Avoiding nerve injuries during surgeries in the submandibular traiagle.

ICHIMURA Keiichi

doi:10.5981/jjhnc1974.23.649

In order to avoid nerve complications during a surgery when the nerve is potentially in danger anatomically, either early identification of the nerve followed by taking it out of the operative field or using a method that will safeguard the nerve will be made. The lingual nerve is a large nerve with a consistently uniform anatomical course and should be identified during a surgery for the presence of the submandibular ganglion. On the other hand, there has been some discussion as to whether the marginal mandibular branch of the facial nerve should be routinely identified at surgery.<br>In order to assess the incidence of neural complications, we reviewed the records of 121 patients who underwent excision of the submandibular triangle components except for malignancies at the University of Tokyo Hospital during the last 20 years. Marginal mandibular branch paralysis, although transient, was present in 30% of 124 resections. The paralysis was more frequent when nerve identification was performed. Postoperative lingual nerve paresthesia was observed in only 3 resections.<br>Based on the results of this study and understanding of the anatomy of the nerve, we propose that a low “non-identification” approach appears to be the technique that offers the least risk of damage to the mandibular branch when the purpose of the surgery is limited to only excision of the submandibular gland. Surgery for tumors should be distinguished from that for inflammatory lesions. In such, at least submandibular neck dissection should be performed, and the nerve should be identified. In either method, a skin incision just above the level of the hyoid bone is recommended.<br>When the postertor border of the mylohyoid muscle is retracted anteriorly, the lingual nerve is easily identified. Care is taken not to damage the nerve as it crosses the superficial aspect of the submandibular duct.

Avoiding nerve injuries during surgeries in the submandibular traiagle.

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