Submandibular gland removal at Derby Hospital

What is submandibular gland removal?

Submandibular gland removal, also called submandibular gland excision, is an operation to remove one of your submandibular glands. These are two salivary glands about the size of a plum, sitting just below your lower jaw, that between them produce most of your everyday saliva.

What conditions does submandibular gland removal treat?

The most common reason for this operation is infection, which often happens when the tube (duct) draining saliva from the gland becomes blocked, usually by a small stone. Other reasons include:

• repeated infection or swelling caused by a blocked salivary duct, often due to a stone
• growths or tumours in the gland, which may be non-cancerous or cancerous
• a sialocele (a swelling caused by a build-up of saliva that isn't draining properly).

What are the benefits of submandibular gland removal?

Removing the gland treats the underlying problem directly and helps prevent further episodes of infection, which can occasionally become serious if left untreated. Removing just one submandibular gland won't affect how much saliva you produce overall, since you have several other salivary glands that will keep your mouth moist.

Are there different types of submandibular gland removal?

There are two main ways this operation can be done. The most common is through a cut in your neck, just below your jaw, while some surgeons can instead operate through your mouth, avoiding a visible neck scar, which may be an option if you have a stone nearer the opening of the duct.

Each approach carries a different pattern of risk to the nerves near the gland, so your surgeon will discuss which is most suitable for you. If your infection is caused by a single stone that's easy to reach, it may sometimes be possible to remove just the stone rather than the whole gland, though this isn't always possible, for example if the stone is deep in the gland.

What happens before submandibular gland removal?

You'll be sent a letter with instructions on when to stop eating and drinking (fasting) before your operation, and what time to arrive. You may also need a pre-assessment appointment beforehand, where a nurse checks you're fit for the anaesthetic and answers any questions.

On the day, you'll be seen by a doctor, and possibly the anaesthetist, before your operation.

What happens during submandibular gland removal?

This operation is carried out under general anaesthetic, so you'll be asleep throughout. It generally follows this pattern:

1. Your surgeon makes a cut, usually around 5cm (2 inches) long, in the upper part of your neck, just below your jawline.
2. If your infection is caused by a stone, they may also need to make a small cut inside your mouth to remove it.
3. Once the gland is removed, the cut in your neck is closed with stitches.
4. A small drainage tube is often placed through the skin into the wound, to drain away any blood that collects; this is usually removed the morning after surgery.

An uncomplicated operation usually takes around 45 minutes to an hour.

What does recovery from submandibular gland removal look like?

You'll usually need to stay in hospital overnight after your operation. You're unlikely to be in much pain, but regular pain relief will be arranged for you, and you can expect a little swelling around the area.

It's usual to take a week off work to recover, and possibly longer depending on your job; avoid strenuous activity during this time. Keep the wound dry for the first week, so take care when washing or shaving, and your stitches will usually need to be removed around a week after surgery.

All cuts through the skin leave a scar, though most fade over several months and become difficult to see once fully healed, eventually blending into the natural folds of your neck.

What are the risks and complications of submandibular gland removal?

Bleeding from the wound is uncommon, but if it happens, it's usually within the first 12 hours, which is why you'll stay in hospital overnight. Infection is also uncommon, and if your surgeon thinks you're at risk, you'll be given a short course of antibiotics.

There are three nerves close to the gland that can be bruised or, rarely, damaged during surgery. The nerve most commonly affected controls your lower lip, and bruising here can cause a slightly crooked smile, while the nerves controlling feeling in, or movement of, your tongue are affected less often.

Nerve problems are usually temporary and can take several months to recover, though permanent damage is possible in the most difficult cases. In one study, temporary nerve problems that fully recovered occurred in around 16 in 100 people, and permanent weakness of the lower lip in around 2 in 100 people.

Very rarely, bleeding can collect under the skin (called a haematoma) soon after surgery, so tell your care team straight away if you notice increasing swelling in your neck. Removing one submandibular gland won't leave you with a dry mouth, since your other salivary glands will keep your mouth moist.