The neck is prepared and draped in a sterile fashion. The incision is made approximately two fingerbreadths below the inferior border of the mandible in a skin crease.
The incision is carried through the platysma muscle, and subplatysmal flaps are elevated with care to avoid injury to the marginal mandibular nerve.The superficial layer of the deep cervical fascia is divided and the anterior facial vein is divided and ligated.
Elevation of this fascia exposes the submandibular gland. The dissection is then performed superiorly, and the facial artery is dived and ligated.
The mylohyoid muscle is retracted anteriorly, and the gland is retracted posteroinferiorly, exposing the lingual nerve and Wharton duct. The submandibular ganglion is divided, freeing the lingual nerve.
Wharton duct is then divided and ligated. The hypoglossal nerve runs superficial to the hyoglossus muscle. The hypoglossal nerve is preserved as the inferior border of the gland is dissected free.
The facial artery is encountered again, and it is divided and ligated. After ensuring hemostasis, the wound is closed in layers over a drain.
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