Glandular Excision Research Articles

Minimally invasive intervention for gynecomastia excision: two case reports

Gynecomastia is characterized by abnormal and excessive development of breast tissue in male patients. Depending on the volume of the breasts and the amount of excess skin, it may be unilateral or bilateral. Surgery is considered the standard of care, with several techniques documented, including different types of incisions made in the periareolar or intra-areolar skin. The most common surgical technique is conventional open surgery, which utilizes a semicircular inferior periareolar incision. To achieve superior aesthetic outcomes, various alternatives to open surgery have been proposed, including vacuum-assisted excision, endoscopic mastectomy, and liposuction Herein, we present two cases involving male patients, aged 29 and 24, who reported bilateral breast enlargement. We used the same incision for both liposuction and glandular excision. Our patients underwent combined liposuction on two planes: subcutaneous and subglandular, accompanied by sharp parenchymal excision. These small incisions, measuring 1–1.5 cm, are discreetly placed within the inframammary fold across the breast width. The patients experienced an uneventful recovery without any complications.

The GLAND-IQ Technique for Surgical Correction of Moderate to Severe Gynecomastia.

Surgical correction of gynecomastia currently ranks in the top five cosmetic procedures performed in men in the United States. Although removal of excess gland is relatively straightforward, the combination of glandular/fatty excess, significant skin redundancy, nipple ptosis, and nipple-areolar complex hypertrophy poses a significant challenge in the male patient desiring inconspicuous scars. The latter renders any form of skin and nipple reduction/elevation using traditional mastopexy patterns or breast amputation with free nipple grafting less favorable due to the surgical stigmata and scars produced with these techniques. To that end, we present our experience treating cases of moderate to severe gynecomastia involving significant skin excess (defined as Simon grade IIb and III) with a technique focused on avoiding visible extra-areolar scars, called the glandular excision, liposuction-assisted, areolar mastopexy for nipple repositioning and skin reduction with internal quilting sutures.

Extensive Ultrasonic Liposuction in Gynecomastia: An Alternative Approach without Surgical Gland Excision

Aim: Skin and gland removals made on the chest wall may result in noticeable scars that can be challenging for patients to tolerate. This study aimed to define an extensive ultrasonic liposuction approach without surgical excision for gynecomastia. We also investigated its effectiveness in reducing complications and improving cosmetic outcomes. Materials and Methods: Gynecomastia patients with Rohrich grades II and III were evaluated according to skin quality. 46 patients who met these criteria underwent ultrasonic liposuction performed by the senior author between February 2021 and April 2023. These patients were compared with 58 who underwent surgery using suction-assisted liposuction combined with peri areolar mastopexy and glandular excision. Results: Our study found that patients who underwent extensive ultrasonic liposuction had a complication rate of 8.7%. Of the total number of patients, only one experienced a seroma complication, and three experienced residual breast tissue/ptosis. None of the patients required revision surgery. In comparison, the control group that underwent peri-areolar mastopexy and glandular excision had a higher complication rate (10.3%). Conclusion: We used the basic principles of plastic surgery for wound contraction. Distributing the wound healing mechanisms to a broad surface allowed us to achieve better cosmetics without forming a noticeable scar on the chest wall. Keywords: Breast Ptosis, Extensive Liposuction, Gynecomastia Surgery, Ultrasonic Liposuction, Vaser Liposuction

Redefining the Axillary Aesthetic: Surgical Management of Axillary Tissue Hypertrophy.

Background and Objectives: Axillary tissue hypertrophy consists of ectopic breast tissue and occurs in up to six percent of women. Women complain of pain, interference with activity, and dissatisfaction with appearance. While it is recommended that accessory breast tissue be removed via surgical excision, there is lack of consensus on the best technique for the surgical management of axillary tissue hypertrophy. In this study, the senior authors (BC and NT) review outcomes and complications as they pertain to the surgical treatment of axillary tissue hypertrophy and axillary contouring. Materials and Methods: A retrospective review of all patients (n = 35), from two separate institutions, who presented with axillary tissue hypertrophy between December 2019 and August 2021 was conducted. All patients underwent a technique that included direct crescentic dermato-lipectomy and glandular excision with axillary crease obliteration. Tissue was sent for histological analysis after removal. During a six-month follow-up period, all patient outcomes were recorded. Results: The authors treated 35 women with axillary tissue hypertrophy. All patients complained of aesthetic deformity with significant discomfort leading to the desire for surgery. Histologically, all specimens contained benign breast and adipose tissue. Hypertrophic scarring, seroma, and axillary cording were noted complications. Conclusions: Detailed is the surgical management and optimal technique that can be used to treat both adipose and fibroglandular axillary tissue hypertrophy while simultaneously providing a favorable axillary aesthetic.

