Clinical and Aesthetic Outcomes in Conventional and Minimally Invasive Submandibular Gland Excision Approaches

This narrative literature review is an evaluation of the cosmetic, perioperative, and clinical outcomes of alternative approaches to submandibular gland excision, including conventional and robotic transoral excision, as well as endoscopic and robotic retroauricular excision, in comparison with the traditional transcervical approach. We intend to compare the cosmetic impact of each procedure based on the type of scar and location. PubMed and Google Scholar identified studies published between January 2000 and May 2025 which reported the outcomes of submandibular gland excisions performed using a transcervical, transoral, or retroauricular technique. Our analysis showed that the transcervical approach provides reliable access but carries risks of marginal mandibular nerve injury (18.7%) and visible cervical scarring. Conventional transoral excision avoids external scars and reduces the risk to the marginal mandibular branch and hypoglossal nerves but increases the risk of lingual nerve neuropraxia, with transient sensory deficits reported in 25–43% of patients. Robotic transoral excision preserves the sublingual gland and may improve completeness of resection, but operative times remain prolonged (<190 min). Endoscopic and robotic retroauricular excision can hide scars in the hairline and provide improved cosmetic satisfaction scores, with limitations including longer operative times and learning curves. Alternative approaches to submandibular gland excision provide improved cosmetic outcomes with comparable safety profiles to the transcervical approach.