Dr Ameen

Article written by Dr Ameen, ENT Specialist Kuala Lumpur

A submandibulectomy is the surgical removal of the submandibular salivary gland. This gland sits just below the jawline on both sides of your neck. I perform this operation to treat chronic infections, salivary stones or tumours in the gland.

The surgery requires an incision about two to three centimetres below the lower jaw. I carefully identify and protect the nearby nerves that control your tongue and lower lip movements. The gland is then completely removed. The entire procedure takes one to two hours.

After the operation, you will wake up with a small drain tube in your neck to prevent fluid buildup. Mild to moderate pain and swelling under the jaw are normal for the first few days. You might also experience temporary numbness in your lower lip or tongue. Most patients stay in a private hospital in Kuala Lumpur for one to two nights until the drain is removed and pain is well controlled.

Indications for Submandibulectomy

I recommend this surgery when medical management fails or when a structural abnormality poses a long term health risk. The strongest clinical reasons include:

• Benign salivary gland tumours: Pleomorphic adenoma is the most common reason for surgery. We remove these growths to prevent them from continuing to enlarge and to eliminate the small risk of future malignant transformation.
• Malignant salivary gland tumours: Cancers such as adenoid cystic carcinoma or mucoepidermoid carcinoma require complete surgical excision and sometimes concurrent neck dissection.
• Chronic recurrent sialadenitis: Severe and repeated bacterial infections that do not respond to antibiotics and significantly impair daily life.
• Symptomatic sialolithiasis: Large salivary stones causing persistent pain and swelling during meals that cannot be managed with conservative measures or minimally invasive removal.
• Cystic lesions: Large branchial cleft cysts or ranulas located within or extending from the submandibular space requiring complete excision.

Complications of Submandibulectomy

Every head and neck surgery carries inherent risks. I discuss these thoroughly during our consultation so you understand what to expect. The overall safety profile is excellent when performed by an experienced specialist.

• Marginal mandibular nerve weakness: Temporary weakness of the lower lip occurs in 5 to 10 percent of cases due to nerve stretching and usually resolves within months. Permanent weakness happens in 1 to 2 percent of cases.
• Lingual nerve injury: Numbness or altered taste on one side of the tongue happens in 2 to 5 percent of patients. This is often temporary but can be permanent.
• Hypoglossal nerve injury: Weakness of the tongue muscles on the operated side occurs in 1 to 2 percent of cases, affecting tongue movement during speech and swallowing.
• Haematoma formation: Bleeding requiring surgical evacuation happens in 1 to 2 percent of cases. We place a drain to minimize this risk.
• Salivary fistula: Leakage of saliva into the wound bed occurs in 2 to 4 percent of cases and typically resolves with pressure dressings and temporary dietary modifications.
• Infection: Wound infection happens in 1 to 3 percent of cases and is treated with a course of oral antibiotics.
• Chyle leak: Injury to the lymphatic channels in the lower neck occurs in less than 1 percent of cases, requiring a specialized low fat diet.

Estimated Procedure Cost (Professional Fees)

Medical fees in Malaysia are guided by the Private Healthcare Facilities and Services Act. Based on the PHFSA 2013 regulations for excision of the submandibular gland (Code F4440), the maximum allowable professional fees are:

• Surgeon Professional Fee (MAJOR 1): RM1,565
• Anaesthetist Professional Fee (INTER 5): RM505
• Total Maximum Professional Fees: RM2,070

Total Estimated Cost

• Total Estimated Cost (including hospital facility fees, operating theatre charges, specialised equipment rental, medications and consumables): RM11,000 to RM13,000
• Disclaimer: This is an estimated total cost only. Actual bills vary significantly depending on the specific hospital, room type and individual patient needs across Malaysia. Patients should always request a detailed itemised cost estimate from their chosen hospital or medical centre before proceeding.

Frequently Asked Questions

Will there be a visible scar after the surgery? Yes, the incision is placed in a natural skin crease about two centimetres below the jawline. The scar usually fades significantly over six to twelve months and becomes barely noticeable.

How long does the numbness in my lip or tongue last? Temporary numbness from nerve stretching typically improves within three to six months. We use careful surgical techniques to minimize this risk, but permanent changes can occasionally occur.

Do I need radiation therapy after the surgery? Radiation is only recommended if the final pathology report shows a malignant tumour with high risk features like positive margins or perineural invasion. Benign conditions do not require postoperative radiation.

Will my mouth feel dry after removing the gland? No, you will not experience a dry mouth. The other major salivary glands, including the parotid and sublingual glands, will easily produce enough saliva to keep your mouth moist.

When can I return to work after the procedure? Most patients return to desk jobs within one to two weeks once the surgical drain is removed and initial swelling subsides. Jobs requiring heavy physical exertion may require three to four weeks of recovery.

When to Seek Consultation

Finding a lump under your jaw or dealing with painful swelling during meals is frustrating. The vast majority of submandibular gland issues are benign and highly treatable with modern surgical techniques.

If you have noticed a persistent swelling under your jawline or suffer from recurrent painful infections, do not wait. Book a consultation at my Kuala Lumpur clinic for a thorough physical examination and ultrasound evaluation. We will map out a clear, personalized treatment plan to address your concerns and restore your comfort.

About the Author

Dr. Ameen is a Resident Ear, Nose & Throat Consultant at KPJ Ampang Puteri Specialist Hospital, situated in Selangor near the Kuala Lumpur border and serving patients from both Ampang and Kuala Lumpur.

He earned his medical degree (MB BCh BAO Hons) in Ireland and completed his Master of Otorhinolaryngology at Universiti Kebangsaan Malaysia. With comprehensive tertiary training from Hospital Kuala Lumpur and Hospital Tunku Azizah, he expertly manages complex adult and pediatric ENT conditions, including sinus, ear, throat, and vertigo disorders.

Before taking on his current role as a Resident ENT Consultant at KPJ Ampang Puteri Specialist Hospital, Dr. Ameen spent three years building extensive private center experience in Kuala Lumpur as a sessional ENT Consultant at Sunway Medical Centre Velocity and Columbia Asia Hospital Setapak.