The Burden of Anabolic Androgenic Steroid-Induced Gynecomastia.

Introduction Gynecomastia is benign proliferation of male breast tissue that can be idiopathic or secondary to hormonal imbalance. Consumption of steroids plays a major role in the development of gynecomastia. The increased consumption of anabolic androgenic steroid (AAS) in youngsters to boost the physical strength and improve appearance is associated with increased prevalence of gynecomastia. True estimation of AAS-associated gynecomastia is difficult to calculate and prone to underestimation because of low social acceptance. Accurate estimation is required to assess future healthcare, for prevention and to give appropriate treatment. Aims and Objectives The aim of this study was to calculate the steroid consumption in gynecomastia patients accurately so that appropriate treatment can be given and their response to treatment could be analysed. Methods This is a prospective study done in a tertiary care hospital from June 2019 to June 2022. All the gynecomastia patients treated during this period in Burns & Plastic Surgery Department of PGIMS Rohtak were included in the study. Patient's detailed history was recorded and also after 3 months of surgery patients were again enquired about their history to record any change. Results Real prevalence of AAS-associated gynecomastia (39.19%) was much higher than that recorded in preoperative period (4.05%). Also, AAS users were having higher body mass index and a greater proportion of patients were bodybuilders. Conclusion Patients with high body mass index, athletic body, and history of recent weight gain should raise the suspicion of anabolic steroid intake. Surgery is not always indicated in AAS-associated gynecomastia. If gynecomastia persisted, surgery necessitates and it involves meticulous intraoperative hemostasis and careful glandular excision to minimize recurrence and achieve low complication rates.

Transoral Approach Used to Remove a Giant Sialolith

Study Design: Case Report.Objective: Sialoliths are a cause of Sialolithiasis affecting an estimated 12 in 1000 adult population. The patient’s presentation vary from being asymptomatic to pain with swelling and purulent discharge if accompanied with a infection. Giant sialoliths greater than 15 mm are rare. The purpose of the article is to document and educate clinicians on the management of giant sialoliths with possible sparing of the salivary gland.Methods: This report documents a patient with a sialolith measuring 45 mm in the widest diameter removed using a trans-oral approach.Results: The patient presented with an intra-oral sialolith which was asymptomatic except for the hard swelling felt cervically. Clinical examination and radiographic imaging was adequate for a diagnosis and the fact that there was no tenderness over the glandular area a decision to spare the gland was made.Conclusion: There are few reports of giant sialoliths and majority present with sialadenitis. In this case it was rare for the stone to have reached this size with hardly any symptoms. In patients where the gland has not been affected clinicians may consider sparing it and remove only the sialolith to reduce the morbidity and risks associated with glandular excision.

Anthropometric Measurements and Analysis for Objective Assessment of Gynecomastia Surgery Results.

Gynecomastia surgery is one of the most common aesthetic procedures in males. There is a lack of objective analytical parameters to judge outcomes. In this study, the authors aim to introduce novel anthropometric measurements and analysis techniques for the objective assessment of surgical outcomes based on specific aesthetic targets. To introduce quantification of gynecomastia surgery outcomes and compare the results among the different grades of gynecomastia. A total of 192 patients with gynecomastia were included. The patient cases were grouped according to grades and a set of anthropometric measurements were taken both before the operation and 6 months postoperatively. Liposuction and glandular excision were done through minimal incisions in all grades of gynecomastia, with the addition of ultrasound and nipple areola complex (NAC) lifting plaster in selected Grade 3 and all Grade 4 cases. A statistically significant improvement in the perimeter of the triangular relationship of sternal notch and nipples, the elevation of the NAC, the reduction of the area of the NAC, and the correction of asymmetry of the chest were seen in all grades of gynecomastia, with increased differences in higher grades. A systematic objective analysis of the specific aesthetic targets helps to reliably compare results in a standard way and for carrying out improvisation of surgeons' techniques. Meanwhile, this approach helps identifying the need for customization, eventually providing symmetric and aesthetically pleasing surgical results.

