Chapter 9: Submandibular Approach

Question 1

Submandibular approach is often referred to as _____ approach

Answer 1

Risdon

Question 2

In Dingman and Grabb’s study the marginal mandibular branch was almost ____cm below the inferior border of the mandible in ____% of specimens

Answer 2

1 cm

19%

Question 3

Dingman and Grabb’s study demonstrated the marginal mandibular branch was ______ the inferior border anterior to the point of crossing with the facial artery

Answer 3

above

Question 4

In Ziarah and Atkinson’s study, _____% of marginal mandibular branches passed ______ the inferior border before reaching the facial vessels.

Answer 4

53%

below

Question 5

In Ziarah and Atkinson’s study, they found that _____% of cases the nerve extended inferior to the inferior border after crossing the facial vessels to a distance of ____cm

Answer 5

6%

1.5

Question 6

In Dingman and Grabb what percentage of individual has a single marginal mandibular branch between the angle of the mandible and the facial vessels? What percentage had 2 branches? What percentage had 3 branches? What percentage had 4 branches?

Answer 6

21%
67%
9%
3%

Question 7

The facial artery originates from ____

Answer 7

External carotid artery

Question 8

At what region does the facial artery become visible on the external surface of the mandible?

Answer 8

Around the anterior border of the masseter muscle.

Question 9

Does the facial artery lie anterior or posterior to the facial vein above the inferior border of the mandible?

Answer 9

Anterior

Question 10

The primary venous outlet of the face is?

Answer 10

Facial vein

Question 11

The facial vein originates as what vein? And where?

Answer 11

Angular vein in the angle between the nose and the eye.

Question 12

Does the facial vein course anterior or posterior to the facial artery above the inferior border of the mandible?

Answer 12

Posterior

Question 13

The facial vein runs deep or superficial to the surface of the submandibular gland?

Answer 13

Superficial

Question 14

The facial vein flows into what vein? What other vein does it join?

Answer 14

Internal jugular vein

Retromandibular vein

Question 15

How far below the inferior border of the mandible is your incision?

Answer 15

2cm

Question 16

The superior portion of the incision should be undermined approximately ___cm?
The inferior portion of the incision is undermined approximately ____cm?

Answer 16

1cm

2cm

Question 17

What are the layers of the initial incision?

Answer 17

1. Skin
2. Subcutaneous
3. Platysma
4. Superficial layer of the deep cervical fascia
5. Submandibular gland

Question 18

At what anatomic landmark is the facial vein most frequently encountered?

Answer 18

Premasseteric notch

Question 19

At what anatomic landmark is the marginal mandibular branch most frequently encountered?

Answer 19

Premasseteric notch

Question 20

At what depth in relation to the inferior border of the mandible should the superficial layer of the deep cervical fascia be incised/undermined?

Answer 20

1.5cm

Question 21

What is the name of the submandibular lymph node often encountered at the premasseteric notch?

Answer 21

Node of Stahr

Question 22

Where is the facial artery in relation to the Node of Stahr?

Answer 22

Just anterior to the node, deep to the superficial layer of the deep cervical fascia.

Question 23

What is the final layer of tissue anterior to the premasseteric notch? Posterior to the premasseteric notch?

Answer 23

periosteum

pterygomasseteric sling

Question 24

What layers require sutures for closure?

Answer 24

1. pterygomasseteric sling
2. platysma
3. subcutaneous
4. skin
   * superficial layer of deep cervical fascia does not require definitive suturing

Question 25

What is the rationale for “steps” in the anterior portion of the incision (lightning bolt type incision) or the surgical splitting of the lower lip) ?

Answer 25

Breaking up the incision line to minimize scar contracture during healing