Removal of Submandibular Gland

  • Reference Number: HEY-142/2018
  • Departments: Maxillofacial Department

Introduction

This leaflet has been produced to give you general information about your procedure. Most of your questions should have been answered by this leaflet.  It is not intended to replace the discussion between you and your doctor, but may act as a starting point for discussion.   If after reading it you have any concerns or require further explanation, please discuss this with a member of the healthcare team caring for you.

What is the submandibular gland?

The submandibular gland is a salivary gland about the size of a plum that lies just 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.

Why do I need treatment?

Why does the gland need to be removed?

The most common reason for removing a submandibular gland is infection. For many patients this is associated with blockage of the duct, which may be the result of a stone.

Are there any alternatives and what would happen if I have nothing done?

Sometimes it is possible just to remove the stone. It is not always easy to reach the stone, especially if it is far back in the duct or in the gland itself. On many occasions the gland may be considered to be too diseased to be left. If ignored you may have further episodes of infection which if severe can be life-threatening however this is rare.

Can there be any complications or risks?

There are complications and risks of this surgery and it is important that you are aware of these and have the opportunity to discuss them with your surgeon.

Are there any risks?

Two nerves are at risk. The first is a very fine one and is usually retracted rather than seen. It powers the muscles that move the lower lip. If damaged the result is a lop sided smile. The second is the nerve that supplies sensation to one side of the tongue. This is identified and preserved in the operation, but sometimes attempts to stop bleeding or stretching lead to some altered sensation such as numbness or tingling of one side of the tongue.

How do I prepare for treatment?

Please read the information leaflet. Share the information it contains with your partner and family (if you wish) so that they can be of help and support. There may be information they need to know, especially if they are taking care of you following this examination.

You will be given a letter detailing where you should attend, starving instructions and the time to report to the ward. Staff will greet you and show you around the ward. You will be seen by the doctor and possibly the anaesthetist. The type of anaesthetic you will be having is called a general anaesthetic. You will be prescribed pain relief to manage any pain you may suffer following the operation

You may be required to attend a pre-assessment where the nurse will prepare you for the surgery and you can ask any questions you may have. She will also ensure you are fit for the anesthetic.

What will happen?

What does the operation involve?

The submandibular gland is removed under a general anaesthetic, i.e. you are asleep during the operation. The operation involves a cut around two to three inches long in the upper part of the neck just below the jaw. Once the gland has been removed the incision is held together with stitches. These usually need to be removed about a week after surgery. At the end of the operation a small tube is also placed through the skin into the underlying wound to drain any blood which may collect. This may be removed on the morning following surgery, or the day after.

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 the mouth to remove that stone.

How long will the operation take?

The length of time partly depends upon the degree of difficulty. In an uncomplicated procedure it takes approximately an hour to remove the submandibular gland.

What happens afterwards?

What can I expect after the operation?

You usually need two or three nights in hospital following the surgery. It is unlikely to be very sore but regular pain relief medication will be arranged for you.

Since part of the gland is taken away it results in hollowing in front of and below the ear. There will be a scar, but this is made as invisible as possible by placing incisions in skin creases. Initially a scar may appear red and lumpy but tend to fade to a white line after six months or so.

There will be numbness of the skin, particularly of the ear, because the nerves supplying sensation are cut in the operation. Some of the numbness fades in the first year, but it is usual for numbness of the ear lobe to remain. As nerves recover, some patients’ experience sweating or flushing of the skin over the gland, especially when they eat. This is called Frey’s syndrome.

Do I need any time off work?

It is usual to take a week off work to recover from the surgery and possibly more
depending on your job. 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 the wound dry for the first week following surgery. This obviously means you need to take care when washing or shaving.

Should you require further advice on the issues contained in this leaflet, please do not hesitate to contact the Maxillofacial Unit on tel no: (01482) 463218

General Advice and Consent

Most of your questions should have been answered by this leaflet, but remember that this is only a starting point for discussion with the healthcare team.

Consent to treatment

Before any doctor, nurse or therapist examines or treats you, they must seek your consent or permission. In order to make a decision, you need to have information from health professionals about the treatment or investigation which is being offered to you. You should always ask them more questions if you do not understand or if you want more information.

The information you receive should be about your condition, the alternatives available to you, and whether it carries risks as well as the benefits. What is important is that your consent is genuine or valid. That means:

  • you must be able to give your consent
  • you must be given enough information to enable you to make a decision
  • you must be acting under your own free will and not under the strong influence of another person

Information about you

We collect and use your information to provide you with care and treatment. As part of your care, information about you will be shared between members of a healthcare team, some of whom you may not meet. Your information may also be used to help train staff, to check the quality of our care, to manage and plan the health service, and to help with research. Wherever possible we use anonymous data.

We may pass on relevant information to other health organisations that provide you with care. All information is treated as strictly confidential and is not given to anyone who does not need it. If you have any concerns please ask your doctor, or the person caring for you.

Under the General Data Protection Regulation and the Data Protection Act 2018 we are responsible for maintaining the confidentiality of any information we hold about you. For further information visit the following page: Confidential Information about You.

If you or your carer needs information about your health and wellbeing and about your care and treatment in a different format, such as large print, braille or audio, due to disability, impairment or sensory loss, please advise a member of staff and this can be arranged.