Prospective pilot study protocol evaluating the safety and feasibility of robot-assisted nipple-sparing mastectomy (RNSM)

IntroductionNipple-sparing mastectomy (NSM) can be performed for the treatment of breast cancer and risk reduction, but total mammary glandular excision in NSM can be technically challenging. Minimally invasive robot-assisted NSM...

Surgical management of gynaecomastia by using cross chest liposuction and limited periareolar incision for gland excision: an interesting case report

Gynaecomastia is excessive or abnormal enlargement of male breast tissue. It is one of a common problem among young men. The term gynaecomastia means female like enlargement of male breast due to increase ductal tissue, stroma or fat. Most common cause of gynaecomastia is idiopathic. Surgical treatment of gynaecomastia involves liposuction and glandular excision and in few cases skin excision. Here author presents a case of 24 years old young healthy male with Simon’s grade 2B bilateral gynaecomastia. He had stubborn fat over bilateral chest which was resistant to exercise. Gynaecomastia was mixed type in characteristic having adipose tissue as well as glandular tissue enlargement. Bilateral liposuction and glandular excision by limited periareolar incision under general anesthesia as a day care procedure was done. In our procedure we used Cross chest liposuction. Patient was discharged at the same evening without any complications. After four months of follow up patient has male pattern chest with almost invisible scar and intact Nipple areolar complex (NAC) sensation.

Minimal Incision Technique For Gynecomastia

Background:Gynecomastia or enlargement of the male breasts affects a large proportion of males, with most patients requiring surgical intervention as only a few lesions are actually resolved with medical management alone. Surgery cures the patients of their problems, albeit, at the cost of scarring and other cosmetic problems in some patients. Therefore, refinements in the surgical process are still ongoing so as to provide the best results with minimal scarring.Aims and Objectives:To find out the feasibility of a minimal incision technique for glandular excision after liposuction in patients with gynecomastia so as to decrease the final visible scars in these patients.Materials and Methods:From July 2018 to September 2018, eight patients were subjected to gynecomastia surgery employing liposuction and gland removal through a single transverse 5–7 mm incision in the nipple. All the patients subjected to this technique had Grade IIa gynecomastia as per Simon’s scale. The Global Aesthetic Improvement Scale, comprising a 5-point Likert scale, was employed to find out the satisfaction level of the patients 12 months after surgery; this level was compared with that of a similar population of patients being operated on by employing liposuction and subcutaneous mastectomy by the periareolar technique.Results:The mean operating time was 110 min, and there was minimal bleeding during the procedure. Complications were also negligible, and all patients achieved an excellent chest contour with restoration of protective nipple sensation when evaluated 12 months after surgery. The difference in mean between the 2 patient groups was 0.125 with a p-value of 0.64.Conclusions:Glandular excision through a single transverse incision made through the nipple is a safe approach in selected patients and it produces excellent cosmetic outcomes. However, it requires patience on the part of the surgeon to achieve the desired goals of the surgery.

Jinekomasti Tedavisinde Cerrahi Tekniklerin Değerlendirilmesi: 65 Olgunun Analizi

Aim: Gynecomastia is a benign enlargement of the breast in males. Surgical treatment options include liposuction, glandular excision and the combination of liposuction and glandular excision. In this study, it was aimed to evaluate 65 consecutive gynecomastia patients who were operated using different techniques and to present the treatment approach, and results and complications related to surgical techniques.Material and Methods: Sixty five patients who underwent gynecomastia operation in our clinic between June 2016 and January 2019 were included in this study. Demographic data, preoperative and postoperative photographs, clinical classification, perioperative details, postoperative results and complications were evaluated retrospectively.Results: Fifty five (84.6%) patients had bilateral gynecomastia and 10 (15.4%) patients had unilateral gynecomastia. Of the 120 breasts operated, 91 (75.8%) were Grade II, 20 (16.7%) were Grade III and 9 (7.5%) were Grade I, according to the Simon classification. Twenty-eight (43.1%) patients underwent liposuction and glandular excision, 35 (53.8%) patients underwent liposuction alone, and two (3.1%) patients underwent glandular excision only. Skin excision was performed for two patients at the first operation. Only two patients, one for inadequate reduction and the other for skin excess, were demanded revision surgery.Conclusion: Surgical treatment options for gynecomastia patients can be determined according to clinical evaluation of breast tissue and skin excess. In young patients with good skin quality, skin excision can be left for a second session. Although there was no significant difference between the methods used in this study, more complications were found with the excisional technique.

