Submandibular Silaladenectomy-
• Indications
1.Chronic Sialadenitis (due to Calculi)
2.Benign Tumour of S/m sal gland
3.Malignant Tumour of S/m sal gland
4.As a part of Commando operation/MRND
• Anesthesia – General
• Position – Supine with neck extended and turned to opposite side
• Incision – Oblique incision 2.5 cm below and parallel to lower border of mandible, anterior to the level of Angle of Mandible
This is to safeguard Marginal Mandibular Nerve and Cervical branch of the Facial Nerve.
Operative Procedure
• Step 1
Incision deepened by dividing subcutaneous tissue and platysma. Sub platysmal flap-Superficial lobe of Sub mandibular gland is exposed.
• Step 2
Facial artery and common facial vein are divided between ligatures separately.
Facial artery has an ‘S’ shaped relationship with the Submandibular gland. It enters the gland from the supero lateral aspect of the gland. Soon it divides in to two. Ideally the branch which goes into the submandibular gland is ligated and divided, leaving the main trunk.
Adjacent to Facial Artery lies the Submandibular Ganglion which is secretomotor to both Submandibular gland and Sub lingual salivary gland.
The branches to the Submandibular gland alone are divided.
• Step 3
Mylohyoid muscle is retraced medially and deep lobe of the gland is dissected out, safe guarding Lingual nerve and Hypoglossal nerve, on either side of the Submandibular duct.
• Step 4
Sub mandibular duct is ligated & divided near its termination in the mouth and the gland is removed.
Submandibular duct (Wharton's duct) Lies on the Hyoglossus between the lingual (above) and hypoglossal nerve (below)
Commando Operation
En block removal of 1º malignancy of the oral cavity, partial removal of the mandible, floor of the mouth and/or tongue & a radical neck dissection.
Commando Operation is not done nowadays becuse earlier it was thought that the lymphatic drainage from the oral cavity passes through the mandible.
Thanks for sharing your experience.
ReplyDeleteback shoulder brace