Submandibular region

Code: NS26
Lecturer: Dr. S. Kandiah
Date: 11th October 2013

Learning Objectives

The submandibular gland and duct

Facial artery
Hypoglossal nerve
Lymphatics of the head and neck

Mandible External Aspect

2
1

5
6

Mandible External Aspect

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2005 Elsevier

Mandible Internal Aspect

Submandibular
fossasubmandibular
gland;
Sublingual fossasublingual gland

Mandible Internal Aspect

Medial Pterygoid

Superior and Inferior

Mental Spines

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2005 Elsevier

Hyoid bone supports the larynx

1) Stylohyoid
ligament
attaches to
lesser horn of
hyoid bone
2) Keeps airway
open

Suprahyoid Muscles
Digastric
Stylohyoid
Mylohyoid

Geniohyoid

Mylohyoid Muscle
Paired muscle, originates
from the mylohyoid line on
the internal aspect of the
mandible
Anterior fibres insert into the
midline raphe, posterior
fibres insert onto the hyoid
bone
Nerve supply = nerve to
mylohyoid, branch of V3 (1st
branchial derivative)
Action = to elevate the floor
of the mouth in the first
stage of swallowing. May
also depress the mandible
or raise the hyoid bone

Digastric Muscle
Digastric = two bellies
connected by an
intermediate tendon
fastened to the hyoid
bone by a band of fascia
Anterior belly = derivative
of the first branchial arch
(Trigeminal nerve)
Posterior belly =
derivative of the second
branchial arch (Facial
nerve)

Digastric Muscle II
Posterior belly of digastric
arises from a groove
medial to the mastoid
process; the stylohyoid
muscle arises from the
styloid process and runs
alongside it (also CNVII
nerve supply)
Posterior digastric is an
important landmark as
deep to it runs the
internal jugular vein, the
cranial nerves VII, X, XI
and XII and the carotid
arteries

Digastric Muscle III

The anterior belly of
digastric arises from the
intermediate tendon and
inserts into the digastric
fossa on the mandible
Actions = to depress the
mandible and elevate the
hyoid bone; paired
digastrics are second to
lateral pterygoid in
mandibular depression.
Posterior bellies active
during chewing and
swallowing

Mental Spines

Geniohyoid Muscle
Arises from the inferior
mental spines on the
internal aspect of the
mandible
Inserts onto the anterior
hyoid bone
Nerve supply = first
cervical spinal nerve via
hypoglossal
Actions = elevates the
hyoid bone and draws it
forward; when the hyoid
is fixed it depresses the
mandible
Support the tongue

Hyoglossus Muscle
One of the extrinsic muscles of
the tongue others are
styloglossus, genioglossus,
palatoglossus
Hyoglossus attaches to the
length of the greater cornu of
the hyoid bone and front of the
body of the hyoid bone
Action = to depress the tongue
Nerve supply to all extrinsic
muscles of the tongue except
for palatoglossus is
Hypoglossal Nerve (CNXII)
Palatoglossus is innervated by
the pharyngeal plexus(X
nerve)

Muscles of floor of mouth

Anterior belly of digastric
Mylohyoid from mylohyoid line of
mandible to hyoid bone

Branches of External Carotid

External Carotid

Superior thyroid
Lingual
Facial
Occipital
Ascending Pharyngeal
Posterior auricular
Maxillary
Superficial temporal

Relations of hyoglossus
Lateral/superficial
Medial/deep

Lateral/Superficial
Lingual nerve
Submandibular gland and duct
XII

Medial/Deep
IX
Stylohyoid ligament
Lingual artery

Salivary Glands

Sublingual
Submandibular
Parotid
Why are stones more common in the first
2?

