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Which nerves are at risk in submandibular surgery? | CION Cancer Clinics
Three nerves run close to the submandibular gland: one that moves the corner of the lower lip, one that gives the tongue its feeling and taste, and one that moves the tongue. Any of them can be stretched or bruised during surgery. Lip weakness is the most common problem and is usually temporary. Lasting injury is uncommon, and a nerve is removed on purpose only when a cancer involves it. CION Cancer Clinics’ surgical oncologists in Hyderabad can talk this through with you.
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Medically reviewed by Dr. Muralidhar MuddusettyConsultant Surgical Oncologist · MBBS (AIIMS), MS (Surgery, AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh) · last reviewed September 2026, next review due September 2027
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On this page
- Which nerves can be injured during submandibular gland surgery?
- What does each nerve do, and what would you notice?
- Is the change likely to be temporary or lasting?
- How does the surgical team try to protect these nerves?
- When is a nerve removed on purpose?
- What do people often get wrong about nerve injury?
- Common questions about nerves and submandibular surgery
The short answer
Which nerves can be injured during submandibular gland surgery?
Three nerves pass close to the gland, and each controls something you would notice. The nerve to the lower lip is the one most often affected. The two nerves serving the tongue are affected less often. Most nerve problems after this operation come from stretching or bruising, and they improve with time.
Why the nerves are close enough to be at risk
The gland sits in a small space under the jaw. The lip nerve runs in the tissue just above it. The tongue nerves loop around and under it on their way into the mouth. The surgeon has to lift the gland away from all three, and even gentle handling can stun a nerve for a while.
What makes the risk higher
Scarring from repeated infection, an earlier operation in the same area, past radiotherapy or a large tumour can all make the nerves harder to see and separate. A cancer that has grown into or along a nerve changes the plan altogether, because leaving that nerve could mean leaving cancer behind.
This page describes general risks. It cannot tell you your own risk. Your surgeon can, once they have seen your scans.The three nerves
What does each nerve do, and what would you notice?
Each nerve has a different job. Knowing which is which makes it easier to describe a change to your team.
The lip nerve
Its medical name is the marginal mandibular nerve, a branch of the facial nerve. It moves the muscles at the corner of your lower lip on that side.
If it is affected
- A lopsided smile
- The lower lip does not pull down on one side
- Some dribbling when drinking
The tongue feeling nerve
The lingual nerve carries touch and taste from the front of the tongue on that side, and feeling from the floor of the mouth.
If it is affected
- Numbness or tingling on one side of the tongue
- A change in taste at the front of the tongue
- Biting the tongue without noticing
The tongue movement nerve
The hypoglossal nerve moves the tongue. Injury is the least common of the three, but its effects on speech and eating are the most noticeable.
If it is affected
- The tongue points to one side when pushed out
- Some sounds are harder to say clearly
- Food collects on one side of the mouth
Not sure whether this applies to you?
Ask an oncologistReading the signs
Is the change likely to be temporary or lasting?
What you may notice
What it usually means
The lip is weak straight after surgery, and the surgeon saw the nerve intact
Usually bruising or stretching. Movement tends to return over weeks to months.
The tongue feels numb but moves normally
The feeling nerve has been stunned. Sensation often comes back slowly, starting at the edges.
The surgeon tells you a nerve had to be cut or removed
The change is likely to last. Ask about therapy and practical ways to adapt.
Nothing has improved after many months
Recovery may have gone as far as it will. A review with your surgeon or a speech therapist is worthwhile.
A new weakness appears weeks after you were fine
This is not the usual pattern. Tell your team promptly so they can check the area.
In the operating theatre
How does the surgical team try to protect these nerves?
Planning from the scans
Scans and the needle test show how big the lump is and whether it is likely to be a cancer. This tells the surgeon how close to the nerves they will need to work.
Placing the cut low
The cut is placed a little below the jawline, because the lip nerve runs above it. The surgeon then lifts the tissue in a layer that keeps the nerve out of the way.
Finding each nerve
The tongue nerves are found and gently separated from the gland before it comes out. Some centres also use a nerve monitor, which signals when a nerve is touched. Ask your centre whether they use one.
Telling you what was found
After the operation, the surgeon should tell you whether every nerve was seen and kept. If one was removed, you should hear why.
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When cancer is involved
When is a nerve removed on purpose?
Sometimes a nerve has to be taken out deliberately. This happens when a cancer has grown into the nerve or wrapped around it, and keeping the nerve would mean leaving cancer behind. The team weighs this before surgery wherever the scans allow.
