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6.4.8: 8. Facial, Lingual, and Hypoglossal Nerves in Submandibular Salivary Gland Surgery

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  • If functioning preoperatively, one should aim to have functioning nerves postoperatively

    Benign salivary tumours

    • Displace, but do not invade nerve
    • Nerve can always be dissected / peeled off tumours

    Malignant tumours

    • Functioning, normal looking nerve may be peeled off tumour and microscopic residuum treated with postoperative radiotherapy
    • If nerve is invaded/encased by tumour or has impaired function
    • Confirm malignancy on frozen section
    • Resect involved segment until free margins on frozen section (perineural spread can extend many centimetres beyond normal looking nerve)
    • Immediately graft a resected marginal mandibular nerve if you wish to restore lower lip function or hypoglossal nerve
    • Lingual nerve generally not grafted if resected

    No postoperative radiotherapy or frozen section with known malignancy adherent to, or invading nerve

    • Be surgically more aggressive
    • Do not peel nerve off tumour, but resect nerve at least 1cm beyond obvious tumour to achieve clear margins