Salivary Glands: North London Oral Facial Treatments

What is the sublingual gland?

The sublingual gland is a salivary gland about the size of an almond that lies underneath the tongue in the floor of your mouth. Saliva drains from it through a number of small tubes that open on the inside of the mouth underneath the tongue. The most common reason for removing a sublingual gland is as a result of a blockage to these drainage tubes. This can lead to a swelling (ranula).

What does the operation involve?

The sublingual gland is removed under a general anaesthetic, ie: you are put to sleep completely. The operation involves making a cut around 2cm long (1½") underneath the tongue on the inside of the lower teeth. Once the gland has been removed the incision is held together again with stitches. These are usually dissolvable but may take several weeks to disappear.

How long will the operation take?

The length of time partly depends upon the degree of difficulty. In an uncomplicated procedure it will take approximately 30 minutes to remove the sublingual gland.

What can I expect after the operation?

You usually require a night in hospital following the surgery. It is unlikely to be very sore but regular painkillers will be arranged for you. There is relatively little swelling following submandibular gland removal.

Do I need any time off work?

It is usually advisable to take a week off work to recover from the surgery. During this time you should avoid strenuous activity. It is important to remember that you will not be able to drive or operate machinery for 48 hours after your general anaesthetic.

Will I have a scar?

At the time of surgery the wound is only gently held together with a few stitches so initially you will see some gaps. Please do not be concerned by this. All cuts leave a scar but inside the mouth the majority of these fade with time and are difficult to see when they are fully healed. It will take a couple of months for your scar to fade completely.

What are the possible problems?
  • Bleeding from the wound is unlikely to be a problem. If it occurs it usually does so within the first 12 hours of surgery which is why you need to stay in hospital overnight.
  • Infection is uncommon but if your surgeon thinks it may happen to you a short course of antibiotics will be arranged.
What are the possible complications?

There are potential complications with any operation. Fortunately with this type of surgery complications are rare and may not happen to you. However it is important that you are aware of them and have the opportunity to discuss them with your surgeon.

  • Numbness of the tongue - the lingual nerve which supplies feeling to the side of the tongue can become bruised as a result of surgery. If this occurs you will experience a tingly or numb feeling in the tongue, similar to the sensation after having an injection at the dentist. This numbness may take several months to disappear and in a minority of patients may last for ever.
  • Damage to the submandibular duct - the submandibular duct is the name of the tube which carries saliva from the submandibular gland into the mouth. The submandibular gland is a salivary gland about the size of a plum that lies immediately below the lower jaw at the top of the neck. The duct runs close to the sublingual gland before opening on the inside of the mouth under the tongue immediately behind the lower front teeth. If this duct is damaged saliva may not drain properly from the submandibular gland and the gland may therefore swell in the upper part of the neck. The majority of these swellings settle down on their own.
Are there are any long-term effects of having my sublingual gland removed?

The removal of one sublingual gland will not have an impact on the amount of saliva that you produce. There are many other saliva glands left in and around your mouth that will still keep it moist.

Will I need further appointments?

A review appointment will be arranged before you leave hospital to see your surgeon again.

Parotid Gland

What is the parotid gland?

The parotid gland is a salivary gland that lies immediately in front of the ear. Saliva drains from it through a tube that opens on the inside of the cheek next to the upper back teeth. The parotid gland is most commonly operated on to remove a lump.

What does the operation involve?

The parotid gland is removed under general anaesthesia, ie you are put to sleep completely. The operation involves making a cut immediately in front of the ear. This cut is extended either downwards into the neck or behind the ear. Once the gland has been removed the incision is held together again with stitches. These need to be removed around a week after surgery. At the end of the operation a small tube is also placed through the skin into the underlying wound to drain any blood which may collect. This is usually removed on the morning following surgery.

Will anything else be done while I am asleep?

If your gland is being removed because of infection that is caused by a stone it may also be necessary to make a cut inside the mouth to remove that stone.

How long will the operation take?

Removal of all or part of the parotid gland is a complicated operation which takes approximately two hours.

What can I expect after the operation?

You usually need a night in hospital following the surgery. It is unlikely to be very sore but regular painkillers will be arranged for you. There is relatively little swelling following parotid gland removal. Since part of the gland is taken away it can leave a dent under the skin.

Do I need any time off work?

It is usually advisable to take a week off from work to recover from the surgery. During this time you should avoid strenuous activity.

Is there anything that I need to do when I get home?

It is important to keep the wound dry for the first week following surgery. This obviously means you need to take care when washing or shaving.

Will I have a scar?

All cuts made through the skin leave a scar but the majority of these fade with time and are difficult to see when they are fully healed. It may take several months for your scar to fade but eventually it should blend into the natural folds and contours of your face.