Case Report: The TRTMI Procedure, a Novel Surgical Technique for Gynecomastia

Gynecomastia presents the most common breast issue in men. It is defined as benign proliferation and enlargement of male breast glandular tissue that distributes most prevalently among neonates, adolescents, and elderly men. With a prevalence of over 60% in the male population, various classifications and treatment options have emerged to address male gynecomastia. Surgical treatment presents challenges and is used when gynecomastia has been present for several years or if medical therapy has been unsuccessful. We attempt to address some of these surgical challenges as they relate to aesthetic goals by presenting our surgical technique. Our surgical technique, the Tissue Resection Through Minimal Incision method, is described with illustrations included. Surgical candidates are selected after a review of the patient’s history, a thorough physical evaluation, obtaining any necessary imaging, and a detailed discussion with the patient. A hybrid, minimally invasive, and direct excision technique is used, including both standard VASER liposuction and direct glandular tissue resection via only a single 3-mm, well-hidden incision using simple instruments readily available with reproducible outcomes. We stress the idea of tissue inversion being key to make this feasible. Several case examples are presented with before and after comparisons, demonstrating good aesthetic results and skin retraction. In the more than 80 cases performed, one patient presented with dusky nipple areolar complex in the recovery room, which resolved with topical nitroglycerin. No nipple areolar complex necrosis occurred, nor hospitalizations were required for the cases performed. A few cases of tissue edema and swelling occurred correlating with inadequate compression or strenuous activity. Incisions were well hidden and aesthetically pleasing to patients. We briefly review gynecomastia classification and treatment options focused on surgical approaches. Of the various surgical methods available to treat gynecomastia, limitations and challenges include unfavorable scar and risk profiles, as well as inadequacy of tissue resection with the minimally invasive techniques. To meet this unmet need, our patented Tissue Resection Through Minimal Incision technique offers a novel minimally invasive approach that includes adequate tissue excision while maximizing aesthetic results and with nominal scarring. There is great need in surgical treatment of gynecomastia to minimize incisions and improve outcomes. Glandular tissue excision is a challenge to the cosmetic profile because of incisions used. Our novel technique and benefits involved address those concerns. However, our procedure does not address gynecomastia cases with excessive skin redundancy that requires excision. Further studies are still needed to address such challenges regarding aesthetic profile goals.

Surgical Management of High Grade Gynecomastia: Combination of Liposuction, Glandular Resection and a Circumareolar Skin Reduction

Background: Gynecomastia is defined as an excessivelydeveloped male breast to the extent it resembles the femaleone. Emotional discomfort and social embracement motivatethe patients to seek a medical advice, to restore the masculinebreast shape. In high grade gynecomastia, the contributingfactors are excess redundant skin, fibro-glandular tissue andabundant adiposity, each component should be consideredseparately in the patient's surgical plan. Various surgicalprocedures were succeeded to correct this deformity but withdrawbacks such as residual unsightly scar, or contour irregularities.Objectives: Were to treat high grades of gynecomastiawith a multifaceted procedure; by combining liposuction,glandular excision together with excess skin resection throughcircumareolar concentric approach.Aim: This study has evaluated that procedure as regardtechnical refinements, early and late complications and aestheticoutcome.Method: In this case series, eighteen healthy male patientswho had bilateral gynecomastia, had undergone correction oftheir breast deformity with that multifaceted procedure betweenJanuary 2016 and June 2017, their ages ranged from [17-61years old, with mean ± 30.94].Results: All patients were satisfied with the results exceptone patient who had undergone reoperation. The early complicationrate was 27.7%; it was consistent with other series.The follow-up aesthetic evaluation scale showed that 65% ofpatients with very good result, 22% of patients with goodresult, 17% patients with average result, and only one patienthad poor result.Conclusion: This combination had succeeded to addressthe contributing causes of severe gynecomastia. The problemsof excess and displaced tissues were properly dealt withthrough circumareolar approach to achieve a pleasant scarconfined to the areola with flat male chest

Anabolic-androgenic Steroid Use Among Gynecomastia Patients: Prevalence and Relevance to Surgical Management.

