Endoscopic submandibular sialadenectomy via an anterior chest wall approach: Elzahaby seven key steps

Technique: Based on our earlier experience in different endoscopic neck surgeries, the authors developed a structured technique with seven key steps for performing endoscopic SM sialadenectomy via anterior chest wall using three ports. This structured technique was applied in ten successive patients with benign SM lesions. A detailed description and a video of the surgical technique are provided. Results: All procedures were successfully completed endoscopically. Operative time ranged from 75 to 110 min (mean = 89 ± 10.74 min). Blood loss ranged from 5 to 20 ml (mean = 6.50 ± 4.74 ml). Mean SM gland volume was 29.12 ± 25.64). No significant postoperative complications were reported except for temporary neck/chest wall paresthesia in 6 cases, wound cellulitis in one diabetic patient and temporary neck contracture in another patient. The postoperative histopathological analysis was pleomorphic adenoma in 4 cases and chronic calcular sialadenitis in the remaining 6 cases. Most of the patients (80 %) were extremely satisfied with the procedure. Conclusion: The seven key steps described are comprehensive, applicable, and easy to learn. The good magnification, illumination, clarity and overt superior esthetic outcome and patient satisfaction outweigh the long operative time needed. The video shows in detail these key steps allowing anterior chest wall endoscopic SM sialadenectomy to be considered a viable alternative to conventional open approach in well-selected patients.