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.
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.
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.