How can a surgeon avoid damaging the nerve while shaving the salivary glands during my facelift?

Question

How can a surgeon avoid damaging the nerve while shaving the salivary glands during my facelift? Is he able to see it?

Kevin Sadati, DO · Answer

Shaving orexcision of submandibular gland is not necessary in face and neck lift. Anexperienced surgeon can perform this procedure, but there is no guaranty thatthe nerve is not going to be injured.
Submandibular glands are playing a major rolein producing saliva for oral hygiene and food digestion. Removing these glandscan be a risky and compromise salivary function. Older plastic surgeonscommonly remove parts of these large glands to achieve a more angular jawlines.I have performed well over 2500 facelifts and occasionally there are patientswith larger submandibular glands that protrude post operatively. To reduce thesize of these glands I have injected Botox into the glands and there have beensignificant reduction in their size.

Ronald J. Edelson, MD · Answer

I have heard of surgeons removing the salivary glands during a facelift.  Not a good idea at all.  Shaving them?  I have no idea what the surgeon plans to do, but I would advise against it and consider getting another opinion or ask g the surgeon to clarify exactly what is going to be done.  Sounds odd to me.

Boris M. Ackerman, MD · Answer

The goal of a facelift is to create the best result with lowest risk profile.  In certain cases excision of superficial lobe of submandibular gland is needed to get optimal result.  An experienced and talented surgeon can perform this procedure with minimal risk.  Thorough knowledge of anatomy, excellent skills and experience is needed to attempt this maneuver.  Discuss your concerns with your surgeon.

Harold J. Kaplan, MD · Answer

I am assuming you have been offered a partial removal of the submandibular gland as part of your facelift. This is not commonly done and probably can be avoided but if you had a huge and ptotic gland an experienced surgeon in the head and neck region could safely perform the procedure but there is some risk to the marginal mandibular branch of the facial nerve. Nothing should be done to the parotid salivary gland.

James M. Ridgway, MD, FACS · Answer

The question you ask is a very good one. It is not common
for patients to have reduction of the salivary glands (parotid or
submandibular), but in some circumstances it makes all of the difference in the
overall facelift result. To ensure your result it is important that your
surgeon has done this before and has even been involved in removing these
glands for other medical reasons. To this end, you have a professional that is
qualified and understands the detailed anatomy involved in achieving your
overall facelift result.Be healthy and be well, James M. Ridgway, MD, FACS

Jed H. Horowitz, MD, FACS · Answer

Removal of salivary glands with #facelift-surgeryRemoval of the glands is not commonly necessary however they can create a large swelling under the mandible. Surgeons experienced in this method should not have difficulties in avoiding the nerve.

Vincent N. Zubowicz, MD · Answer

Rarely the submandibular glands are removed if they are oversized as part of a facelift. The marginal mandibular branch of the facial nerve is in the vicinity but in the hands of the skill surgeon is at minimal risk.

Robert M. Lowen, MD · Answer

Most surgeons avoid removing or "shaving" the superficial part of the submandibular gland because of the risks of nerve injury and bleeding.The reason for doing any surgery on the gland is because it can appear as a lump in the neck just in front of the angle of the mandible after the skin and platysma muscle are tightened. The gland, even when large, can be hidden behind sagging muscle and skin in the aging face but loses its camouflage when these tissues are tightened. Surgeons offering removal of the superficial part of submandibular gland must be sure they can clearly see the nerve and stay in the proper plane of dissection. Access is done via an incision under the chin and then dissection under the platysma muscle laterally until the gland is visualized. If bleeding occurs it must be controlled precisely and is best prevented by selective bipolar electrocautery. If injury to the marginal mandibular nerve occurs there will be weakness of the muscle that pulls down the angle of the mouth, the depressor anguli oris. Injury to the lingual nerve, while unlikely since it is on the deep surface of the gland, results in loss of taste and sensation to the the anterior one third of the tongue.

David Saadat, MD · Answer

Shaving
the salivary gland is a very risky procedure because of the surrounding nerves.
The surgeon must be well trained in performing those types of surgery.Facial plastic surgeons typically also
specialize in ENT surgeryand are
therefore well-trained in salivary gland surgery.

Barry L. Eppley, MD, DMD · Answer

The two potential salivary glands that can be encountered during a facelift are the parotid and submandibular glands. They very rarely need to be reduced in facelift surgery and neither one is 'shaved' if they need to be treated. The superficial lobe of the parotid gland can be removed on the side of the face and the submandibular gland can be resuspended or removed in the neck. The indications for doing so are rare and there are facial nerve risks for doing so. Stimulating and visibly seeing the nerves that run in and around these glands are the maneuvers done to lessen their risk of injury.

How can a surgeon avoid damaging the nerve while shaving the salivary glands during my facelift?

Answers (17)

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