title: Transoral submandibular ganglion neurectomy: an anatomical feasibility study.
abstract: BACKGROUND
  The management of sialorrhea can be difficult for both the patient and the clinician. Current management includes behavioral modification, anticholinergics, botulinum injections, and a variety of surgical options, which all have demonstrated some efficacy. As minimally invasive procedures flourish, we explore the feasibility of highly selective transoral submandibular neurectomy (TOSN) for the management of sialorrhea.
  
  
  METHODS
  Ten human cadaver dissections of the floor of mouth were performed bilaterally, for a total of 20 separate cases. An intraoral technique for highly selective, submandibular ganglion neurectomy is demonstrated.
  
  
  RESULTS
  A transoral submandibular ganglion neurectomy was performed in 10 cadavers (20 neurectomies) easily and reliably, without injury to the submandibular duct or the main trunk of the lingual nerve.
  
  
  CONCLUSIONS
  Transoral submandibular neurectomy is an attractive addition to the armamentarium of surgical options for the treatment of medically intractable sialorrhea. Further study in selected patients would need to be performed to demonstrate clinical feasibility.
authors.affiliation: Division of Otolaryngology-Head and Neck Surgery, George Washington University, Washington, DC, USA.
authors.forename: Todd
authors.initials: T
authors.lastname: Spock
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, The University of Iowa, Iowa City, Iowa, USA.
authors.forename: Henry T
authors.initials: HT
authors.lastname: Hoffman
authors.affiliation: Division of Otolaryngology-Head and Neck Surgery, George Washington University, Washington, DC, USA ajoshi@mfa.gwu.edu.
authors.forename: Arjun S
authors.initials: AS
authors.lastname: Joshi
mesh_terms: D002102:Cadaver; D005240:Feasibility Studies; D005726:Ganglia, Parasympathetic / Q000601:surgery*; D006801:Humans; D008036:Lingual Nerve / Q000601:surgery*; D009055:Mouth; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods*; D017764:Parasympathectomy / Q000379:methods*; D012798:Sialorrhea / Q000601:surgery*; D013363:Submandibular Gland / Q000294:innervation*
keywords: botulinum neurotoxin; drooling; lingual nerve; neurectomy; ptyalism; sialorrhea; submandibular ganglion