What are the possible problems?
  • Bleeding from the wound is unlikely to be a problem. If it occurs it usually does so within the first 12 hours of surgery which is why you need to stay in hospital overnight.
  • Infection is uncommon but if your surgeon thinks it may happen to you a short course of antibiotics will be prescribed.
  • Sometimes saliva leaks out of the wound (salivary fistula). This problem usually settles down on its own but can take several weeks to get better.
The surgeon tells me that damage to nerves is possible. What does this mean?

The facial nerve runs directly through the centre of the parotid gland. It is the nerve that makes the muscles of the face work. Damage to some or all of that nerve can result in weakness of the muscles on one side of your face. Most nerve damage occurs as a result of bruising since the facial nerve is held out of the way and protected during surgery. If nerve damage occurs it is usually temporary although it can take several months to recover fully.

The nerve that supplies feeling to your ear lobe (greater auricular nerve) sometimes requires removal to gain access to the parotid gland and as a result you may end up with a numb or tingling feeling in your ear lobe.

Is permanent nerve damage possible?

Although the majority of damage to the nerves is temporary permanent damage is possible but usually only occurs in the most difficult cases.

Are there any long-term effects if I have my parotid gland removed?

The removal of one parotid gland will not have an impact on the amount of saliva that you produce. There are many other salivary glands left in and around the mouth that will still keep it moist.

Some patients notice that the skin in and around the ear sweats excessively after the parotid gland has been removed (gustatory sweating, Frey's syndrome). The sweating is particularly noticeable around mealtime when the skin can also turn red and feel warm. If this occurs it can usually be alleviated with simple treatments that do not require further surgery.

Submandibular Gland

What is the submandibular gland?

The submandibular gland is a salivary gland about the size of a plum that lies immediately below the lower jaw. Saliva drains from it through a tube that opens on the inside of the mouth under the tongue immediately behind the lower front teeth. The most common reason for removing a submandibular gland is as a result of infection that occurs if the tubes that drain saliva become blocked. Blockages usually arise as a result of stones.

What does the operation involve?

The submandibular gland is removed under a general anaesthetic, ie you are put to sleep completely. The operation involves a cut around two inches long (5cm) in the upper part of the neck just below the jaw line. Once the gland has been removed the incision is held together again with stitches. These usually need to be removed around a week after surgery. At the end of the operation a small tube is also placed through the skin into the underlying wound to drain any blood which may collect. This is usually removed on the morning following surgery.

Will anything else be done while I am asleep?

If your gland is being removed because of infection that is caused by a stone it may also be necessary to make a cut inside the mouth to remove that stone.

How long will the operation take?

The length of time partly depends upon the degree of difficulty. In an uncomplicated procedure it will take approximately 45 minutes to remove the submandibular gland.

What can I expect after the operation?

You usually require a night in hospital following the surgery. It is unlikely to be very sore but regular painkillers will be arranged for you. There is relatively little swelling following submandibular gland removal.

Do I need any time off work?

It is usually advisable to take a week off from work to recover from the surgery. During this time you should avoid strenuous activity.

Is there anything that I need to do when I get home?

It is important to keep the wound dry for the first week following surgery. This obviously means you need to take care when washing or shaving.

Will I have a scar?

All cuts made through the skin leave a scar but the majority of these fade with time and are difficult to see when they are fully healed. It may take several months for your scar to fade but eventually it should blend into the natural folds and contours of your face.

What are the possible problems?
  • Bleeding from the wound is unlikely to be a problem. If it occurs it usually does so within the first 12 hours of surgery which is why you need to stay in hospital overnight.
  • Infection is uncommon but if your surgeon thinks it may happen to you a short course of antibiotics will be prescribed.
The surgeon tells me that damage to nerves is possible. What does this mean?

There are three nerves that lie close to the submandibular gland that can be damaged during its removal. Most nerve damage occurs as a result of bruising of the nerves since they are held out of the way and protected during surgery. If nerve damage occurs it is usually temporary. There are three nerves that can be damaged all with varying results:

  • Weakness of the lower lip - a lower branch of the facial nerve is the nerve most likely to be bruised in the removal of a submandibular gland. If bruising occurs it affects the movement of your lower lip, leading to a slightly crooked smile.
  • Numbness of the tongue - the lingual nerve is rarely bruised. Since it is the nerve that supplies feeling to the side of the tongue bruising results in a tingly or numb feeling in the tongue, similar to the sensation after having an injection at the dentist.
  • Restricted tongue movement - the hypoglossal nerve is only very rarely bruised. It is a nerve that makes the tongue move and damage can therefore result in decrease of tongue movement.
Is permanent nerve damage possible?

The majority of damage to nerves is temporary although it can take several months for them to recover. Permanent damage is possible and usually occurs in only the most difficult cases.

If a salivary gland is removed will I be left with a dry mouth?

The removal of one submandibular gland will not have an impact on the amount of saliva that you produce. There are many other salivary glands left in and around the mouth that will still keep it moist.

*Information kindly provided by the British Association of Oral and Maxillofacial Surgeons www.baoms.org.uk