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These notes give an overall guide to your stay in hospital. You may see some differences in the details of your treatment, since it is tailored to suit your own condition.
WHAT IS THE SUBMANDIBULAR GLAND?
The submandibular gland makes saliva to wet the food in your mouth. It is shaped like a prune and fits under the side of your jawbone. The saliva runs from the gland along a tube, which opens, into your mouth under the base of your tongue. If a swelling or stone grows in the gland, the gland has to be removed. If a stone forms in the tube (duct), the stone is removed without taking out the gland or the duct.
WHAT DOES THE OPERATION CONSIST OF?
To remove the gland a cut is made just below the side of the jawbone. The gland is freed and taken out. The cut in the skin is stitched up.
If a stone needs to be removed from the duct, the operation is much simpler. The inside of the mouth is numbed with local anaesthesia, a cut is made just under the tongue and the stone is removed. The cut does not need to be stitched up.
The following description applies to removal of the whole gland.
WHAT HAPPENS BEFORE THE OPERATION?
Reception
When registering at reception your medical aid details will be required. Your medical aid may require that you obtain an authority number from them for the hospital. Please check this. If you are not on a member of a medical aid you will be required to pay a deposit or to sign an indemnity form. As far as possible we will try to advise you about hospital costs before your admission.
Welcome to the ward
You will be welcomed to the ward by the nurses or the receptionist and will have your details checked. Some basic tests will be done such as pulse, temperature, blood pressure and urine examination. You will be asked to hand in any medicines or drugs you may be taking, so that your drug treatment in hospital will be correct. Please tell the nurses of any allergies to drugs or dressings. The surgeon will have explained the operation and you will be asked to sign your consent for the operation. If you are not clear about any part of the operation then read this again and then ask for more details from the surgeon or from the nurses.
Visit by the anaesthetist
The anaesthetist who will be giving your anaesthetic will interview and examine you. He will be especially interested in chest troubles, dental treatment and any previous anaesthetics you have had
Diet
You will have your usual diet until 6 hours before the operation when you will be asked to take nothing by mouth. This will let your stomach empty to prevent vomiting during the operation.
Shaving
The operation area will be shaved to remove excess hair.
Timing of the operation
The timing of your operation is pre-arranged so that the nurses will tell you when to expect to go to the operating theatre. Do not be surprised, however, if there are changes to the exact timing.
Transfer to theatre
You will be taken on a trolley to the operating suite by the staff. You will be wearing a cotton gown, rings will be fastened with tape and removable dentures will be left on the ward. There will be several checks on your details on the way to the operating theatre where your anaesthetic will begin.
The operation is then performed
WHAT HAPPENS AFTER THE OPERATION?
Coming round after the anaesthetic
Although you will be conscious a minute or two after the operation ends, you are unlikely to remember anything until you are back in your bed on the ward. Some patients feel a bit sick for up to 24 hours after operation, but this passes off. You will be given some treatment for sickness if necessary.
Will it hurt?
There is some discomfort rather than severe pain. You will be given injections or tablets to control this as required. Ask for more if the pain is still unpleasant. You will be expected to get out of bed the day after operation. By the end of one week the wound should be virtually painfree.
Drinking and eating
You will be able to drink within an hour or two of the operation provided you are not feeling sick. The next day you should be able to manage small helpings of normal food.
Opening bowels
It is quite normal for the bowels not to open for a day or so after operation. A laxative is sometimes required.
Passing urine
It is important that you pass urine and empty your bladder within 6?12 hours of the operation. If you find using a bed pan difficult, the nurses will assist you to a commode or the toilet.
Sleeping
You will be offered painkillers rather than sleeping pills to help you to sleep. If you cannot sleep despite the painkillers please let the nurses know.
The wound
The wound has a dressing, which may show some staining with blood in the first 24 hours. The wound is held together by fine stitches. They are usually removed after 4?5 days. The dressing, which is usually waterproof to allow showering, will be kept on until the stitches are removed.
Sometimes a plastic suction drain is used to suck out excessive secretions from the wound. This will be attached to a plastic portable suction bottle. It is pain free and is removed after a day or two.
There may be some purple bruising around the wound which spreads downward by gravity and fades to a yellow colour after 2 to 3 days. It is not important.
There may be some swelling of the surrounding skin, which also improves in 2 to 3 days.
After 7 to 10 days, slight crusts on the wound will fall off.
Washing
You can wash the wound area as soon as the dressing has been removed. Soap and tap water are entirely adequate. Salted water is not necessary.
How long in hospital?
Usually you will feel fit enough to leave hospital after 1 to 2 days. Sometimes you are able to leave hospital on the same day. You will be given an appointment for a check up about a 4 to 6 days after your operation.
Sick notes
Please ask your surgeon for any sick notes or certificates that you may require.
After you leave hospital
You are likely to feel a bit tired but will gradually improve so that after about a week you will be able to return to your normal level of activity.
Driving
You can drive as soon as you leave hospital.
Work
You should be able to return to work within 2 weeks.
Complications
Occasionally there is some weakness to the muscles in the corner of the mouth lasting a month or two because of bruising of a branch of the facial nerve. This nerve should not be permanently damaged but a small risk exists.
Rarely there is some numbness or weakness of the tongue. This also improves in a month or two. Infection is a rare problem and will be appropriately treated. There may occasionally be a little discharge of saliva through the wound for a week or two. This always gets better.
The swelling in the gland will be examined under a microscope to find out the exact cause of the problem
Occasionally swellings come back on the operated side or even appear on the opposite side. You will be examined from time to time after the operation to check on this.
GENERAL ADVICE
The operation should not be underestimated, but the wound heals with barely a mark and the long-term results are good. If you have any problems or queries, please ask the nurses or doctors.
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