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Revisiting the relationship between the submandibular duct, lingual nerve and hypoglossal nerve
- Department of Cardiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
- Department of Anatomy, Faculty of Medicine, Balıkesir University, Balıkesir, Turkey
open access
Abstract
Background: The aim of the study was to evaluate the relations between submandibular duct, lingual nerve and hypoglossal nerve for making a reassessment of this area in fresh frozen specimens. Also, the distance between the angle of the mandible and the vertical line drawn from the point where submandibular duct crossed lingual nerve to the base of the mandible was measured to determine a new landmark for neck surgeons.
Materials and methods: Fourteen fresh frozen head and neck specimens were dissected and evaluated. A marginal mandibular incision was made from the mastoid process to the chin.
Results: In 8 cases, lingual nerve was crossing the submandibular duct superiorly; in 5 cases, lingual nerve was crossing the duct infero-medially and in 1 case it was parallel to the duct. In 1 case, lingual nerve subdivided into anterior and posterior branches. In 2 cases, 2 parallel submandibular ducts were found and the lingual nerve was crossing the upper duct from superior. In 1 case, lingual nerve was crossing the duct infero-medially and then it was subdividing into branches superior to mylohyoid. In 12 cases, the course of hypoglossal nerve was classical. In 1 case, hypoglossal nerve crossed the submandibular duct medially and coursed parallel to the tendon of posterior belly of digastric. And in another case, hypoglossal nerve crossed the inferior branch of submandibular duct medially. The other structures in this area were as usual.
Conclusions: The main factor for reducing nerve damage during surgery is the understanding of the anatomy of this area.
Abstract
Background: The aim of the study was to evaluate the relations between submandibular duct, lingual nerve and hypoglossal nerve for making a reassessment of this area in fresh frozen specimens. Also, the distance between the angle of the mandible and the vertical line drawn from the point where submandibular duct crossed lingual nerve to the base of the mandible was measured to determine a new landmark for neck surgeons.
Materials and methods: Fourteen fresh frozen head and neck specimens were dissected and evaluated. A marginal mandibular incision was made from the mastoid process to the chin.
Results: In 8 cases, lingual nerve was crossing the submandibular duct superiorly; in 5 cases, lingual nerve was crossing the duct infero-medially and in 1 case it was parallel to the duct. In 1 case, lingual nerve subdivided into anterior and posterior branches. In 2 cases, 2 parallel submandibular ducts were found and the lingual nerve was crossing the upper duct from superior. In 1 case, lingual nerve was crossing the duct infero-medially and then it was subdividing into branches superior to mylohyoid. In 12 cases, the course of hypoglossal nerve was classical. In 1 case, hypoglossal nerve crossed the submandibular duct medially and coursed parallel to the tendon of posterior belly of digastric. And in another case, hypoglossal nerve crossed the inferior branch of submandibular duct medially. The other structures in this area were as usual.
Conclusions: The main factor for reducing nerve damage during surgery is the understanding of the anatomy of this area.
Keywords
lingual nerve; submandibular duct; hypoglossal nerve; anatomy; dissection
Title
Revisiting the relationship between the submandibular duct, lingual nerve and hypoglossal nerve
Journal
Issue
Article type
Original article
Pages
521-526
Published online
2018-01-26
Page views
2511
Article views/downloads
3798
DOI
Pubmed
Bibliographic record
Folia Morphol 2018;77(3):521-526.
Keywords
lingual nerve
submandibular duct
hypoglossal nerve
anatomy
dissection
Authors
C. Günenç Beşer
B. Erçakmak
H. B. Ilgaz
A. Vatansever
M. F. Sargon
- Al-Amery SM, Nambiar P, Naidu M, et al. Variation in lingual nerve course: a human cadaveric study. PLoS One. 2016; 11(9): e0162773.
- Bademci G, Yaşargil MG. Microsurgical anatomy of the hypoglossal nerve. J Clin Neurosci. 2006; 13(8): 841–847.
- Carlson GW. The salivary glands. Embryology, anatomy, and surgical applications. Surg Clin North Am. 2000; 80(1): 261–73, xii.
- Castelli WA, Huelke DF, Celis A. Some basic anatomic features in paralingual space surgery. Oral Surg Oral Med Oral Pathol. 1969; 27(5): 613–621.
- Chen SR, Li WB, Zhu W. The double ducts of the submandibular gland – 1 Case. Chin J Clin Anat. 2000; 18: 88.
- Erdogmus S, Govsa F, Celik S. Anatomic position of the lingual nerve in the mandibular third molar region as potential risk factors for nerve palsy. J Craniofac Surg. 2008; 19(1): 264–270.
- Gadodia A, Seith A, Neyaz Z, et al. Magnetic resonance identification of an accessory submandibular duct and gland: an unusual variant. J Laryngol Otol. 2007; 121(9): e18.
- Guerrissi JO, Taborda G. Endoscopic excision of the submandibular gland by an intraoral approach. J Craniofac Surg. 2001; 12(3): 299–303.
- Halim A. Human anatomy: regional and clinical for dental students: I.K. International publishing house pvt. Limited. 2008.
- Hong SS, Yheulon CG, Sniezek JC. Salivary gland surgery and medical malpractice. Otolaryngol Head Neck Surg. 2013; 148(4): 589–594.
- Horsburgh A, Massoud TF. The salivary ducts of Wharton and Stenson: analysis of normal variant sialographic morphometry and a historical review. Ann Anat. 2013; 195(3): 238–242.
- Hölzle FW, Wolff KD. Anatomic position of the lingual nerve in the mandibular third molar region with special consideration of an atrophied mandibular crest: an anatomical study. Int J Oral Maxillofac Surg. 2001; 30(4): 333–338.
- Ichimura K, Nibu K, Tanaka T. Nerve paralysis after surgery in the submandibular triangle: review of University of Tokyo Hospital experience. Head Neck. 1997; 19(1): 48–53.
- Klepácek I, Skulec R. Relation between lingual nerve, submandibular gland duct and mandibular body in the sublingual space. Acta Chir Plast. 1993; 36(1): 26–27.
- Mendes MB, de Carvalho Leite Leal Nunes CM, de Almeida Lopes MC. Anatomical relationship of lingual nerve to the region of mandibular third molar. J Oral Maxillofac Res. 2013; 4(4): e2.
- Holsinger F, Bui D. Anatomy, function, and evaluation of the salivary glands. Salivary Gland Disorders. 2007: 1–16.
- Parker S. MRCS Applied Basic Science and Clinical Topics: JP Medical Limited. 2013.
- Smith AD, Elahi MM, Kawamoto HK, et al. Excision of the submandibular gland by an intraoral approach. Plast Reconstr Surg. 2000; 105(6): 2092–2095.
- Standring S. Gray’s anatomy: the anatomical basis of clinical practice, 40th edition. Churchill Livingstone–Elsevier, London 2008: 505–507.
- Towers JF. Duplication of the submandibular salivary duct. Oral Surg Oral Med Oral Pathol. 1977; 44(2): 326.
- Zhang L, Xu H, Cai Zg, et al. Clinical and anatomic study on the ducts of the submandibular and sublingual glands. J Oral Maxillofac Surg. 2010; 68(3): 606–610.