Surgery for Submandibular and Sublingual Malignant Tumors

Abstract

For many decades, surgery has been the primary treatment for malignant submandibular gland neoplasms. Nonetheless, due to the heterogeneity and rarity of submandibular gland malignant tumors and the high frequency of chronic benign processes in this region, management can be complex. Preoperative investigations such as fine needle aspiration and imaging are critical to achieve the correct diagnosis so that suitable surgery can be planned. In general, for malignant submandibular gland neoplasms, the minimal treatment necessary is excision of the submandibular gland with a level I lymph node dissection. Malignant sublingual neoplasms are rare, and patients often present with advanced disease. Excision of the tumor with a level I neck dissection is also indicated. Salivary gland cancer in the submandibular or sublingual gland is generally more aggressive than the same histologic type in the parotid gland. Neck dissection may be required and primarily depends on the stage and histological grade. Adjuvant therapy most frequently consists of radiation and can improve local control and overall survival. Factors that influence prognosis after surgical treatment include histologic grade, stage at presentation, and positive surgical margins.