Incidence of Wharton's duct stenosis in floor of the mouth cancers excised with scalpel or cautery vs CO2 laser.

Surgery of the floor of the mouth (FOM) using a scalpel or cautery has produced stenosis of Wharton's duct, necessitating further surgery because of painful enlargement to the gland or suspected metastasis. The laser has been proposed as an alternative method that might avoid this complication. A retrospective study comparing these excisional techniques was done at Walter Reed Army Medical Center between 1973 and 1983. Of a total of 58 lesions, 35 were T1N0M0 and 23 were T2N0M0 (two synchronous lesions being present). Of 35 lesions excised with a scalpel, 11 had an associated submandibular gland resection. Of the remaining 25, two developed secondary duct stenosis. Of 10 lesions excised with cautery, three had an associated excision of the submandibular gland. Of the remaining seven, two developed stenosis and one required subsequent excision of the gland. Of 12 lesions excised with laser, four developed stenosis and two required subsequent excision of the gland. Laser excision appears to be of no advantage in avoiding further surgery of the submandibular gland. A submandibular gland resection at the time of the original resection of T1N0 or T2N0 cancers of the FOM does not appear warranted.