Removal of the submandibular salivary gland
Information for patients from the British Association of Oral and Maxillofacial Surgeons (BOAMS)
This leaflet has been designed to answer some of the common questions patients have about this treatment option. It is not meant to replace the information discussed between you and your doctor, but can act as a starting point for such a discussion or as a useful reminder of the key points. If after reading this leaflet you still have questions, please ask a member of staff.
What is the submandibular gland?
The submandibular gland is a salivary gland about the size of a plum, that lies immediately below the lower jaw. Saliva drains from it through a tube that opens on the inside of the mouth under the tongue, immediately behind the lower front teeth.
The most common reason for removing a submandibular gland is as a result of infection that occurs if the tubes that drain saliva become blocked. Blockages usually arise as a result of stones.
What does the operation involve?
Your submandibular gland is removed under a general anaesthetic (you are asleep).
The operation involves a cut around 5cm long in the upper part of your neck, just below your jaw line. Once the gland has been removed the cut is held together again with stitches. These usually need to be removed around a week after surgery.
At the end of your operation a small tube is also placed through the skin into your wound to drain any blood which may collect. This is usually removed on the morning following your surgery.
Will anything else be done while I am asleep?
If your gland is being removed because of infection that is caused by a stone, it may also be necessary to make a cut inside your mouth to remove that stone.
How long will the operation take?
The length of time the operation takes partly depends on how difficult the operation is. In an uncomplicated procedure it will take approximately 45 minutes to remove the submandibular gland.
What can I expect after my operation?
You usually need a night in hospital following your surgery.
You are unlikely to feel very sore but regular painkillers will be arranged for you.
There is a little swelling following submandibular gland removal.
Do I need any time off work?
We usually advise you to take a week off from work to recover from your surgery. During this time you should avoid strenuous activity.
Is there anything that I need to do when I get home?
It is important to keep your wound dry for the first week following surgery; you will need to take care when washing or shaving.
Will I have a scar?
All cuts made through the skin leave a scar but most of these fade with time and are difficult to see when they are fully healed. It may take several months for your scar to fade but eventually it should blend into the natural folds and contours of your face.
What are the possible problems?
Bleeding from the wound is unlikely to be a problem. If it happens it usually does so within the first 12 hours of surgery, which is why you need to stay in hospital overnight.
Infection is uncommon but if your surgeon thinks it is a possibility you will be prescribed a short course of antibiotics.
The surgeon tells me that damage to nerves is possible. What does this mean?
There are three nerves that lie close to your submandibular gland that can be damaged during its removal. Most nerve damage happens as a result of bruising of the nerves since they are held out of the way and protected during surgery. If nerve damage occurs it is usually temporary.
There are three nerves that can be damaged, all with varying results.
Weakness of the lower lip. A lower branch of the facial nerve is the nerve most likely to be bruised in the removal of a submandibular gland. If bruising occurs it affects the movement of your lower lip, leading to a slightly crooked smile.
Numbness of the tongue. The lingual nerve is rarely bruised. Since it is the nerve that supplies feeling to the side of the tongue, bruising results in a tingly or numb feeling in the tongue, similar to the sensation after having an injection at the dentist.
Restricted tongue movement. The hypoglossal nerve is very rarely bruised. It is a nerve that makes the tongue move and damage can result in a decrease of tongue movement.
Is permanent nerve damage possible?
Most nerve damage is temporary, although it can take several months for them to recover. Permanent damage is possible and usually occurs in only the most difficult cases.
If a salivary gland is removed will I be left with a dry mouth?
The removal of one submandibular gland will not affect the amount of saliva that you produce. There are many other salivary glands left in and around your mouth that will still keep it moist.
What if I have any questions or concerns?
If you have any questions or concerns, please speak to the healthcare professional responsible for your care.