Drainless Resection of the Submandibular Gland with Facial Vessel Preservation: A Comparative Study

Abstract Objective: Resection of the submandibular gland (SMG) is a common surgery and many surgeons leave a drainage system in the surgical field. However, surgical drain may increase risk of complication and related prolonged hospitalization time. The purpose of this study was to investigate the safety of SMG resection without any surgical drainage system. Methods: This retrospective trial on SMG surgery was conducted between 2016 and 2019. Patients were assigned into one of two main groups: surgical drain (+) (n=20) and surgical drain (-) (n=17). All surgical procedures were done via a standardized surgical technique. Facial vessels were dissected and only glandular branches were ligated. Also, non-identification method was applied for marginal mandibular nerve (MMN) protecting. In surgical drain (-) group, before the wound closure, oxidized regenerated cellulose (ORC) was placed in the surgical field. Moreover, a closed suction drain was inserted in surgical drain (+) group. Results: A total of 37 SMG resections were performed: 15 patients had sialolithiasis, 14 patients had pleomorphic adenoma and 8 patients had chronic sialadenitis. There were 20 women (54%) and 17 men (46%), with an age range of 23-70 years. No major complications were observed in surgical drain (-) group. There were two cases with minor complications. One patient (5.8%) occurred transient paralysis of the MMN. Other patient developed seroma and it was easily managed with repeated punctures. ORC related allergic reaction or adverse incident were not detected in any of the patients. On the other hand, in surgical drain (+) group, 2 patients (10%) developed a hematoma on the first postoperative day and local wound infection was detected in 4 patients (20%). We found that the surgical drain usage was related to prolonged hospitalization, worse wound healing and problems with scarring. Conclusion: Our findings provide evidence for the safe drainless resection of the SMG using ORC. It may be possible to prevent all of these undesirable conditions by a surgery which performed without drain insertion.