Background:

The current tendency is to de-escalate treatment for early oral cancers and manage them with wide local excision and avoid neck dissection and microvascular free-flap reconstruction, to maintain functional outcomes and quality of life. One complication following resection of oral cancers involving the floor of mouth is submandibular gland obstruction, with reported rates varying considerably from 17 to 49%.^1-3 

Obstructed glands not only cause discomfort for patients but can also mask nodal spread. As such, further imaging such as ultrasound scanning is often required. Patients might also fear recurrence, which has been shown to be a dominant concern during follow-up

Objectives:

The study aimed to report rates, associated factors and outcomes of submandibular gland obstruction following surgery for squamous cell carcinoma in the floor of the mouth or ventral tongue without a neck dissection where resection has involved or was in very close proximity to the submandibular duct.

Methods:

A retrospective casenote review was performed on patients having only primary local surgical resection for squamous cell carcinoma of the floor of mouth or ventral tongue between January 2007 to December 2011.

Principle Findings:

There were 62 patients and 15 (24%) developed submandibular gland symptoms post-operatively. Symptoms resolved spontaneously for 14 (93%) of the 15, with the other single patient (7%) having their submandibular duct repositioned. Comparatively, 2/17 (12%) of patients developed symptoms when the duct was repositioned during primary surgery. No patients had their submandibular gland removed.

Conclusion:

Resection of small tumours associated with the floor of mouth and ventral tongue in proximity to the duct is associated with obstructive symptoms in about a quarter of patients and this is reduced by half when redirecting the duct. Symptoms are self-limiting and self-resolving, however a prospective study would help clarify the potential benefits of repositioning the duct.