Oral facial surgery Surgical prcedure infrmatin leaflet Name f prcedure: Remval f submandibular salivary gland This leaflet explains sme f the benefits, risks and alternatives t the peratin. We want yu t have an infrmed chice s yu can make the right decisin. Please ask yur surgical team abut anything yu d nt fully understand r want t be explained in mre detail. We recmmend that yu read this leaflet carefully. Yu and yur dctr (r ther apprpriate health prfessinal) will als need t recrd that yu agree t have the prcedure by signing a cnsent frm, which yur health prfessinal will give yu. What is the submandibular gland? The submandibular gland is a salivary gland abut the size f a plum that lies immediately belw the lwer jaw. Saliva drains frm it thrugh a tube that pens n the inside f the muth under the tngue immediately behind the lwer frnt teeth. The mst cmmn reasn fr remving a submandibular gland is as a result f infectin that ccurs if the tubes that drain saliva becme blcked. Blckages usually arise as a result f stnes What des the peratin invlve? The submandibular gland is remved under a general anaesthetic, yu are put t sleep cmpletely. The peratin invlves a cut arund tw inches lng (5cm) in the upper part f the neck just belw the jaw line. Once the gland has been remved the incisin is held tgether again with stitches. These usually need t be remved arund a week after surgery. At the end f the peratin a small tube is als placed thrugh the skin int the underlying wund t drain any bld which may cllect. This is usually remved n the mrning fllwing surgery. If a salivary gland is remved will I be left with a dry muth? The remval f ne submandibular gland will nt have an impact n the amunt f saliva that yu prduce. There are many ther salivary glands left in and arund the muth that will still keep it mist. Will anything else be dne while I am asleep? If yur gland is being remved because f infectin that is caused by a stne it may als be necessary t make a cut inside the muth t remve that stne. Hw lng will the peratin take? The length f time partly depends upn the degree f difficulty. In an uncmplicated prcedure it will take apprximately 45 minutes t remve the submandibular gland. Benefits f the prcedure The aim f the prcedure is t remve the disease in yur salivary gland. Serius r frequent risks Everything we d in life has risks. Remval f the submandibular salivary gland is generally a safe peratin with few risks. The general risks f surgery include prblems with: the wund (fr example, infectin); breathing (fr example, a chest infectin); Surgical prcedure infrmatin leaflet 1 f 6 Versin 1.7 Remval f submandibular salivary gland Expiry date: 24 th June 2017
the heart (fr example, abnrmal rhythm r, ccasinally, a heart attack); and bld clts (fr example, in the legs r ccasinally in the lung). Thse specifically related t remval f the submandibular salivary gland include prblems with the fllwing. Infectin Infectin is uncmmn but if yur surgen thinks it may happen t yu a shrt curse f antibitics will be prescribed. Bleeding Bleeding frm the wund is unlikely t be a prblem. If it ccurs it usually des s within the first 12 hurs f surgery which is why yu need t stay in hspital vernight. Scarring f the skin All cuts made thrugh the skin leave a scar but the majrity f these fade with time and are difficult t see when they are fully healed. It may take several mnths fr yur scar t fade but eventually it shuld blend int the natural flds and cnturs f yur face. Numbness f the tngue The lingual nerve is rarely bruised. Since it is the nerve that supplies feeling t the side f the tngue bruising results in a tingly r numb feeling in the tngue, similar t the sensatin after having an injectin at the dentist. Weakness f the lwer lip A lwer branch f the facial nerve is the nerve mst likely t be bruised in the remval f a submandibular gland. If bruising ccurs it affects the mvement f yur lwer lip, leading t a slightly crked smile. Restricted tngue mvement The hypglssal nerve is nly very rarely bruised. It is a nerve that makes the tngue mve and damage can therefre result in decrease f tngue mvement. Is permanent nerve damage pssible? The majrity f damage t nerves is temprary althugh it can take several mnths fr them t recver. Permanent damage is pssible and usually ccurs in nly the mst difficult cases. Are there are any lng-term effects f having my submandibular gland remved? The remval f ne sublingual gland will nt have an impact n the amunt f saliva that yu prduce. There are many ther saliva glands left in and arund yur muth that will still