Partial Removal of the Submaxillary Gland for Aesthetic Indications: A Systematic Review and Critical Analysis of the Evidence

Background: Neck aesthetics is an essential feature for a youthful attractive appearance. Deep neck surgery involving partial resection of the submandibular gland (SMG) has been a controversial issue in aesthetic surgery given its challenging technique and potential risks. The aim of this review is to evaluate the safety and efficacy of partial SMG resection in patients undergoing aesthetic neck surgery. Methods: We undertook a systematic review of the literature and analysis of studies reporting surgical outcomes and complications of partial SMG resection from Medline, Cochrane and Google Scholar databases from 1950 to March 30, 2019. Two independent reviewers conducted titles and abstracts screening and data extraction. Data were analyzed using mixed methods appraisal tool and a clinical impact score. Results: Six studies including 602 patients who underwent 1200 partial SMG resections were included. All studies reported aesthetic improvement according to Ellenbogen aesthetic neck ideals. Hematoma related to partial SMG resection was encountered in one case (0.08%), hematoma related to cervicofacial skin flap was encountered in 26 cases (1.4%), sialoceles happened in 16 cases (1.3%), transient marginal mandibular nerve weakness occurred in 86 cases (4.7%). No mortalities, permanent motor nerve damage or dry mouth were reported. The clinical impact score was positive for five out of the six reports. Conclusion: Partial SMG resection in patients undergoing aesthetic neck surgery may represent an effective procedure to enhance neck aesthetics and is associated with minor, self-limiting complications. Future controlled studies with prospective evaluation of aesthetic outcome and patient-reported outcome measures are needed. Level of Evidence III: This 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.