Facial, hypoglossal and lingual nerves in submandibular gland surgery

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

Benign salivary tumours

  • Displace, but do not invade nerve
  • Nerve can always be dissected / peeled off 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

Index: Clinical Practice Guidelines for Submandibular Gland

Resource Appropriate Submandibular Gland Guideline Scenarios