Endoscopic submandibular gland resection preserving great auricular nerve and periaural sensation
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.
Section snippets
Patients
The protocol of this prospective study has been approved by the Institutional Review Board of Korea University Hospital, and the investigators have obtained written informed consent from each participant or each participant's guardian. From February 2011 to May 2013, 22 patients with endoscopic SMG resection through a linear hairline incision and sub-GAN dissection were included in the study. All of the subjects were given detailed information about this technique and provided informed consent.
Results
The age at diagnosis of the 16 female and 6 male patients ranged from 21 to 71 years (mean, 41.5 years). The mean surgery time (including flap elevation) was 109.0 ± 23.8 min and the mean drainage was 85.5 ± 40.2 cc. The mean hospital stay was 4.6 ± 0.7 days. 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,
Discussion
This study showed that it is possible to develop an adequate working space with a linear hairline incision without any extension of the skin incision and the sub-GAN dissection through the potential plane between the GAN and sternocleidomastoid muscle; this finding is in contrast to previous studies in which the skin flap was elevated over the GAN [8], [9], [10]. A benefit of the sub-GAN dissection technique is the ability to make a direct and wide exposure of the posterior portion of the SMG.
Conclusions
This study suggests that a linear skin incision and sub-GAN dissection may be feasible for the performance of a direct approach to the SMG. Via an endoscopic SMG resection, it achieves adequate working space for the procedure and avoids damage to the GAN.
Conflict of interest
Authors have nothing to disclose.
Acknowledgments
This research was supported by the Korea Health Technology R&D Project (grant number: HI14C0748) through the Korea Health Industry Development Institute (KHIDI) by the Ministry of Health & Welfare, and a Grant-in-Aid for Korea University Research and Business Foundation.
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