Everyday Oral Surgery Surgical Approaches: Submandibular and Retromandibular (with Dr. Andrew Jenzer)
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Oct 1, 2024 Dr. Andrew Jenzer, an oral and maxillofacial surgeon and educator from North Carolina, shares his insights on innovative surgical approaches. He discusses when to use the submandibular approach and stresses the importance of nerve testing. Listeners learn about key instruments and techniques, such as local anesthetics versus pure epinephrine, incision planning, and recognizing the node of Stahr. Jenzer also elaborates on the retromandibular approach, exploring different incision variations and managing complex nerve structures during surgery.
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Artery Lifting As A Nerve Safety Maneuver
- The marginal mandibular branch often runs superficial to the facial artery and vein, so lifting those vessels (Hayes-Martin maneuver) helps protect the nerve.
- Multiple marginal branches are common, so expect variations and test proactively.
Use Lift-And-Cut 'Zipper' Dissection
- Dissect using a 'lift-and-cut' zipper technique to avoid creating an inverted pyramid and to maximize exposure.
- Use fine McCabe dissectors and Kittners, and work toward each other to protect deeper structures.
Ride The Submandibular Gland Upward
- When advancing to the mandible, find and 'ride' the submandibular gland superiorly as a reliable highway to the inferior border.
- Test tissues frequently and re-approximate deep slings at closure to reduce traction on the nerve.