What the scans and the operation can show
A tumour that already causes numbness or weakness before surgery may be involving a nerve. Some salivary cancers, particularly adenoid cystic carcinoma, are known for spreading along nerves. Sometimes this is only found during the operation, which is why your consent form may mention it.
Questions to ask before you sign
Ask which nerves are near your tumour. Ask whether any is expected to be removed, and what that would change in daily life. Ask what the plan is if a nerve looks involved during the operation. Ask whether nerve repair or a nerve graft is something your surgeon would consider. Bring the family member who will help you decide, so you both hear the same answers.
Commonly believed
What do people often get wrong about nerve injury?
"Any numbness after surgery means the nerve was cut."
Most numbness comes from a nerve being stretched or bruised, and it often improves. The skin around the scar is also numb after nearly every neck operation, because tiny skin nerves are divided. Your surgeon can tell you whether the main nerves were seen and kept.
"If the smile is crooked now, it will stay that way."
Lip weakness in the first weeks is usually temporary. Movement often returns gradually over the following months. Give it time before assuming the worst, and ask your team what they saw during the operation.
"An experienced surgeon carries no risk of nerve injury."
Experience matters, but nerve problems can happen in careful hands, especially where there is scarring or cancer near a nerve. It is fair to ask how often your surgeon does this operation and which problems they see.
"Hard massage or heat will bring the nerve back faster."
No home treatment has been shown to speed nerve recovery. Heat on a numb area can cause burns you do not feel. Exercises taught by a speech therapist or physiotherapist are the useful step.
Did you know
Almost everyone has a small patch of numb skin around a neck scar after surgery. It comes from tiny skin nerves, not the lip or tongue nerves, and it tends to shrink over the following months.
Questions we are asked
Common questions about nerves and submandibular surgery
How common is nerve injury after submandibular surgery?
Temporary weakness of the lower lip is the most common nerve problem. Lasting injury to any of the three nerves is uncommon. The chance depends on why the gland is removed, whether there is scarring from infection, and whether a cancer is close to a nerve. Ask your surgeon about your own situation.
How long does lip weakness take to recover?
When the nerve was kept but stretched, movement usually begins to return over several weeks and keeps improving for some months. The pace varies from person to person. If you see no improvement at all after several months, ask for a review so the team can look at what else may help.
Can a damaged nerve be repaired?
Sometimes. If a nerve is cut during an operation, the surgeon may be able to join the ends, or place a nerve graft, a short piece of nerve taken from elsewhere. This is not possible or useful in every case. Ask before surgery whether repair would be considered if it were needed.
Will I be able to speak normally?
Most people speak normally after this operation. If the tongue movement nerve is affected, some sounds can be harder for a while. A speech therapist can teach exercises that help the tongue work better. Numbness alone rarely changes speech much, though it can feel strange at first.
Why does my tongue feel numb when the cut was on my neck?
The nerve that gives the tongue its feeling runs right beside the submandibular gland on its way into the mouth. Separating the gland from it can stun the nerve, even though the cut is in the neck. The numbness is usually on the same side as the surgery.
Is nerve monitoring used during the operation?
Some centres use a nerve monitor, which gives a signal when the surgeon is close to or touching a nerve. It supports careful surgery and does not replace it. Ask your centre whether they use one for your operation, and how it fits into the way they work.
What should I tell my surgeon after the operation?
Tell them about any change in your smile, dribbling, numbness, altered taste, tongue biting or difficulty moving food around your mouth. Note when each began and whether it is improving. A short note on your phone makes the follow-up visit easier and helps the team track your recovery.
Does radiotherapy after surgery affect nerve recovery?
Radiotherapy can slow healing in the treated area, and it brings its own changes in the mouth, such as dryness. It does not usually undo nerve recovery that is already under way. Your radiation oncologist will explain what to expect from your own treatment plan.
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Sources
- NHS — Salivary gland cancer
- Cancer Research UK — Salivary gland cancer
- National Cancer Institute — Salivary gland cancer treatment (PDQ), patient version
- Cancer.Net — Salivary gland cancer
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
Submandibular Gland Removal: What It InvolvesThe operation itself, from start to recoveryTongue Movement and Sensation AfterwardsLiving with a numb or weak tongue while it recoversThe Neck Scar After Submandibular SurgeryWhy the skin around the scar feels numbComplications and Red FlagsWhich changes after surgery need a call the same day
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