Excision of submandibular (submaxillary) gland
CPT4 code
Name of the Procedure:
Excision of Submandibular (Submaxillary) Gland
Summary
The excision of the submandibular gland, also known as submaxillary gland removal, is a surgical procedure to remove one of the salivary glands located beneath the lower jaw.
Purpose
The procedure is typically performed to address problems such as chronic sialadenitis (inflammation of the gland), recurrent infections, or tumors (benign or malignant) within the gland. The goal is to alleviate symptoms, prevent recurrent infections or blockages, and remove any potentially cancerous tissue.
Indications
- Persistent pain or swelling in the submandibular area.
- Recurrent infections or abscesses in the gland.
- Presence of a tumor or suspicious mass in the gland.
- Chronic obstruction of the salivary duct, leading to sialadenitis.
Preparation
- Fasting for at least 6-8 hours before the procedure.
- Discontinuation of certain medications, such as blood thinners, as advised by the surgeon.
- Preoperative blood tests and imaging studies like ultrasound or CT scan to evaluate the gland and surrounding structures.
Procedure Description
- The patient is given general anesthesia to ensure they are asleep and pain-free.
- An incision is made under the jawline to access the submandibular gland.
- The surgeon carefully dissects through the tissues, taking care to avoid important structures like the facial nerve.
- The submandibular gland is identified, isolated, and then excised.
- The duct connecting the gland to the mouth is also removed or tied off to prevent leakage.
- The incision is then closed with sutures, and a small drain may be placed to prevent fluid accumulation.
- The area is cleaned and dressed.
Duration
The procedure typically takes about 1 to 2 hours.
Setting
The procedure is most often performed in a hospital operating room or a specialized surgical center.
Personnel
- Surgeons specialized in head and neck surgery or otolaryngology (ENT).
- Anesthesiologist.
- Surgical nurses and assistants.
Risks and Complications
- Infection at the surgical site.
- Bleeding or hematoma formation.
- Damage to the facial nerve, leading to temporary or permanent weakness or numbness in the face.
- Saliva leakage or formation of a saliva fistula.
- Scarring.
Benefits
- Relief from chronic pain and swelling.
- Prevention of recurrent infections and complications.
- Removal of potentially cancerous or harmful tissue.
- Improved quality of life.
Recovery
- Post-operative care includes pain management, usually with prescribed pain relievers.
- Patients may need to stay overnight in the hospital for monitoring.
- Instructions will be provided on how to care for the incision site, including keeping it clean and dry.
- Most patients can resume normal activities within 1 to 2 weeks, although strenuous activities should be avoided initially.
- Follow-up appointments are necessary to monitor healing and address any concerns.
Alternatives
- Conservative management with antibiotics for infections or sialendoscopy to remove stones or drain abscesses.
- Radiation therapy for malignant tumors if surgery is not an option.
- Each alternative has its own risks and benefits, which should be discussed thoroughly with the healthcare provider.
Patient Experience
During the procedure, patients are under general anesthesia and will not feel any pain. Post-operatively, there may be discomfort or pain at the incision site, which is managed with medication. Some swelling and bruising are normal. Patients typically feel gradually better over the first week, with significant improvement in pain and function within two weeks.