Overview
Patients now ask for reduction of the submandibular glands, which can bulge under the jaw, but most plastic surgeons get no formal training in the procedure. The authors present a seven-step operative sequence built from more than 24 years of one surgeon's experience. They reviewed records from 2018 to 2022 of patients who had a deep neck lift that included gland reduction.
Findings
- 1,100 patients reviewed; 922 had submandibular gland reduction (1,844 glands).
- All anterior neck lift patients had temporary weakness of the lower lip on both sides; recovery was uneven between sides in 7.1%.
- Temporary dry mouth (xerostomia): 2 patients.
- Recurrent gland inflammation (sialadenitis): 1 patient.
- No sialoceles, no uncontrolled bleeding during surgery, no postoperative hematomas.
- The seven steps: (1) incision placement, (2) wide platysma elevation, (3) visual axis optimization, (4) optical cavity creation, (5) gland mobilization, (6) controlled reduction (Carina technique), (7) capsular reconstruction.
What it means for a patient
- Gland reduction can be part of a deep neck lift when the glands cause fullness under the jaw.
- In this series, every patient who had the front-of-neck approach had temporary lower lip weakness. Ask your surgeon how long recovery took and what to expect.
- Serious problems such as saliva collections and blood collections did not occur in this series.
- These are one expert surgeon's results. The authors state the method does not replace the anatomic knowledge and judgment needed to perform it.
Why this paper matters
It gives a named, step-by-step sequence for submandibular gland reduction and reports complications across 1,844 glands. The authors present it as a teaching framework for surgeons who have little formal training in this procedure.
Terms
- Submandibular gland (SMG): a saliva gland under each side of the jaw that can cause fullness in the upper neck.
- Deep cervicoplasty: a neck lift that treats structures below the platysma muscle.
- Platysma: the thin muscle that covers the front of the neck.
- Xerostomia: dry mouth.
- Sialadenitis: inflammation or infection of a saliva gland.
- Sialocele: a collection of saliva under the skin after gland surgery.
- Capsular reconstruction: closing the thin outer layer of the gland after part of it is removed.