📝 "What Are Important Anatomical Structures Of The Transcervical Approach To Avoid?"

Quick Review #277 - #surgery #surgeon #doctorgallagher #oralsurgery #oralsurgeon #omfs #dentist #dentistry #dental

- 5.6.25

Key Anatomical Structures to Avoid:

1. ​ Marginal Mandibular Branch of the Facial Nerve (CN VII)

- Course: Travels superficial to the facial artery and vein, just inferior to the body of the mandible.

- Risk: Injury causes lower lip droop (asymmetric smile).

- Surgical tip: Keep the incision at least 2 cm below the inferior border of the mandible to reduce risk.

1. ​ Facial Artery and Facial Vein

- Course: The facial artery runs deep to the submandibular gland and emerges at the anterior edge. The facial vein lies more superficial and posterior.

- Risk: Bleeding; hematoma formation; compromise to blood supply.

- Surgical tip: Use blunt dissection around the anteroinferior aspect of the gland to avoid vascular injury.

1. ​ Hypoglossal Nerve (CN XII)

- Course: Crosses the carotid arteries and then loops anteriorly under the digastric muscle toward the tongue.

- Risk: Injury can cause ipsilateral tongue paralysis.

- Surgical tip: The hypoglossal nerve runs deep to the posterior belly of the digastric and the submandibular gland, so avoid deep medial dissection.

1. ​ Lingual Nerve (Branch of V3)

- Course: Lies medial and superior to the submandibular duct, close to the posterior floor of mouth.

- Risk: Injury may lead to tongue numbness or altered taste.

- Surgical tip: Although more at risk intraorally, it may be encountered if dissection extends superiorly and medially.

1. ​ Submandibular (Wharton’s) Duct

- Course: Emerges from the deep portion of the gland, runs forward and medial to the lingual nerve.

- Risk: Injury may cause salivary fistula or obstruction.

- Surgical tip: Preserve the deep lobe of the gland and avoid extending medially unless necessary for drainage.

1. ​ Mylohyoid Muscle

- Note: While not a nerve or vessel, it separates the submandibular and sublingual spaces.

- Surgical tip: Recognizing its position helps determine abscess spread and whether intraoral or extraoral drainage is indicated.

Additional Structures to Consider

- Anterior belly of the digastric muscle: Landmark for the submandibular triangle.

- Platysma muscle: Should be incised sharply; damage has minimal consequences but affects cosmesis if not repaired.

- Submandibular gland: If infected or necrotic, partial or complete gland excision may be indicated.

References:

1. ​ Wikipedia contributors. (n.d.). Transverse cervical artery. Wikipedia. Retrieved May 5, 2025, from https://lnkd.in/e4yWx4j5
2. ​ Miloro, M., Ghali, G. E., Larsen, P. E., & Waite, P. D. (Eds.). (2022).

Peterson’s Principles of Oral and Maxillofacial Surgery (4th ed.). Springer.

1. ​ Abubaker, A. O., Lam, D. K., & Benson, K. (2016).

Oral and Maxillofacial Surgery Secrets (3rd ed.). Elsevier

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