Resection of benign tumours of the submandibular gland with harmonic scalpel-assisted minimally extracapsular dissection

Objective: This study was performed to compare the oncologic and functional outcomes in patients with benign submandibular gland (SMG) tumours after harmonic scalpel-assisted minimally extracapsular dissection (HS-MECD) or total gland excision (TGE). Methods: In total, 133 consecutive patients who were preoperatively diagnosed with benign SMG tumours (pleomorphic adenoma, Warthin's tumour, basal cell adenoma, or lymphoepithelial cyst) from 2013 to 2016 were included in this two-centre retrospective study. Sixty-four patients underwent HS-MECD and 69 patients underwent TGE. All tumours were within 4 cm. Surgical variables, complications, functional outcomes, and recurrence rates were evaluated. Results: The operation time, blood loss, drainage time and volume, and length of hospital stay were significantly lower in the HS-MECD than TGE group. HS-MECD reduced local pain and transient facial nerve paralysis outcomes. Incision scars and facial deformities were less visible according to the visual analogue scale. No significant differences were found in either unstimulated or stimulated whole saliva at 1 month postoperatively, whilst higher unstimulated levels were detected in the HS-MECD group at 6 months. The recurrence rate was similar between the two groups. Conclusion: For benign SMG tumours of <4 cm, HS-MECD represents a less invasive technique than TGE and affords patients increased postoperative functionality.