Submandibular duct repositioning after excision of floor of mouth cancer.

ABSTRACT

PURPOSE: Floor-of-mouth cancers frequently involve the submandibular duct. When neck dissection, which removes the submandibular gland, is not planned, the duct requires repositioning and cannulation to avoid obstructive sialoadenitis caused by scarring and stricture after excision of the primary lesion. A swollen submandibular salivary gland may be difficult to differentiate from a metastatic node and complicate subsequent oncologic management. This study reviews the clinical course and complications after repositioning and cannulation of the submandibular duct. PATIENTS AND METHODS: Thirteen patients who underwent 21 duct cannulations over a 25-month period were reviewed for assessment of submandibular gland function and complications of the procedure. RESULTS: Only two patients (15%) had episodes of postoperative neck swelling during follow-up. The commonest complication was early loss of the cannula in 7 of 21 patients (33%). There were no cases of local recurrence of the tumor, and only 1 patient of 10 with carcinomas had later cervical metastasis. CONCLUSIONS: Repositioning and cannulation of the submandibular duct is a sound procedure that does not compromise the cancer resection. The problem of later chronic swelling of the salivary gland is avoided. Fixation of the catheter has been inadequate in one third of patients.