Theoretical perspectives on submandibular gland preservation in head and neck cancer surgery: a pre-research review.

In the neck dissection procedures for head and neck squamous cell carcinoma (HNSCC), the submandibular gland (SMG) is frequently and routinely removed. However, is the sacrifice of the SMG truly indispensable? We have analyzed this issue from multiple viewpoints. Anatomically, there are no lymph nodes (LNs) within the gland, thus eliminating the risk of cancer metastasizing to the SMG via LNs. From a pathological perspective, apart from cases in which the primary tumor tissue directly invades or adjacent LNs have extracapsular invasion, the probability of the SMG being affected by cancer is extremely low. In terms of patient survival rate, preserving the SMG during surgery does not exert a substantial impact on this critical metric. Preserving the SMG can assist in maintaining its secretory function. Nevertheless, the precise preservation of the SMG presents challenges. In addition to requiring greater data assistance, this idea may lengthen the procedure and raise the bar for surgeon skill. Although difficulties persisting, the significance of this perspective is far-reaching. The preservation of the SMG represents further exploration by clinicians in the realm of functional neck dissection. On the premise of ensuring safety, we endeavor to preserve more functional structures and reduce the resection scope, focusing not only on enabling patients with HNSCC to survive but also on guaranteeing their quality of life in the long term after treatment. Finally, we have proposed development directions and future prospects for this field, hoping to inspire fellow scholars. This study aims to analyze the necessity of performing SMG resection in head and neck cancer surgery, evaluate the evidence for SMG preservation (encompassing anatomical, pathological, survival, and functional aspects), discuss relevant controversies, and propose future research directions to provide guidance for clinical practice.