Treatment of a 4 cm Benign Tumour in the Deep Portion of the Submandibular Gland
Clinical Scenario
This protocol applies to a benign submandibular gland tumour measuring 4 cm and located in the deep portion of the submandibular gland (SMG) — a presentation that carries specific surgical implications distinct from more superficially situated lesions.
Why Location and Size Matter
A tumour of this size situated in the deep portion of the SMG poses unique anatomical challenges. Based on clinical evidence, less extensive gland-sparing approaches are not recommended for this specific scenario; the depth and size of the lesion directly inform the surgical strategy required to minimise recurrence risk.
Treatment Approach (Partial Overview)
The recommended intervention is total gland excision (TGE) performed under general anaesthesia via a transcervical approach. The full protocol details the precise surgical sequence — including soft-tissue dissection planes, vascular ligation, ductal management, and nerve preservation — that must be followed to complete this procedure safely.
Full procedural steps, anatomical landmarks, and intraoperative considerations are available in the complete structured protocol below.
References
DOI: 10.1177/0300060519892783
- Thus, based on our experience, we do not recommend HS-MECD for tumours of 4 cm in the deep portion of the SMG.
- As such, the primary operation should extirpate the entire SMG to minimise the risk of recurrence.
- TGE began with a transcervical incision below the mandibular border.
- The skin flap was elevated under the platysma, and the SMG and tumour were exposed.
- The facial artery and vein were ligated before the gland was mobilised anteriorly from the free edge of the mylohyoid muscle.
- Wharton's duct was also ligated while taking care to avoid injury to the lingual and hypoglossal nerves.
- Finally, the tumour was removed with the whole SMG.
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