Anabolic-androgenic steroids (AAS) are widely implicated in gynecomastia development. Surgery is the definitive treatment for cases persisting after cessation of AAS use. Currently, the relevance of AAS use to the surgical approach of gynecomastia has not been well explored. This study aims to compare patient characteristics, surgical outcomes, and surgical management of gynecomastia correction in AAS users versus nonusers. A retrospective cohort study was performed with patients who underwent bilateral gynecomastia reduction surgery between January 2005 and August 2015 by a single surgeon at an academic hospital. Demographic data, AAS usage details, operative documentation, and follow-up outcomes were reviewed. A total of 964 cases were reviewed. Eleven percent (n = 105) of the patients had a history of AAS use. Compared with non-AAS users, AAS users were older at time of gynecomastia onset (15 years vs 13 years, P < 0.001) and surgery (28 years vs 25 years, P < 0.001). The AAS users had higher body mass index (27.3 kg/m vs 25.7 kg/m, P < 0.001) and a greater proportion of patients self-identified as bodybuilders (40.0% vs 22.4%, P = 0.002). Although no difference was found in the excised bilateral mastectomy volume (92.1 cm vs 76.4 cm, P = 0.20), The AAS users had significantly less lipoaspirate fat volume (250 mL vs 300 mL, P = 0.005). No difference was found in total complication rates. However, AAS users had significantly more revision mastectomy surgeries (3.8% vs 1.1%; P = 0.02). The unique breast composition of AAS users necessitates a surgical approach with meticulous intraoperative hemostasis and careful glandular excision to minimize recurrence and achieve comparable low complication rates.

Evaluation of Glandular Liposculpture as a Single Treatment for Grades I and II Gynaecomastia

BackgroundGynaecomastia is a benign enlargement of the male breast, of which the psychological burden on the patient can be considerable, with the increased risk of disorders such as depression, anxiety, and social phobia. Minimal scarring can be achieved by liposuction alone, though it is known to have a limited effect on the dense glandular and fibroconnective tissues. We know of few studies published on “liposuction alone”, so we designed this study to evaluate the outcome of combining liposuction with glandular liposculpturing through two axillary incisions as a single treatment for the management of grades I and II gynaecomastia.MethodsWe made a retrospective analysis of 18 patients with grade I or II gynaecomastia who were operated on by combined liposuction and glandular liposculpturing using a fat disruptor cannula, without glandular excision, during the period 2014–2016. Patient satisfaction was assessed using the Breast Evaluation Questionnaire (BEQ), which is a 5-point Likert scale (1 = very dissatisfied; 2 = dissatisfied; 3 = neither; 4 = satisfied; 5 = very satisfied). The post-operative aesthetic appearance of the chest was evaluated by five independent observers on a scale from 1 to 5 (5 = considerable improvement).ResultsThe patient mean (SD) overall satisfaction score was 4.7 (0.7), in which 92% of the responders were “satisfied” to “very satisfied”. The mean (SD) BEQ for all questions answered increased from 2.1 (0.2) “dissatisfied” preoperatively to 4.1 (0.2) “satisfied” post-operatively. The observers’ mean (SD) rate for the improvement in the shape of the front chest wall was 4.1 (0.7). No haematomas were recorded, one patient developed a wound infection, and two patients complained of remnants of tissue. The median (IQR) body mass index was 27.4 (26.7–29.4), 11 patients had gynaecomastia grade I, and 7 patients grade II. The median (IQR) volume of aspirated fat was 700 ml (650–800), operating time was 67 (65–75) minutes, 14 patients had general anaesthesia, and hospital charges were US$ 538 (481–594).ConclusionsCombined liposuction and liposculpturing using the fat disruptor cannula resulted in satisfied patients and acceptable outcomes according to the observers’ ratings. It could be a useful alternative with an outcome that corresponds to that of more expensive methods.Level of Evidence IVThis journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

The Need of Glandular Excision After Convantional Liposuction in Gynecomastia

The Need of Glandular Excision After Convantional Liposuction in Gynecomastia

Thoracodorsal artery perforator fasciocutaneous flap in the treatment of chronic hidradenitis suppurativa of axilla

