DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS:
Chronic left submandibular gland infection.
POSTOPERATIVE DIAGNOSIS:
Chronic left submandibular gland infection.
PROCEDURE PERFORMED:
Excision of left submandibular gland.
SURGEON: John Doe, MD
ANESTHESIA: General.
INDICATIONS FOR OPERATION: The patient is a (XX)-year-old woman with chronic recurrent swelling and pain despite antibiotic management. The risks and benefits have been discussed. The patient was interviewed preoperatively in the holding area prior to sedatives. All questions were answered and the consent signed.
DESCRIPTION OF OPERATION: The patient was placed in the supine position under general anesthesia with endotracheal tube. The head was turned to the right, and the neck was prepped with Betadine and draped sterilely.
The incision was marked and injected with 1% Xylocaine with epinephrine in the skin only. This was opened sterilely with a 15 blade and carried down to the platysma with the Bovie. The platysma was incised, and the inferior edge of the submandibular gland was identified, and the tissues were elevated. The gland was elevated as the undersurface of the gland was dissected. The soft tissues were taken off the superior surface of the gland, keeping on the plane of the fascia. The marginal mandibular branch, which was seen and could be seen to cause movement as the cautery had come near it, was elevated superiorly with the fascia and kept intact.
The dissection was carried out along the inferior border, where the facial artery was identified and ligated as it gave a branch into the gland. The superior tissues were taken off the superior surface of the gland, staying on the fascia. The gland was released from the mylohyoid muscle, and this was reflected superiorly. The fifth cranial nerve was identified and extension of the gland was left with 1 cm and ligated. The gland was elevated superiorly, and the twelfth nerve was seen above the digastric tendon and was left down with the tissues and preserved throughout the dissection. As the dissection was carried superiorly, the duct was identified and ligated, and some accessory tissue following the duct was ligated as well with 3-0 chromic.
With the fifth, seventh and twelfth nerves identified and preserved, the wound was irrigated with antibiotic solution, and the specimen was sent to pathology. A drain was brought out through a separate opening and sutured to the skin with 2-0 silk. The platysma was closed with 3-0 chromic followed by 5-0 Dexon for the skin. The patient tolerated the procedure well and was taken to the recovery room in good condition with no complication.
