Surgical Treatment of Submandibular Gland Pathologies

Öz

Objective: We aimed to evaluate clinical presentations, histopathological diagnosis and complications of patients operated for a submandibular gland pathology. Methods: Medical records of 34 patients who were oper­ated for a submandibular gland pathology between 2007 and 2016 years evaluated retrospectively. Results: 21 (61.8%) of these patients were male and 13 (38.2%) were female. The mean age of the patients was 41.7±16.6 years. Post-operative histopathological diagnosis was benign in 30 patients (88.2%), malign in 4 patients (11.8%). In the benign group, diagnosis was sialoalolithiasis in 20 patients, chronic sialoadenitis in 6 patients and pleomorphic adenoma in 4 patients. In ma­lign group, the histopathologic result for all patients was adenoid cystic carcinoma. Complication rate of subman­dibular excision surgery was 11.7%. Marginal mandibular nerve paresis was the most common complication. Conclusion: New surgery methods have been presented in the literature because of the incision scar and marginal mandibular nerve paresis during the transcervical surgi­cal approach. However, submandibular gland excision through transcervical approach is still the most used and safe method.

Anahtar Kelimeler

• Submandibular gland, surgery, histopathology, complication

Submandibular Bez Patolojilerinin Cerrahi Tedavisi

Öz

Amaç: Submandibular bezde görülen patolojiler nedeniyle opere ettiğimiz hastaların klinik özelliklerini, histopatolojik sonuçlarını ve cerrahi komplikasyonlarını literatür bilgileri eşliğinde değerlendirmektir. Yöntemler: Submandibular bezde görülen patolojiler nedeniyle 2007 ile 2016 yılları arasında kliniğimizde opere edilen 34 hastanın klinik verileri retrospektif olarak incelendi. Bulgular: Hastaların 21’i (%61,8) erkek, 13’ü (%38,2) kadındı. Hastaların yaş ortalaması 41,7±16,6 yıl şeklindeydi. Hastaların post-operatif patoloji sonucu 30 hastada (%88,2) benign, 4 hastada (%11,8) malign olarak geldi. Benign hastaların 20’sinde siyalolitiyazis, 6’sında kronik sialoadenit mevcuttu. Patoloji sonucu 4 hastada pleomorfik adenom olarak bulunurken, malign 4 hastanın tanısı adenoid kistik karsinomdu. Post-operatif komplikasyon oranı %11,7 bulundu. En sık komplikasyon olarak marjinal mandibular sinir parezisi görüldü. Sonuç: Boyunda oluşan insizyon skarından ve marjinal mandibular sinir parezisi komplikasyonlarından dolayı son zamanlarda yeni cerrahi yöntemler arayışına başlanmış olsa da, transservikal yol ile submandibular bez eksizyonu halen en çok kullanılan güvenli bir cerrahi yöntemdir.

Anahtar Kelimeler

• Submandibular bez, cerrahi, histopatoloji, komplikasyon

Kaynakça

1. 1. Stanley MW, Bardales RH, Beneke J, et al. Sialolithiasis. Differential diagnostic problems in fine-needle aspiration cytology. Am J Clin Pathol 1996;106:229-233.
2. 2. Leung AK, Choi MC, Wagner GA. Multiple sialoliths and a sialolith of unusual size in the submandibular duct: a case report. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1999;87:331-333.
3. 3. Özkurt FE, Bakır S, Akdağ M, et al. Parotis bezi proksimal duktusunda yerleşmiş taş: Olgu sunumu. Dicle Med J 2013;40:144-145.
4. 4. Rapidis AD, Stavrianos S, Lagogiannis G, Faratzis G. Tumors of the submandibular gland: Clinicopathologic analysis of 23 patients. J Oral Maxillofac Surg 2004;62:1203- 1208.
5. 5. Spiro RH. Salivary neoplasms: overview of a 35 year experience with 2807 patients. Head Neck Surg 1986;8:177-184.
6. 6. Ellies M, Laskawi R, Arglebe C, Schott A. Surgical management of nonneoplastic diseases of the submandibular gland. A follow- up study. Int J Oral Maxillofac Surg 1996;25:285-289.
7. 7. Work WP, Hecht DW: Inflammatory diseases of the major salivary glands. In Papparella MM, Shumrick DF (eds): Otolaryngology, vol 3.Philadelphia, WB Saunders 1980; 2235-2243.
8. 8. Brodner L, Azaz B. Submandibular sialolithiasis in children. J Oral Maxillofac Surg 1989;40:551-554.

9. 9. Berçin S, Kutluhan A, Yurttaş V, Kanmaz A. Submandibuler sialolityazise yaklaşımımız. Yeni Tıp Dergisi 2009;26:16- 19.
10. 10. Preuss SF, Klussmann JP, Wittekindt C, et al. Submandibular gland excision: 15 years of experience. J Oral Maxillofac Surg 2007;65:953-957.
11. 11. Smith WP, Peters WJ, Markus AF. Submandibular gland surgery: an audit of clinical findings, pathology and postoperative morbidity. Ann R Coll Surg Eng 1993;75:164-167.
12. 12. Guerrissi JO, Taborda G. Endoscopic excision of the submandibular gland by an intraoral approach. J Craniofac Surg 2001;12:299-303.
13. 13. Baek CH, Jeong HS. Endoscope-assisted submandibular sialadenectomy: a new minimally invasive approach to the submandibular gland. Am J Otolaryngol 2006;27:306-309.
14. 14. De Virgilio A, Park YM, Kim WS, et al. Robotic sialoadenectomy of the submandibular gland via a modified facelift approach. Int J Oral Maxillofac Surg 2012;41:1325- 1329.