Submandibular gland (SMG) excision can be achieved by conventional approach (Conv) through a cervical incision or endoscopic surgery (Endo). The aim of this study was to propose a new concept and technique of full endoscopic SMG excision through the retroauricular hairline incision and investigate its safety and feasibility.

A total of 141 patients with SMG diseases treated at our department from 2021 to 2024 were retrospectively enrolled in the Endo group (n = 74) and the Conv group (n = 67). Interested variables included age, sex, pathological diagnosis, incision length, intraoperative bleeding, operation duration, hospitalization stay, complications, and aesthetic satisfaction score. SPSS software 26.0 and G power 3.1.9 were used for analysis.

There were no significant differences between the two groups in age, sex, follow-up period, pathological type, incision length or postoperative complications. Significant differences were found for the amount of bleeding [Endo: 12.5 (10.0) mL; Conv: 20.0 (20.0) mL, P < 0.001] and aesthetic satisfaction score [Endo: 8.8 ± 1.3; Conv: 7.5 ± 1.8, P < 0.001]. The operation duration of the Endo group was longer for early cases [Endo: 110.0 (27.5) min; Conv: 87.0 (40.0) min, P < 0.001], yet there was no significant difference from the thirtieth case [Endo: 85.0 (20.0) min; Conv: 89.0 (52.5) min, P = 0.894]. No recurrence of SMG diseases occurred during the follow-up period.

Full endoscopic SMG excision through the retroauricular hairline approach results in less intraoperative bleeding, invisible scars, and greater patient satisfaction, achieving ideal clinical and cosmetic outcomes.