The anatomical basis of the submandibular gland and its clinical importance. a cadaver study

Abstract

The submandibular gland can be involved in a variety of different diseases. Although tumours of the gland are rare, it is difficult to distinguish whether it is malignant or benign and a final diagnosis is often only possible after excision of the diseased gland. Anterior surgery of the upper cervical spine often necessitates removal of the gland to enable access the vertebrae. As the gland has many functions, excision may cause numerous clinical complications and side-effects. The aim of this study was to identify and evaluate the anatomy of the submandibular gland and its relations in terms of differences between males and females as well as left and right sides. Fifty-six glands were dissected. A Vernier caliper was used to measure the distance from the symphysis mentis to the anterior and posterior ends of both glands to determine the length and the width was determined perpendicular to the length. The average distance from the symphysis mentis to the gland was greater on the right than the left side in both males and females (L=33.01„b1.49mm, R=34.13„b1.46mm). Although the measurements for males were greater, it was not significant (T-test, p>0.05). The glands¡¦ length (l) and width (w) was slightly larger in males than in females (males l=34.12¡Ó1.58mm w=31.36¡Ó1.23mm; females l=33.95¡Ó1.38mm w=30.02¡Ó1.32mm). There was no significant difference between the sexes in this regard (T-test, p>0.05). The normal practice to remove the submandibular gland during surgery to the upper cervical spine that involves the anterior retropharyngeal approach should be discouraged, since it may lead to xerostomia in the elderly. The gland¡¦s superficial anatomy allows for quick and easy mobilisation, even in patients with short necks, and resection of healthy glands should be avoided at all costs.