Sublingual Gland Tumors

Virtually all sublingual gland tumors will be malignant and as for all salivary tumors, primary surgery is the treatment of choice. Prognosis will be determined by the histologic grade and the stage of the tumor. In the very rare benign tumor or with small low-grade carcinomas a transoral wide local resection may be successfully performed (Blanchaert, Ord, and Kumar 1998). This will be easier to undertake in edentulous patients, and Wharton's

Figure 9.11. Delivering sublingual gland with low-grade malignant tumor via an intraoral wide local excision. Republished with permission from Blanchaert RG, Ord RA, Kumar D. 1998. Polymorphous low-grade adenocarcinoma of the sublingual gland. Int J Oral Maxillofac Surg 27:115-117.

Figure 9.12a. Adenoid cystic carcinoma of sublingual gland closely approximated to the mandible (seen via an intraoral mirror photograph).

duct will require a sialodochoplasty procedure (Figure 9.11). In most cases due to grade, tumor size, the presence of teeth, and involvement of mandibular periosteum/bone a wider access will be required. If the periosteum is uninvolved and can be safely peeled from the lingual bone a standard "pull through" approach or a lip split with mandibulotomy can be used (Figure 9.12). The functional result of the lip split/mandibulotomy is better than the pull through (Devine, Rogers, and McNally et al. 2001). As both of these methods of access involve entering the neck, a supraomohyoid neck dissection is usually carried out in the N0 neck even for low-grade tumors (Figure 9.13).

When positive nodes are present, type I modified radical neck dissection is required. Both lingual and hypoglossal nerves can be involved by these tumors at an early stage, particularly the ACC. Sacrifice of the nerve with proximal tracing and frozen section guidance as described for the submandibular tumors may be needed. In tumors fixed to periosteum or where minimal cortical erosion is present, an oblique marginal mandibular resection angling the cut to take a greater height of the lingual plate will be utilized. The marginal mandibular resection can be performed with the pull through or mandibulotomy approach. Where the medullary bone is invaded a segmental mandibular resection with a composite en bloc resection of the floor of the mouth is safest and will provide excellent access (Figure 9.14). In these

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