy, occurred. The mean scores of pain and paresthesia evaluated with the graded scale approximated 0 (no pain or paresthesia). The cosmetic result score was as low as 1.5 (“extremely satisfied” or “satisfied”).

Conclusion

Linear hairline incision and sub-GAN dissection were feasible to acquire the sufficient working space for endoscopic SMG resection without sensory deterioration of GAN. This procedure may be useful to apply the surgery of other upper neck masses or thyroidectomy via retroauricular approach.

Introduction

Until recently, to improve cosmetic results, endoscopic resection of the submandibular gland (SMG) through various routes has been assessed [1], [2], [3]. Endoscopic SMG resection via a facelift incision has shown superior cosmetic results than the conventional approach [4] and a better visual field than the transoral endoscopic approach [5], [6]. However, it is sometimes difficult to achieve sufficient working space during the surgical procedure, thus, necessitating an additional long curvilinear incision along the postauricular sulcus and hairline as well as wide extension of the subcutaneous dissection [6], [7], [8], [9]. Of most importance is that the risk of great auricular nerve (GAN) damage may be increased when elevating the skin flap or using endoscopic instruments. In addition, the posterior portion of the SMG is obscured by its course, which runs near the mandibular angle (Fig. 1). However, the literature contains minimal discussion regarding the effective management of the GAN and its proper approach including flap elevation. We report our experience and technique of endoscopic SMG resection through the potential plane between the GAN and the sternocleidomastoid muscle (sub-GAN dissection) and show its technical feasibility and advantages.