Submandibular gland

Question 1

What are the 3 muscles closely related to submandibular

Answer 1

Mylohyoid Hyoglossus Posterior belly of digastric

Question 2

Where would you do an incision for submandibular gland?

Answer 2

4 cm below and parallel to the lower border of mandible to avoid injury to marginal mandibular branch of facial nerve

Question 3

What layers would you have to divide to reach the gland ?

Answer 3

Skin, subcutaneous fat, platysma, investing layer of deep cervical fasica

Question 4

What structures running across the gland must be ligated and divided?

Answer 4

Facial vein and facial artery. Facial artery arches over and grooves the posterior part of gland. As facial artery hooks under lower border of mandible it closely related to marginal mandibular branch of facical nerve and gives off submental artery at this point. Lymph nodes may be adherent to surface of gland.

Question 5

Where does whartons duct originate? submandibular duct.

Answer 5

Originates from superficial part of submandibular gland, but it emerges deep. Empties into the sublingual papilla next to base of frenulum.

Question 6

What 3 nerves are at risk during submandibular excision?

Answer 6

Marginal mandibular branch of facial nerve. lies about 2.5 cm up from mandible. Injury causes flattening and inversion of ipsilateral lower lip.

Lingual nerve - lies above deep portion - sensory innervation to 2/3 ipsilater tongue.

hypoglossal nerve - motor injury to ipsilateral tongue - injury cause dysarthria.