keep it mist. Mst peple will nt experience any serius cmplicatins frm their surgery. The risks increase fr the elderly peple, thse wh are verweight and individuals wh already have heart, chest r ther medical cnditins such as diabetes r kidney failure. As with all surgery, there is a risk that yu may die. Yu will be cared fr by a skilled team f dctrs, nurses and ther healthcare wrkers wh are invlved in this type f surgery every day. If prblems arise, we will be able t assess them and deal with them apprpriately. Other prcedures that are available Remval f a stne frm the duct if present, by surgery, endscpy r lithtripsy if practical Surgical prcedure infrmatin leaflet 2 f 6 Versin 1.7 Remval f submandibular salivary gland Expiry date: 24 th June 2017
Yur anaesthetic We will usually carry ut yur surgery under a general anaesthetic. This means that yu will be asleep during yur peratin and yu will feel nthing. Befre yu cme int hspital There are sme things yu can d t prepare yurself fr yur peratin and reduce the chance f difficulties with the anaesthetic. If yu smke, cnsider giving up fr several weeks befre the peratin. Smking reduces the amunt f xygen in yur bld and increases the risks f breathing prblems during and after an peratin. If yu are verweight, many f the risks f anaesthesia are increased. Reducing yur weight will help. If yu have lse r brken teeth r crwns that are nt secure, yu may want t visit yur dentist fr treatment. The anaesthetist will usually want t put a tube in yur thrat t help yu breathe. If yur teeth are nt secure, they may be damaged. If yu have lng-standing medical prblems, such as diabetes, hypertensin (high bld pressure), asthma r epilepsy, yu shuld cnsider asking yur GP t give yu a check-up. Yur pre-surgery visit by the anaesthetist After yu cme int hspital, the anaesthetist will cme t see yu and ask yu questins abut: yur general health and fitness; any serius illnesses yu have had; any prblems with previus anaesthetics; medicines yu are taking; allergies yu have; chest pain; shrtness f breath; heartburn; prblems with mving yur neck r pening yur muth; and any lse teeth, caps, crwns r bridges. Yur anaesthetist will discuss with yu the different methds f anaesthesia they can use. After talking abut the benefits, risks and yur preferences, yu can then decide tgether what is best fr yu. Als, befre yur peratin a member f the theatre nursing staff may visit yu. He r she will be able t answer any questins yu may have abut what t expect when yu g t theatre. On the day f yur peratin Nthing t eat and drink (nil by muth) It is imprtant that yu fllw the instructins we give yu abut eating and drinking. We will ask yu nt t eat r drink anything fr six hurs befre yur peratin. This is because any fd r liquid in yur stmach culd cme up int the back f yur thrat and g int yur lungs while yu are being anaesthetised. Yu may take a few sips f plain water up t tw hurs befre yur peratin s yu can take any medicatin tablets. Yur nrmal medicines Cntinue t take yur nrmal medicines up t and including the day f yur surgery. If we d nt want yu t take yur nrmal medicatin, yur surgen r anaesthetist will explain what yu shuld d. It is imprtant t let us knw if yu are taking anticagulant drugs (fr example, warfarin, aspirin r clpidgrel). We will need t knw if yu dn t feel well and have a cugh, a cld r any ther illness when yu are due t cme int hspital fr yur peratin. Depending n yur illness and hw urgent yur surgery is, we may need t delay yur peratin as it may be better fr yu t recver frm this illness befre yur surgery. Surgical prcedure infrmatin leaflet 3 f 6 Versin 1.7 Remval f submandibular salivary gland Expiry date: 24 th June 2017
Yur anaesthetic When it is time fr yur peratin, a member f staff will take yu frm the ward t the perating theatre. They will take yu int the anaesthetic rm and the anaesthetist will get yu ready fr yur anaesthetic. T mnitr yu during yur peratin, yur anaesthetist will attach yu t a machine t watch yur heart, yur bld pressure and the xygen level in yur bld. General anaesthesia usually starts with an injectin f medicine int a vein. A fine tube (venfln) will be placed in a vein in yur arm r hand and the medicines will be injected thrugh the tube. Smetimes yu will be asked t breathe a mixture f gases and xygen thrugh a mask t give the same effect. Once yu are anaesthetised, the anaesthetist will place a tube dwn yur airway and use a machine t breathe fr yu. Yu will be uncnscius fr the whle f the peratin and we will cntinuusly mnitr yu. Yur anaesthetist will give yu painkilling drugs and fluids during yur peratin. At the end f the peratin yu will be taken t the recvery rm. Pain relief after surgery Pain relief is imprtant as it stps suffering and helps yu recver mre quickly. We will usually give yu tablets, suppsitries r injectins t make sure yu have enugh pain relief. Once yu are cmfrtable and have recvered safely frm yur anaesthetic, we will take yu back t the ward. The ward staff will cntinue t mnitr yu and assess yur pain relief. They will ask yu t describe any pain yu have using the fllwing scale. 