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Submandibular Gland Reduction in Aesthetic Surgery of the Neck: Review of 112 Consecutive Cases.

Mendelson BC, Tutino R - Plast. Reconstr. Surg. (2015)

Bottom Line: Despite this, submandibular gland reduction does not appear to be widely adopted, nor have significant case series been reported in the literature.This review of a consecutive series of aesthetic submandibular gland reductions was undertaken to provide a perspective about its place in neck contouring.Therapeutic, IV.

View Article: PubMed Central - PubMed

Affiliation: Toorak, Victoria, Australia; and Toronto, Ontario, Canada From The Centre for Facial Plastic Surgery and Trillium Health Partners, Joseph Brant Hospital.

ABSTRACT

Background: The indications for reduction of excessive submandibular gland volume in aesthetic rejuvenation of the neck have been well described, as has the surgical anatomy and the surgical technique. Despite this, submandibular gland reduction does not appear to be widely adopted, nor have significant case series been reported in the literature. This review of a consecutive series of aesthetic submandibular gland reductions was undertaken to provide a perspective about its place in neck contouring.

Methods: A retrospective chart review was conducted of all patients on whom the senior author (B.C.M.) had performed submandibular gland reduction for aesthetic reasons. Complications and reoperations were specifically analyzed.

Results: Submandibular gland reduction was performed in 112 of 736 consecutive face lifts between 2002 and 2013, an incidence of 13 percent in primary face lifts and 25 percent in secondary face lifts. The median patient age was 57 years, and 87 percent were women. Major complications were those requiring early reoperation (1.8 percent) to manage significant hematomas; one was potentially fatal. Minor complications (10.8 percent) were managed nonoperatively. Submandibular sialocele (4.5 percent) and marginal mandibular branch neurapraxia (4.5 percent) were the most frequent, and all resolved fully by 3 months. Significantly, no patient reported a permanent dry mouth.

Conclusions: The complication rate with submandibular gland reduction is comparable to that of a neck lift with platysma plication alone, with some additional specific risks: (1) catastrophic airway compression from bleeding deep in the neck, (2) significant increase of neurapraxias in secondary neck lifts, and (3) a moderate incidence of benign submandibular sialocele.

Clinical question/level of evidence: Therapeutic, IV.

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Related in: MedlinePlus

Patient series showing the results of three procedures over 13 years. These show the difference between neck fullness attributable to fat excess and submandibular gland prominence. (Left) A 39-year-old female patient shown preoperatively. (Right) At age 45, 6 years after primary face lift, with midline platysmaplasty, and no defatting submental or subplatysmal and no submandibular gland surgery. Also, placement of prejowl silicone jawline implant (medium size), coronal brow lift, upper and lower blepharoplasties were performed.
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Figure 2: Patient series showing the results of three procedures over 13 years. These show the difference between neck fullness attributable to fat excess and submandibular gland prominence. (Left) A 39-year-old female patient shown preoperatively. (Right) At age 45, 6 years after primary face lift, with midline platysmaplasty, and no defatting submental or subplatysmal and no submandibular gland surgery. Also, placement of prejowl silicone jawline implant (medium size), coronal brow lift, upper and lower blepharoplasties were performed.

Mentions: Prominent submandibular glands present an aesthetic concern in two patient categories.4,10,14 Primary face-lift patients with detectable prominence of the glands contributing to their neck fullness, and secondary patients dissatisfied with their neck contour following a previous face/neck lift, because the glandular prominence had either been overlooked or not fully appreciated until further revealed by correction of their neck laxity (Figs. 2 and 3). The 25 percent incidence of submandibular gland surgery in our secondary/tertiary face-lift patients was twice that of the primary cases. Presumably, this represents patients whose underlying glandular pathologic condition had not been addressed, and the prominence increasing over subsequent years (Fig. 4).


Submandibular Gland Reduction in Aesthetic Surgery of the Neck: Review of 112 Consecutive Cases.

Mendelson BC, Tutino R - Plast. Reconstr. Surg. (2015)

Patient series showing the results of three procedures over 13 years. These show the difference between neck fullness attributable to fat excess and submandibular gland prominence. (Left) A 39-year-old female patient shown preoperatively. (Right) At age 45, 6 years after primary face lift, with midline platysmaplasty, and no defatting submental or subplatysmal and no submandibular gland surgery. Also, placement of prejowl silicone jawline implant (medium size), coronal brow lift, upper and lower blepharoplasties were performed.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4548544&req=5

Figure 2: Patient series showing the results of three procedures over 13 years. These show the difference between neck fullness attributable to fat excess and submandibular gland prominence. (Left) A 39-year-old female patient shown preoperatively. (Right) At age 45, 6 years after primary face lift, with midline platysmaplasty, and no defatting submental or subplatysmal and no submandibular gland surgery. Also, placement of prejowl silicone jawline implant (medium size), coronal brow lift, upper and lower blepharoplasties were performed.
Mentions: Prominent submandibular glands present an aesthetic concern in two patient categories.4,10,14 Primary face-lift patients with detectable prominence of the glands contributing to their neck fullness, and secondary patients dissatisfied with their neck contour following a previous face/neck lift, because the glandular prominence had either been overlooked or not fully appreciated until further revealed by correction of their neck laxity (Figs. 2 and 3). The 25 percent incidence of submandibular gland surgery in our secondary/tertiary face-lift patients was twice that of the primary cases. Presumably, this represents patients whose underlying glandular pathologic condition had not been addressed, and the prominence increasing over subsequent years (Fig. 4).

Bottom Line: Despite this, submandibular gland reduction does not appear to be widely adopted, nor have significant case series been reported in the literature.This review of a consecutive series of aesthetic submandibular gland reductions was undertaken to provide a perspective about its place in neck contouring.Therapeutic, IV.

View Article: PubMed Central - PubMed

Affiliation: Toorak, Victoria, Australia; and Toronto, Ontario, Canada From The Centre for Facial Plastic Surgery and Trillium Health Partners, Joseph Brant Hospital.

ABSTRACT

Background: The indications for reduction of excessive submandibular gland volume in aesthetic rejuvenation of the neck have been well described, as has the surgical anatomy and the surgical technique. Despite this, submandibular gland reduction does not appear to be widely adopted, nor have significant case series been reported in the literature. This review of a consecutive series of aesthetic submandibular gland reductions was undertaken to provide a perspective about its place in neck contouring.

Methods: A retrospective chart review was conducted of all patients on whom the senior author (B.C.M.) had performed submandibular gland reduction for aesthetic reasons. Complications and reoperations were specifically analyzed.

Results: Submandibular gland reduction was performed in 112 of 736 consecutive face lifts between 2002 and 2013, an incidence of 13 percent in primary face lifts and 25 percent in secondary face lifts. The median patient age was 57 years, and 87 percent were women. Major complications were those requiring early reoperation (1.8 percent) to manage significant hematomas; one was potentially fatal. Minor complications (10.8 percent) were managed nonoperatively. Submandibular sialocele (4.5 percent) and marginal mandibular branch neurapraxia (4.5 percent) were the most frequent, and all resolved fully by 3 months. Significantly, no patient reported a permanent dry mouth.

Conclusions: The complication rate with submandibular gland reduction is comparable to that of a neck lift with platysma plication alone, with some additional specific risks: (1) catastrophic airway compression from bleeding deep in the neck, (2) significant increase of neurapraxias in secondary neck lifts, and (3) a moderate incidence of benign submandibular sialocele.

Clinical question/level of evidence: Therapeutic, IV.

Show MeSH
Related in: MedlinePlus