Nerve paralysis after surgery in the submandibular triangle: Review of University of Tokyo Hospital experience

Background: We assessed the incidence of neural complications in submandibular surgery in relation to the type of surgery, experience of the surgeon, and other factors. Methods: We retrospectively reviewed the records of 133 patients who underwent excision of the submandibular triangle components at the University of Tokyo Hospital during the last 19 years. Results: The most frequent complication was mandibular branch paralysis. Excluding 12 patients with malignant tumors, facial weakness was present postoperatively in 29.8% (37) of 124 resections. All palsies subsequently resolved. The paralysis was more frequent when nerve identification was performed than when it was not. Conclusions: The cardinal factors in minimizing incidence of nerve damage are an understanding of the anatomy of the nerves, low and generous skin incision, awareness of orientation in the surgical planes, avoidance of the use of metal retractors, and avoidance of elaborate identification of the nerve. (C) 1997 John Wiley & Sons, Inc.