Why saliva?
Moisture
Food Lubrication
Prevents decay

Submandibular and Sublingual

Glands

Submandibular gland
Superficial and deep parts
Arranged like a C above, to the side of
mylohyoid, and below
Superficial part inferior palpable
Deep part superior non palpable
Lymph to submandibular nodes

Submandibular Gland/Duct
Mucus/serous mixed secretions
Antigravity drainage
Swollen submandibular duct may damage
lingual nerve
Lingual nerve passes lateral to
submandibular duct, then below it, then
medial before it ascends into tongue

Lingual Nerve
Also damaged by careless dental
procedures relating to lower teeth and
gums due to close relationship with inferior
alveolar nerve
Fractures of the mandible
Abcesses of 3rd lower molar tooth

Submandibular Duct
Whartons Duct
5cm long
Opens into the floor of the mouth on the
sublingual papilla beside the frenulum of
the tongue, behind the incisor teeth

Sublingual Gland

Almond shaped
Lies above mylohyoid muscle
Mucus secretions
About 15 ducts
Half open into the submandibular duct
Rest open on the sublingual fold

Salivary glands and ducts

sublingual and submandibular secrete into oral cavity proper

Parotid gland
Sublingual papilla
(opening of duct)
Lingual frenulum
Sublingual gland
secretes via numerous
small ducts
Submandibular
gland and duct

net61

Parotid duct opens

in vestibule opposite
upper 2nd molar

Clinical Perspective
Stone in Whartons Duct

Most common disease of

salivary glands

Twice as common in males as

females

80-95% occur in submandibular

gland or duct

Stones are most common

cause of acute and chronic
infection of salivary glands

Lingual Nerve/Chorda Tympani

Lingual nerve somatic sensation to
anterior 2/3 of tongue
Chorda tympani of VII taste (visceral
sensation) anterior 2/3 tongue and palatal
glands
Chorda tympani of VII parasympathetic
secretory fibres to sublingual and
submandibular glands

Question
What happens when the lingual nerve is
cut at point 1, and point 2?

Hypoglossal Nerve
CNXII
Motor to extrinsic muscles of
the tongue except
palatoglossus
Originates from medulla
oblongata, exiting skull via
hypoglossal canals in the
occipital bone
Emerges medial to the IJV,
ICA, CNIX, CNX, CNXI.
Becomes superficial below the
posterior belly of digastric and
emerges between the IJV and
the ICA

Hypoglossal Nerve
Travels upwards and
forwards on the
hyoglossus muscle deep
to the digastric tendon,
stylohyoid and the
posterior border of
mylohyoid
Passes on the lateral
aspect of genioglossus as
far as the tip of the
tongue
Communicates with the
sympathetic trunk, the
first and second cervical
nerves and the lingual
nerve

Branches of the Hypoglossal Nerve

Meningeal leave hypoglossal
nerve in its canal, travelling
back into the posterior cranial
fossa. Contains mixed sensory
and sympathetic fibres from
upper cervical nerves and
superior cervical sympathetic
ganglion.
2.
Descending Branch contains
fibres only from C1 gives a
branch to the superior belly of
omohyoid. Then joined by the
lower root of the ansa from C2
and C3. The conjunction of the
two roots gives rise to the nerve
to sternothyroid, sternohyoid
and the inferior belly of
omohyoid.
Question?
1.
If the hypoglossal nerve is
purely motor. What nerve
contains the tongue muscle
propioreceptors. What happens
with accessory nerve?
1.

Branches of the Hypoglossal Nerve

3. Nerves to thyrohyoid and
geniohyoid these arise
near the posterior border
of the hyoglossus.
Contain C1 fibres
4. Muscular branches
these are all true
hypoglossal nerve fibres,
and motor to the extrinsic
muscles of the tongue
except palatoglossus

Lymphatics of the Head and Neck

Superficial and Deep
lymphatics
Deep Cervical nodes
superior
(jugulodigastric)
- inferior
(jugulo-omohyoid)
- others

Superficial Lymph Nodes

No lymph nodes in scalp
Ring of nodes around the
skull/neck junction
In the head occipital,
post-auricular, parotid
and buccal
In the neck
submandibular,
submental, superficial
cervical

Sample Question
A patient presents with a submandibular
swelling. Describe the anatomy of the
submandibular gland and duct. What is the
lymph drainage of the gland? Describe the
secretomotor pathway to the gland,
including nerves involved, synapes and
ganglia.