Submandibular Gland Preservation during Concurrent Neck Dissection and Transoral Surgery for Oropharyngeal Squamous Cell Carcinoma

Abstract

Objectives: Analyze the effect of ipsilateral submandibular gland preservation on patients undergoing concurrent neck dissection and transoral surgery for oropharyngeal squamous cell carcinoma. Evaluate for 1) intraoperative communications between the oropharynx and neck, 2) postoperative salivary leaks, and 3) oncologic outcomes. Methods: Retrospective chart review of oropharyngeal squamous cell carcinoma patients undergoing transoral surgery with simultaneous neck dissection(s) at a tertiary referral center between 1999 and 2013 with analysis of operative technique, pathologic diagnosis, postoperative course, complications, and oncologic outcomes. Results: Overall 253 patients were identified. Of these, 96 patients underwent ipsilateral submandibular gland preservation and 157 underwent ipsilateral submandibular gland removal at the time of neck dissection. The prevalence of intraoperative communication between the neck and oropharynx was significantly lower ( P = 0.0017) in cases with submandibular gland preservation (2.08%, n = 2) compared to those with submandibular gland removal (14.13%, n = 22). Similarly, there were fewer postoperative salivary leaks with gland preservation. No postoperative leaks occurred in the gland preservation group (0%, n = 0) compared to a leak prevalence of 8.92% (n = 14) when the gland was removed ( P = 0.0041). There was no difference in local ( P = 0.2208), regional ( P =0.9624), or distant disease ( P = 0.7523) recurrence between the groups. Conclusions: Submandibular gland preservation during neck dissection in patients undergoing transoral surgery for oropharyngeal squamous cell carcinoma reduces the risk of intraoperative and postoperative salivary leaks without compromising oncologic outcomes.