Abstract
Purpose
Conventional surgery for submandibular gland tumour is total excision of the gland affected by the tumour. Gland-preserving surgery is commonly used for benign tumours arising in the parotid gland but not in the submandibular gland. This study evaluated long-term oncological and functional outcomes after gland-preserving surgery in patients with pleomorphic adenoma of the submandibular gland via the submental approach.
Methods
This longitudinal study included 105 consecutive patients with submandibular gland pleomorphic adenoma who underwent the gland-preserving surgery combined with the en-bloc resection of tumours via the submental approach. Salivary scintigraphy was performed 6 months after surgery, and ultrasonography was regularly followed. Intraoperative findings, postoperative complications, cosmetic and salivary functions, and tumour recurrence were assessed in these patients.
Results
Median tumour size and submental incision length were 2.0 and 3.3 cm, respectively. Median operation time and amount of blood loss were 25 min and 18.5 mL, respectively. None had marginal or lingual nerve paralysis and most patients were satisfied with incision scar and facial contour. The salivary function of the affected gland was equal to that of the unaffected gland. One patient (0.9%) had single nodular recurrence 54 months after surgery and others had no recurrence for follow-up of median 96 months.
Conclusions
Pleomorphic adenoma of the submandibular gland can be safely removed by the gland-preserving surgery via the submental approach which has operation time, cosmetic and functional benefits with compromising oncological outcomes.
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References
Albergotti WG, Nguyen SA, Zenk J, Gillespie MB (2012) Extracapsular dissection for benign parotid tumors: a meta-analysis. Laryngoscope 122:1954–1960. https://doi.org/10.1002/lary.23396
Almeslet AS (2020) Pleomorphic adenoma: a systematic review. Int J Clin Pediat Dent 13:284–287. https://doi.org/10.5005/jp-journals-10005-1776
Brennan PA, Ammar M, Matharu J (2017) Contemporary management of benign parotid tumours—the increasing evidence for extracapsular dissection. Oral Dis 23:18–21. https://doi.org/10.1111/odi.12518
Chen MK, Su CC, Tsai YL, Chang CC (2006) Minimally invasive endoscopic resection of the submandibular gland: a new approach. Head Neck 28:1014–1017. https://doi.org/10.1002/hed.20469
Foresta E, Torroni A, Di Nardo F, de Waure C, Poscia A, Gasparini G, Marianetti TM, Pelo S (2014) Pleomorphic adenoma and benign parotid tumors: extracapsular dissection vs superficial parotidectomy–review of literature and meta-analysis. Oral Surg Oral Med Oral Pathol Oral Radiol 117:663–676. https://doi.org/10.1016/j.oooo.2014.02.026
Ge N, Peng X, Zhang L, Cai ZG, Guo CB, Yu GY (2016) Partial sialoadenectomy for the treatment of benign tumours in the submandibular gland. Int J Oral Maxillofac Surg 45:750–755. https://doi.org/10.1016/j.ijom.2015.12.013
Hah JH, Roh DH, Jung YH, Kim KH, Sung MW (2012) Selection of irrigation fluid to eradicate free cancer cells during head and neck cancer surgery. Head Neck 34:546–550. https://doi.org/10.1002/hed.21773
Hong KH, Kim YK (2000) Intraoral removal of the submandibular gland: a new surgical approach. Otolaryngol-Head Neck Surg 122:798–802. https://doi.org/10.1016/s0194-5998(00)70004-0
Hu Y, Zheng C, Cao R, Hong W, Zhang Z (2020) Resection of benign tumours of the submandibular gland with harmonic scalpel-assisted minimally extracapsular dissection. J Int Med Res 48:300060519892783. https://doi.org/10.1177/0300060519892783
Humphrey SP, Williamson RT (2001) A review of saliva: normal composition, flow, and function. J Prosth Dent 85:162–169. https://doi.org/10.1067/mpr.2001.113778
Jaguar GC, Lima EN, Kowalski LP, Pellizon AC, Carvalho AL, Alves FA (2010) Impact of submandibular gland excision on salivary gland function in head and neck cancer patients. Oral Oncol 46:349–354. https://doi.org/10.1016/j.oraloncology.2009.11.018
