Sub maxillectomy
A sub-maxillectomy is a surgical procedure to remove a salivary gland called the sub-maxilla. The operation is performed under general anesthesia by an ENT surgeon, and requires hospitalization for 2 to 3 days.
Find out more about sous maxillectomy from Dr Delagranda, an ENT surgeon in La Roche sur Yon.
Submaxillary glands
The 2 submandibular glands are exocrine glands (exocrine = secreted outside the body), permanently producing 70% of the saliva in the mouth. They are located in the neck on either side of the mandible. They are 3 to 4 cm long, weigh 10 g each, and terminate in a saliva-excreting duct called Wharton’s duct, which is 4 to 5 cm long, 2-3 mm in diameter, and terminates in the floor of the mouth behind the lower incisors at the level of the caruncle on either side of the lingual frenulum. Depending on eating habits (heavy beer-drinkers and bread-eaters), the sub-maxillary glands can increase in volume, but this is not a pathological condition. However, they can also be the site of serious medical problems of tumoral (benign or malignant), infectious or lithiasis (salivary calculus) origin. They may also be the target of more general, systemic pathologies, leading in particular to stenoses in Wharton’s canal (rheumatoid arthritis, Gougerot Sjögren’s disease, lupus, scleroderma, vasculitis, side-effects of radioactive iodine treatment after thyroid cancer).
When should a sub-maxillary gland be removed?
- Appearance of a persistent mass located under the horizontal part of the lower jaw or mandible. This mass corresponds to a tumor, most often benign in 60-65% of cases, but sometimes cancerous in 35-40% of cases (source Refcor). Apart from the appearance of a mass in the neck, there are often few signs: pain is rare, and nerve paralysis exceptional (asymmetry of the lower lip, reduced mobility of the hemi-tongue, sensitivity disorders of the anterior hemi-tongue). Cytopuncture of the intra-glandular mass may be suggested to help differentiate between benign and malignant tumors.
- Presence of chronic infection of the submandibular gland with chronic disabling neck pain. Repeated acute infections progressing to chronic infection are most often due to a stone trapped in Wharton’s canal. If the stone cannot be treated by lithotripsy, sialendoscopy or endo-buccal excision, the only solution is to remove the entire gland by sub-maxillectomy.
- Swelling of the salivary gland at mealtimes, with pain (salivary colic) or without pain (salivary hernia) are symptoms which can be linked to a calculus/lithiasis or stenosis of Wharton’s canal, or a salivary calculus in the submaxillary gland itself. If the stone cannot be treated by lithotripsy, sialendoscopy or endobuccal excision, the only option left is to remove the entire gland: a sub-maxillectomy.
Who is concerned by sub maxillectomy?
Sub maxillectomy mainly concerns adults of all ages. Children are very rarely concerned.
Objectives of submaxillary gland surgery
- Stop pain (stones, stenosis)
- Stop the recurrence of infections (sub maxillitis)
- Prevent the spread of cancer by removing it
- Prevent the troublesome development of a benign tumor
The different stages of the intervention
The surgical procedure
The gland cannot be partially removed; it must always be completely removed.
Submaxillectomy is always performed under general anaesthetic with tracheal intubation. It takes 45 minutes to perform. The arched cervical incision is 4-5 cm long, and is located in a fold of the neck 3 cm from the edge of the mandible to limit aesthetic impact. Submaxillectomy is combined with cervical lymph node curage in the case of cancer only. A drain is placed in the sub-maxillary space at the end of the operation to limit the risk of post-operative haematoma.
Post-surgery recovery period
The patient returns home after an average of 2 or 3 days in hospital. Pain is minimal. Eating can be a little tricky at first, but improves very quickly.
10 days off work
Post-operative care at home: Daily nursing care of the scar
Scar: 4-5 cm in the neck, not very visible as it is in a fold, to be protected from the sun.
Complications associated with sub maxillectomy
In addition to the risks inherent in any surgery involving general anaesthesia, sub maxillectomy carries the risk of rare complications:
- Post-operative hematoma.
- Anesthesia under the jaw, tongue tip and lingual nerve.
- Asymmetry of the mouth when smiling, mainly due to damage to the chin branch of the facial nerve, which is highly sensitive to stretching.
- Reduced tongue mobility due to damage to the hypoglossal nerve.
You may notice a slight depression under the jawline after the operation. This is not a complication, but a consequence of the absence of the removed gland.
Please consult the ENT College’s explanatory sheet on sub maxillectomy for further explanations:
Frequently asked questions
Here is a selection of the questions most frequently asked by Dr Delagranda’s patients for sub-maxillary gland removal in La Roche-sur-Yon.
Will it be difficult for me to eat?
Yes, at first. The tension exerted on the tongue muscles during the operation may be felt for a few days.
Will I still have saliva?
Yes, because there are 5 other main salivary glands and around a thousand accessory salivary glands.
Fees and coverage for the procedure
The sub-maxillectomy operation is covered by health insurance. Contact your mutual insurance company to find out how much coverage there is for any extra fees.
Do you have a question? Need more information?
Dr Antoine Delagranda is available to answer any questions you may have about sub-maxillary gland surgery. Dr Delagranda is a specialist in ENT surgery at the Clinique St-Charles, La Roche sur Yon, France.
ENT consultation for sub maxillectomy in Vendée
Dr Antoine Delagranda will be happy to answer any questions you may have about sub-maxillary gland surgery. Dr Delagranda is a specialist in ENT surgery at the Clinique Saint Charles in La Roche-sur-Yon in the Vendée.