Kocaeli Health Sciences University, Derince Training and Research Hospital, Department of Otorhinolaryngology & Head and Neck Surgery, İbni Sina Mah, Lojman Sok, 41090 Derince/Kocaeli, Turkey.
Kocaeli Health Sciences University, Derince Training and Research Hospital, Department of Otorhinolaryngology & Head and Neck Surgery, İbni Sina Mah, Lojman Sok, 41090 Derince/Kocaeli, Turkey.
J Stomatol Oral Maxillofac Surg. 2020 Nov;121(5):501-505. doi: 10.1016/j.jormas.2019.12.017. Epub 2020 Jan 2.
Resection of the submandibular gland (SMG) is a common surgery and many surgeons leave a drainage system in the surgical field. However, surgical drain may increase risk of complication and related prolonged hospitalization time. The purpose of this study was to investigate the safety of SMG resection without any surgical drainage system.
This retrospective trial on SMG surgery was conducted between 2016 and 2019. Patients were assigned into one of two main groups: surgical drain (+) (n=20) and surgical drain (-) (n=17). All surgical procedures were done via a standardized surgical technique. Facial vessels were dissected and only glandular branches were ligated. Also, non-identification method was applied for marginal mandibular nerve (MMN) protecting. In surgical drain (-) group, before the wound closure, oxidized regenerated cellulose (ORC) was placed in the surgical field. Moreover, a closed suction drain was inserted in surgical drain (+) group.
A total of 37 SMG resections were performed: 15 patients had sialolithiasis, 14 patients had pleomorphic adenoma and 8 patients had chronic sialadenitis. There were 20 women (54%) and 17 men (46%), with an age range of 23-70 years. No major complications were observed in surgical drain (-) group. There were two cases with minor complications. One patient (5.8%) occurred transient paralysis of the MMN. Other patient developed seroma and it was easily managed with repeated punctures. ORC related allergic reaction or adverse incident were not detected in any of the patients. On the other hand, in surgical drain (+) group, 2 patients (10%) developed a hematoma on the first postoperative day and local wound infection was detected in 4 patients (20%). We found that the surgical drain usage was related to prolonged hospitalization, worse wound healing and problems with scarring.
Our findings provide evidence for the safe drainless resection of the SMG using ORC. It may be possible to prevent all of these undesirable conditions by a surgery which performed without drain insertion.
下颌下腺切除术是一种常见的手术，许多外科医生会在手术部位放置引流系统。然而，手术引流可能会增加并发症的风险，并导致住院时间延长。本研究旨在探讨不使用任何外科引流系统行下颌下腺切除术的安全性。
这是一项回顾性的下颌下腺手术研究，于 2016 年至 2019 年进行。患者被分为两组：引流组（+）（n=20）和引流组（-）（n=17）。所有手术均采用标准化手术技术进行。分离面动脉，并结扎腺体分支。另外，还应用非识别法保护下颌缘支。在引流组（-）中，在关闭伤口之前，将氧化再生纤维素（ORC）置于手术部位。引流组（+）中则插入封闭式负压引流管。
共进行了 37 例下颌下腺切除术：涎石症 15 例，多形性腺瘤 14 例，慢性涎腺炎 8 例。患者中女性 20 例（54%），男性 17 例（46%），年龄 23-70 岁。引流组（-）中无严重并发症。有两例轻微并发症。一例患者（5.8%）出现下颌缘支暂时性瘫痪。另一例患者出现血清肿，经多次穿刺即可轻松处理。在任何患者中均未发现 ORC 相关过敏反应或不良事件。另一方面，引流组（+）中有 2 例（10%）患者在术后第 1 天出现血肿，4 例（20%）患者出现局部伤口感染。我们发现，引流的使用与住院时间延长、伤口愈合不良和瘢痕形成问题有关。
我们的研究结果为使用 ORC 安全地进行无引流的下颌下腺切除术提供了证据。通过不插入引流管的手术，可能可以预防所有这些不良情况。
