Innovative Tactic in Submandibular Salivary Gland Resection
Audio Transcription
Please notice that, in order to facilitate the comprehension of this transcription, we divided it in
segments identified by time.
0:00 The evaluation of the submandibular salivary gland can be easily performed. It is found between
the body of the mandible and the hyoid bone. The digastric muscle is mistaken for the edge of the
platysma. When examining the patient in the position [recommended by] of Connell, the submandibular
gland drops even further and is more easily touched. When [the patient is] lying down, one can also feel
the gland with the finger tips.
0:29 The incision should be lower than the conventional, in a way to facilitate the approach to the gland.
This incision is also more distant from the submandibular nerve. The dissection of the platysma must be
enough to reach the gland area. Now showing the dissection, always blunt.
0:57 A stitch is passed through the skin, encompassing the platysma, and returning to the surface of the
skin in order to stabilize the platysma flap in the skin. This facilitates the access of the light retractor
used to visualize the gland. Now showing the gland localization, away from the submandibular nerve;
right below is the capsule of the submandibular gland. The capsule is open in blunt dissection,
facilitating the detachment of the gland.
1:36 After finishing dissection, the removal of the gland is performed. This is done with an
electrocautery with a precision tip, accompanied by a suction tube to remove smoke and blood. Now
showing is the final removal of the gland. We can observe the size, which is considerable in this case.
Now we see the remaining area: approximately 50% of the gland is left.
2:06 A stitch of absorbable material is then passed through the gland encompassing the platysma and
the mylohyoid muscle next to the digastric, as in a Donati stitch. This ensures sufficient anchorage to
obliterate the space left by the removal of the gland as in a Baroudi stitch, avoiding hematoma and
sialoma.
3:03 Now showing is a small residual area that could be the source of sialoma; this area could eventually
be closed with another stitch. We should notice the localization: we are away from the mandibular
nerve. Now showing is an external view and were the gland is located.
3:22 The interplatysmal fat is removed when necessary. Below the interplatysmal fat is the digastric
muscle which is often treated, allowing a more graceful result. The removal of the digastric muscle is
always partial (and never complete).
3:56 Now we can see the amount of tissue removed from the subplatysma. We can see the
submandibular gland, the interplatysmal fat, and the digastric muscle.
4:04 Here we have a lateral transoperatory view, showing a good neck definition. And here, we can see
the extension of the dissection.
4:20 Here we can see the flap traction, according to the necessity.
4:26 This is the hemostatic net (as conceived by Auersvald), performed to close all dead spaces, thus
preventing hematoma.
4:33 Here we can see that the nerves were preserved.
4:37 Here we have a 24h post operatory view. As we can see, no great ecchymosis, no great edema:
findings in good part attributable to the hemostatic net. Here, after the removal of the net, 48 h after
surgery.
4:48 Finally, a pre and an early post operative view.