Li G, Zhi C, Zhu D, Liu Z, Niu Y (2019) Efficacy of povidone-iodine against accidental tumor incision during nephron-sparing surgery: experimental study in patients with renal cell carcinoma. J Int Med Res 47:4993–5002. https://doi.org/10.1177/0300060519874155
Mantsopoulos K, Goncalves M, Schapher M, Iro H (2017) Long-term oncologic and functional outcome in pleomorphic adenomas of the submandibular gland. Laryngoscope Invest Otolaryngol 2:369–372. https://doi.org/10.1002/lio2.113
Mantsopoulos K, Sievert M, Iro AK, Müller SK, Koch M, Schapher M, Agaimy A, Iro H (2021) Histopathological comparison of pleomorphic adenomas of the parotid and submandibular gland. Oral Dis. https://doi.org/10.1111/odi.13858
McGurk M, Thomas BL, Renehan AG (2003) Extracapsular dissection for clinically benign parotid lumps: reduced morbidity without oncological compromise. Brit J Cancer 89:1610–1613. https://doi.org/10.1038/sj.bjc.6601281
Min R, Zun Z, Siyi L, Wenjun Y, Jian S, Chenping Z (2013) Gland-preserving surgery can effectively preserve gland function without increased recurrence in treatment of benign submandibular gland tumour. Brit J Oral Maxillofac Surg 51:615–619. https://doi.org/10.1016/j.bjoms.2013.01.009
Mlees MA, Elbarbary AH (2020) Superficial or partial superficial parotidectomy for the treatment of primary benign parotid tumors. J Surg Oncol 122:1315–1322. https://doi.org/10.1002/jso.25970
Pedersen A, Sørensen CE, Proctor GB, Carpenter GH (2018) Salivary functions in mastication, taste and textural perception, swallowing and initial digestion. Oral Dis 24:1399–1416. https://doi.org/10.1111/odi.12867
Roh JL (2005) Retroauricular hairline incision for removal of upper neck masses. Laryngoscope 115:2161–2166. https://doi.org/10.1097/01.mlg.0000181496.22493.5a
Roh JL (2006) Removal of the submandibular gland by a retroauricular approach. Arch Otolaryngol-Head Neck Surg 132:783–787. https://doi.org/10.1001/archotol.132.7.783
Roh JL (2008) Removal of the submandibular gland by a submental approach: a prospective, randomized, controlled study. Oral Oncol 44:295–300. https://doi.org/10.1016/j.oraloncology.2007.03.003
Roh JL, Park CI (2008a) Function-preserving parotid surgery for benign tumors involving the deep parotid lobe. J Surg Oncol 98:42–45. https://doi.org/10.1002/bjs.6306
Roh JL, Park CI (2008b) Gland-preserving surgery for pleomorphic adenoma in the submandibular gland. B J Surg 95:1252–1256. https://doi.org/10.1002/jso.21082
Roh JL, Kim HS, Park CI (2007) Randomized clinical trial comparing partial parotidectomy versus superficial or total parotidectomy. British J Surg 94:1081–1087. https://doi.org/10.1002/bjs.5947
Sood S, McGurk M, Vaz F (2016) Management of salivary gland tumours: United Kingdom national multidisciplinary guidelines. J Laryngol Otol 130:S142-s149. https://doi.org/10.1017/s0022215116000566
Witt RL (2002) The significance of the margin in parotid surgery for pleomorphic adenoma. Laryngoscope 112:2141–2154. https://doi.org/10.1097/00005537-200212000-00004
Xu H, Mao C, Liu JM, Peng X, Zhu ZH, Yu GY (2011) Microanatomic study of the vascular and duct system of the submandibular gland. J Oral Maxillofac Surg 69:1103–1107. https://doi.org/10.1016/j.joms.2010.03.006
Yu G, Peng X (2019) Conservative and functional surgery in the treatment of salivary gland tumours. I J Oral Sci 11:22. https://doi.org/10.1038/s41368-019-0059-9
Zbären P, Stauffer E (2007) Pleomorphic adenoma of the parotid gland: histopathologic analysis of the capsular characteristics of 218 tumors. Head Neck 29:751–757. https://doi.org/10.1002/hed.20569
Zhang SS, Ma DQ, Guo CB, Huang MX, Peng X, Yu GY (2013) Conservation of salivary secretion and facial nerve function in partial superficial parotidectomy. Int J Oral Maxillofac Surg 42:868–873. https://doi.org/10.1016/j.ijom.2013.03.014
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Roh, JL. Functional gland-preserving surgery for submandibular gland pleomorphic adenoma. J Cancer Res Clin Oncol 148, 2623–2629 (2022). https://doi.org/10.1007/s00432-021-03844-8
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DOI: https://doi.org/10.1007/s00432-021-03844-8