The only definitive treatment of chronic axillar hidradenitis suppurativa (HS) that prevents relapses is 'in toto' excision of the infected glandular tissue. This way a deficiency emerges, which needs to be restored. Reconstruction with split skin graft (SSG) is a most common way of recovery, but thoracodorsal artery perforator (TDAP) fasciocutneous flap delivers better functional and aesthetic results. Between May 2014 and July 2016, 14 patients underwent reconstructive surgery after excision of axillary HS, 2 of them had bilateral lesion. In 15 cases TDAP was used, in 1 case we used thoracodorsal artery capillar perforator flap (TAPcp). In all but 2 cases 1 dominant perforator was found. 1 flap had 2 dominant perforators and 1 flap was supplied by capillary perforators. Size of the flaps spread between 6 × 8 and 10 × 15 cm. 15 reconstructions were successful, 1 flap necrotised because of the lack of compliance of the patient. As a result of the glandular tissue excision carried out because of a chronic HS, a deficiency emerges. TDAP flap is an ideal solution for surgical reconstruction of axillar deficiencies, and a great alternative to SSG.

Orange Peel Excision of Gland: A Novel Surgical Technique for Treatment of Gynecomastia.

Gynecomastia is a common aesthetic problem faced by men with reported incidence as high as 65% with serious psychosocial impact. Although various techniques of liposculpture combined with glandular excision is the standard of treatment, many of the glandular excision techniques have inherent limitations and complications such as leaving a long scar, long operative time, contour abnormalities, and increased risk of hematoma. Here, we describe an innovative "the orange peel excision of gland (OPEG) technique" which overcomes these limitations with excellent cosmetic results. A total of 38 breasts were operated in 20 patients (18 bilateral and 2 unilateral). All the patients underwent suction-assisted liposuction and glandular excision under general anesthesia by our OPEG technique. The average operative time per breast was 60 minutes. One patient had a small hematoma which did not require evacuation. The patient satisfaction rate was 95%. The technique has reduced operative time and avoids residual gland and hematoma with excellent aesthetic outcome.

Autologous fat injection into the pectoralis major as an adjunct to surgical correction of gynecomastia.

Correction of gynecomastia in males is a frequently performed aesthetic procedure. Various surgical options involving the removal of excess skin, fat, or glandular tissue have been described. However, poor aesthetic outcomes, including a flat or depressed pectoral area, limit the success of these techniques. The authors sought to determine patient satisfaction with the results of upper chest augmentation by direct intrapectoral fat injection in conjunction with surgical correction of gynecomastia. In this prospective study, 26 patients underwent liposuction and glandular excision, glandular excision alone, or Benelli-type skin excision. All patients received intramuscular fat injections in predetermined zones of the pectoralis major (PM). The mean volume of fat injected was 160 mL (range, 80-220 mL per breast) bilaterally. Patients were monitored for an average of 16 months (range, 8-24 months). Hematoma formation and consequent infraareolar depression was noted in 1 patient and was corrected by secondary lipografting. Mean patient satisfaction was rated as 8.4 on a scale of 1 (unsatisfactory) to 10 (highly satisfactory). Autologous intrapectoral fat injection performed simultaneously with gynecomastia correction can produce a masculine appearance. The long-term viability of fat cells injected into the PM needs to be determined. 4 Therapeutic.

Surgery of the Salivary Ducts

Successful surgery of the salivary ducts relies on an understanding of the surrounding anatomy and the delicate dissection of tissues in order to reduce morbidity. Trauma to the ducts should be assessed when lacerations or wounds encroach on their paths. Early diagnosis and treatment will reduce the complications of stricture and fistula formation from these injuries. Sialoliths can be located in several places along the length of the salivary ducts. The correct diagnosis and positioning of the stone in the duct is important in establishing the appropriate surgical approach. Imaging using plain films, ultrasonography, and endoscopy can be very valuable, with sialography and CT scans helpful in cases of radiolucent stones, glandular atrophy, or suspected tumor. As the condition becomes more chronic, resulting in glandular atrophy, excision of the diseased gland is often indicated. Treatment of excessive salivary flow in patients with cerebral palsy can be managed by a combination of ductal repositioning and glandular excision. Redirection of both the parotid and submandibular glands can be accomplished, either to reroute excess salivary flow or salvage the duct in cases of lesion excision.