Assisted-Endoscopic Submandibular Gland Resection Using Lateral Oral Vestibule Approach.
Transoral approach using the floor of the mouth to resect
submandibular gland has been in practice since
a long time; however, the clinical application of the vestibular
approach is a relatively novel
approach.
As per my knowledge, the vestibular approach has only been
implemented to resect the thyroid gland , with the clinical application
of transoral transvestibular
endoscopic approach in the surgical removal of the thyroid gland
being reported for the first
time by Wilhelm et al.
Transoral endoscopic thyroidectomy vestibular approach is
currently in use in various institutions. TOETVA has been proposed,
introduced and clinically
performed in various countries including South Korea, Thailand, India, China, Taiwan,
Singapore, USA, Mexico, Japan, Ecuador and Italy.
We present our opinion on the clinical
procedure of TOETVA. The surgical procedure is carried out using a
three-port technique at the
oral vestibule, by placing one 10-mm port for a 30° endoscope and
two additional 5-mm ports
for the dissecting and coagulating instruments.
Submandibular gland resection has been advocated for the treatment of recurrent or
persistent inflammatory conditions, mucocele,
obstruction of the submandibular duct and neoplasia.
Surgery of the submandibular gland using TOETVA places the marginal mandibular
nerve, the hypoglossal nerve, the mental nerve and the lingual nerve at risk.
The constant anatomical connection of the marginal nerve is with the
mandibular notch. The nerve crosses over
on to the mandible at this point and runs forward.
It positions the parotid gland below the angle
of the mandible, usually at a proximity of 1-2 cm, and takes
an anterior course below the border
of the mandible up to the area of the mandibular notch and the facial vessels.
Otolaryngol Open J. 2017; 3(3): 43-46. doi: 10.17140/OTLOJ-3-141