0 = N pain 1 = Mild pain 2 = Mderate pain 3 = Severe pain It is imprtant that yu reprt any pain yu have as sn as yu experience it. What are the risks? Yur anaesthetist will care fr all aspects f yur health and safety ver the perid f yur peratin and immediately afterwards. Risks depend n yur verall health, the nature f yur peratin and hw serius it is. General anaesthesia is safer than it has ever been. If yu are nrmally fit and well, yur risk f dying frm any cause while under anaesthetic is less than ne in 250,000. This is 25 times less likely than dying in a car accident. Side effects f having a general anaesthetic include drwsiness, nausea (feeling sick), muscle pain, sre thrat and headache. Side effects f having a spinal anaesthetic are headache, lw bld pressure, itching f the skin due t the drugs injected and temprary difficulty in passing urine. Rare cmplicatins f a spinal anaesthetic are temprary lss f sensatin in yur legs, pins and needles r muscle weakness in yur legs. Permanent damage t the nerves is very rare. We will discuss with yu the risks f yur anaesthetic. What can I expect after the peratin? Yu usually require a night in hspital fllwing the surgery. It is unlikely t be very sre but regular painkillers will be arranged fr yu. There is relatively little swelling fllwing submandibular gland remval. D I need any time ff wrk? It is usually advisable t take a week ff frm wrk t recver frm the surgery. During this time yu shuld avid strenuus activity. Surgical prcedure infrmatin leaflet 4 f 6 Versin 1.7 Remval f submandibular salivary gland Expiry date: 24 th June 2017
Is there anything that I need t d when I get hme? It is imprtant t keep the wund dry fr the first week fllwing surgery. This bviusly means yu need t take care when washing r shaving. Cntact details If yu have any specific cncerns that yu feel have nt been answered and need explaining please cntact the fllwing: Wrcestershire Ryal Hspital Day Case Ward Nursing Staff (phne 01905 760258) Hawthrne Suite Receptin (phne 01905 760212) Kidderminster Treatment Centre Day Case Ward Nursing Staff (phne 01562 826350) Receptin (phne 01562 826397) Alexandra Hspital Receptin (phne 01527 503854) Additinal Infrmatin The fllwing Internet websites cntain additinal infrmatin that yu may find useful: www.wrcestershirehealth.nhs.uk/acute_trust Infrmatin abut Wrcestershire Acute Hspitals NHS Trust www.patient.c.uk Infrmatin fact sheets n health and disease. www.rca.ac.uk Infrmatin leaflets by the Ryal Cllege f Anaesthetists abut 'Having an anaesthetic'. www.nhsdirect.nhs.uk Online Health Encyclpaedia and Best Treatments Website. Patient Services Department It is imprtant that yu speak t the department yu have been referred t (see the cntacts sectin) if yu have any questins (fr example, abut medicatin) befre yur investigatin r prcedure. If yu have any cncerns abut yur treatment, yu can cntact the Patient Services Department n 0300 123 1733. The Patient Services staff will be happy t discuss yur cncerns and give any help r advice. If yu have a cmplaint and yu want it t be investigated, yu shuld write direct t the Chief Executive at Wrcestershire Acute Hspitals NHS Trust, Charles Hastings Way, Wrcester WR5 1DD r cntact the Patient Services Department fr advice. Please cntact Patient Services n 0300 123 1733 if yu wuld like this leaflet in anther language r frmat (such as Braille r easy read). Bengali Surgical prcedure infrmatin leaflet 5 f 6 Versin 1.7 Remval f submandibular salivary gland Expiry date: 24 th June 2017
Urdu Prtuguese Plish Chinese Cmments We wuld value yur pinin n this leaflet, based n yur experience f having this prcedure dne. Please put any cmments in the bx belw and return them t the Clinical Gvernance Department, Finance Department, Wrcestershire Ryal Hspital, Charles Hastings Way, Wrcester, WR5 1DD. Name f leaflet: Date: Cmments: Thank yu fr yur help. Reference: British Assciatin f Oral and Maxillfacial Surgens Surgical prcedure infrmatin leaflet 6 f 6 Versin 1.7 Remval f submandibular salivary gland Expiry date: 24 th June 2017