Removal of the submandibular gland by a retroauricular approach

OBJECTIVE: To evaluate the benefit of a retroauricular approach by comparing it with a conventional transcervical approach for removal of the submandibular gland. DESIGN: Prospective clinical study. SETTING: Academic center. PATIENTS: Thirty patients with benign submandibular gland disorders. INTERVENTIONS: Patients were divided into 2 surgical groups to undergo retroauricular (n = 15) and conventional (n = 15) procedures matched by age, sex, marital status, and pathologic condition. The retroauricular approach used an incision along the postauricular sulcus and hairline and subcutaneous tunneling to the gland; the conventional approach used an incision along a natural skin crease overlying the gland. MAIN OUTCOME MEASURES: The operation time, complications, hospital stay, and subjective satisfaction of incision scar checked by visual analog scale were compared between groups. RESULTS: The submandibular gland disorders were comparable between groups: pleomorphic adenoma (n = 15), chronic sialadenitis with sialolithiasis in the gland (n = 5) or hilum (n = 8), and Küttner (n = 1) or Kimura (n = 1) disease. Mean +/- SD operation times were 49 +/- 17 minutes in the retroauricular group and 38 +/- 15 minutes in the controls (P = .08). Mean +/- SD hospital stay and complication rates were comparable between groups. The mean +/- SD score of patient satisfaction was 8.9 +/- 0.9 in the retroauricular group and 4.2 +/- 2.9 in the conventional group (P<.001). The incision scar was commonly less visible in the retroauricular group because of hiding by the auricle and natural hair when comparing with the control group. CONCLUSION: The retroauricular approach can provide better cosmetic outcome than the conventional transcervical approach and without significant complications.