The Clinical Application Of Submandibular Incision Combined With Small Intraoral Incision In The Surgical Treatment Of Submandibular Gland Calculus

Objective:In order to introduce a modified surgical method which is can remove submandibular gland and as many Wharton duct as possible for the treatment of submandibular gland calculus,and preliminary evaluates its clinical application.Methods:From January 2013 to December 2018,60 patients with submandibular gland calculus were diagnosed and treated in the Department of Oral and Maxillofacial Surgery,First Hospital of Shanxi Medical University.The patients were divided into the experimental group and the control group.The patients in the experimental group underwent submandibular incision combined with small intraoral incision,while the patients in the control group were performed with traditional submandibular incision.The length of Wharton duct resected,the operation time,intraoperative bleeding loss,drainage volume after the first day,and the time of postoperative hospital stay were compared between the two groups.Postoperative regular follow-up and review,the incidence of postoperative complications such as infection and bleeding,hypoglossal nerve injury,Bartholin duct injury and swallowing pain,recurrence of Wharton duct sialoliths were compared and analyzed.Preliminarily evaluate application of submandibular incision combined with small intraoral incision in the removal of submandibular gland and Wharton duct.Results:1.The average length of Wharton duct resected of experimental group and control group was(4.31±0.43)cm and(2.33±0.42)cm,respectively,and the difference was statistically significant(P<0.05).2.The average operation time of experimental group and control group was(49.61±4.41)minutes and(46.31±4.71)minutes,respectively,and the difference wasn’t statistically significant(P>0.05).3.The average intraoperative bleeding loss of experimental group and control group was(28.33±8.47)ml and(27.92±8.51)ml,respectively,and the difference wasn’t statistically significant(P>0.05).4.The average quantity drainage after the first day of experimental group and control group was(21.58±8.73)ml and(20.12±5.31)ml,respectively,and the difference wasn’t statistically significant(P>0.05).5.The average the time of postoperative hospital stay of experimental group and control group was(6.42±1.24)days and(6.31±1.60)days,respectively,and the difference wasn’t statistically significant(P>0.05).6.Comparisons of postoperative complications:There was 1 case of temporary tongue numbness in the experimental group and 1 case in the control group,the difference had not statistical significance in the occurrence of tongue numbness between the two groups(P > 0.05).At 2 weeks follow-up,the symptoms of tongue tip numbness disappeared in both groups.There were 7 cases of postoperative swallowing pain in the experimental group and 9cases in the control group,and the difference had not statistical significance in the occurrence of tongue numbness(P>0.05).The complication of swallowing pain was gradually relieved 2-3 days after operation.No cases recurrence of Wharton duct sialoliths were found in the experimental group and 2 case in the control group.There was significant difference about postoperative recurrence of Wharton duct sialoliths between the two groups(P < 0.05).One case presented with a solid and painful mass at the surgical side mouth floor,was diagnosed as recurrent sialoliths in residual Wharton duct 2 years after operation.Another case was found recurrent stones in residual Wharton duct who complainted of repeated abnormal redness,pain and swelling of the lateral mouth floor 3 years after surgery.The postoperative complications such as infection,bleeding,hypoglossal gland cyst,abnormal tongue movement and facial nerve marginal mandibular branch injury didn’t occurred in both groups,all incisions healed in stage I.Conclusions:1.Submandibular incision combined with small intraoral incision surgery can remove submandibular gland and as many Wharton duct as possible.It is feasible to operate in clinical surgery,but attention should be paid to the inflow of sublingual gland duct when detaching Wharton duct during operation.2.The operation time of submandibular incision combined with small intraoral incision was longer than the operation time of simple submandibular incision,but the increase of small intraoral incision did not lead to significant increase of intraoperative bleeding loss,drainage volume after the first day and the time of postoperative hospital stay.3.The combination of submandibular incision and small intraoral incision can make up for the limitation of Wharton duct dissociation by simple submandibular incision.It may have some clinical significance in preventing recurrence of Wharton duct sialoliths and secondary infection,for the choice of clinical application in operation.