Video-assisted submandibular sialadenectomy using an ultrasonic scalpel

Objective: To evaluate the benefits in video-assisted submandibular sialadenectomy by using an ultrasonically activated scalpel (HS: Harmonic Scalpel®, Ethicon, Somerville, NJ) and a special handmade lifting device. Methods: The study cohort consisted of four male patients. We considered that the intraglandular part sialolithiasis of the submandibular glands was the main indicator for this technique. Under general anesthesia, a 15–20 mm skin incision was performed just above the inferior margin of the submandibular gland lying parallel to the mandible. We used a 4 mm diameter endoscope that we normally use for paranasal sinus surgery. Appropriate working space was created using a special handmade lifting device that was constructed from a wooden tongue depressor. By using HS, we dissected between the capsule and the circumferential tissue in order to minimize the possibility of damage to the facial nerve and lingual nerve. The submandibular gland was pulled out through the surgical wound, and Whartonʹs duct was then suture-ligated and resected. Results: Endoscopic operation without recourse to conventional open surgery was achieved in all patients. No patients suffered any complications, such as functional disorder of the marginal mandibular, hypoglossal and lingual nerves, or wound hematoma formation. Excellent cosmesis was obtained in all patients. The amount of intraoperative bleeding ranged from 10 to 60 ml (mean: 38.0 ml). The operating time ranged from 175 to 250 min (mean: 232.5 min). Conclusions: We applied two useful devices to achieve the endoscopic submandibular surgery: an HS and a special handmade lifting device. Excellent cosmesis was obtained in all patients without complications. The disadvantage of this method is that the surgery is more time-consuming than conventional open methods.