Facial, hypoglossal and lingual nerves in submandibular gland surgery

If functioning preoperatively, one should aim to have functioning nerves postoperatively

Benign salivary tumours

Malignant tumours

Functioning, normal looking nerve may be peeled off tumour and microscopic residuum treated with postoperative radiotherapy
If nerve is invaded/encased by tumour or has impaired function
Confirm malignancy on frozen section
Resect involved segment until free margins on frozen section (perineural spread can extend many centimetres beyond normal looking nerve)
Immediately graft a resected marginal mandibular nerve if you wish to restore lower lip function or hypoglossal nerve
Lingual nerve generally not grafted if resected

No postoperative radiotherapy or frozen section with known malignancy adherent to, or invading nerve

Be surgically more aggressive
Do not peel nerve off tumour, but resect nerve at least 1cm beyond obvious tumour to achieve clear margins