Submandibular region

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Submandibular gland :

Submandibular gland Dr. Pankaj Maheria

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Extends: Body of the mandible to the hyoid bone. Contains: Submandibular and sublingual glands Suprahyoid muscles Extrinsic muscles of tongue Lingual and hypoglossal nerves Submandibular ganglion Lingual and part of the facial arteries

Submandibular gland :

Submandibular gland It is one of the three paired salivary glands. Walnut in appearance About 10 to 20gms in weight Mixed gland with predominantly serous in type Situation: Digastric triangle and lodges partly in the submandibular fossa of the mandible upto the mylohyoid line opposite the molar and premolar teeth. Part of galnd : Large superficial part Small deep part

Superficial part:

Superficial part Ends - Anterior Posterior Surfaces – Inferior Lateral Medial

Superficial part:

Superficial part Anterior end: Posterior end:

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Among the three surfaces, the investing layer of deep cervical fascia splits into two layers to cover the inferior and medial surfaccs of the gland, Attached respectively to the lower border of the body of mandible and the mylohyoid line.

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inferior surface Skin Superficial fascia Platysma Deep cervical fascia Crossed by the common facial vein and cervical branch of facial nerve, under cover of platysma. Submandibular lymph nodes beneath the deep fascia.

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Lateral surface Submandibular fossa of the mandible Medial pterygoid muscle close to its insertion Facial artery

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Medial surface: Extensive and its relations-are divided into three parts Anterior Posterior Intermediate

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Anterior part Rests on mylohyoid muscle Separated by the mylohyoid vessels and nerves Submental branch of facial artery.

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Posterior part Styloglossus, stylopnaryngeus and glossopharyngeal nerve Posterior belly of digastric and middle constrictor of pharynx Hypoglossal nerve and first part of lingual artery.

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Intermediate part: Rests on the hyoglossus muscle, lingual nerve and submandibular ganglion. hypoglossal nerve Pair of veins Intermediate tendon of digastric.

Deep Part:

Deep Part Extends forward in the interval between the mylohyoid and hyoglossus up to the posterior end of sublingual salivary gland. Relations: Laterally: mylohyoid Medially: hydglossus Above: lingual nerve and submandibular ganglion Below: hypoglossal nerve accompanied by a pair of veins.

Submandibular duct (Wharton's duct):

Submandibular duct (Wharton's duct) About 5cm long Begins from the middle of the deep surface of the superficial part of the gland a little behind the posterior border of mylohyoid.

Submandibular duct (Wharton's duct):

Submandibular duct (Wharton's duct) The duct presents an intimate relation with the lingual nerve. At first the nerve lies above the duct, Then crosses it lateral side Finally ascends medially winding round the lower border of the duct

Blood Supply:

Blood Supply Branches of facial and lingual arteries Veins correspond to the arteries and drain into internal jugular vein

Lymphatic drainage :

Lymphatic drainage Submandibular lymph node Jugulo-digastric lymph nodes

Nerve supply:

Nerve supply Gland is supplied by both parasyrnpathetic and sympathetic nerves. Contrary to the previous opinion, it is now established that both of the them are secretor-motor to the salivary gland.

Nerve supply:

Nerve supply Parasympathetic stimulation produces watery secretion, whereas sympathetic stimulation produces sticky mucus-rich fluid. In addition, the sympathetic provides vaso-motor supply.

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Superior salivatory nucleus Pons Facial nerve Chorda tympani nerve Lingual nerve Submandibular ganglia

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The sympathetic nerves reach the gland around the facial artery and convey post ganglionic fibres from the superior cervical ganglion of the sympathetic trunk

Sublingual gland :

Sublingual gland It is the smallest of the three major salivary glands. Each gland is somewhat almond in shape. 3 to 4 gm in weight Located in the floor of the mouth between the mucous membrane and mylohyoid muscle. Lodges in the sublingual fossa of the mandible

Relations:

Relations In front: Meets with the fellow of opposite side behind the symphysis menti Behind: Deep part of submandibular gland Above Mucous membrane of the mouth forming a raised margin Sublingual fold

Relations:

Relations Below: mylohyoid muscle Laterally: Sublingual fossa of the mandible Above the anterior of mylohyoid line Medially Genioglossus muscle separated by the submandibular duct and lingual nerve.

Ducts of sublingual gland:

Ducts of sublingual gland About 8 to 20 ducts Ducts of Rivinus : open separately in the floor of mouth on the summit of the sublingual fold Duct of Bartholin : Some ducts from the anterior part of gland unite Open into the submandibular duct.

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Blood supply Sublingual and submental arteries. Lymph drainage Submental and submandibular nodes. Nerve supply Same as that of submandibular

APPLIED ANATOMY:

APPLIED ANATOMY Enlargement of submandibular gland Sialolithiasis (salivary calculi) 80% in submandibular SG Sialography Ranula The presence of small lymph nodes actually within the substance of the gland makes removal of the gland an imperative part of block dissection of the neck. Drooling Ludwig's angina:

Thank you :

Thank you

Hyoglossus:

Hyoglossus - It is the key muscle of thisjegion and one of the extrinsic muscle of the tongue. The hyoglossus is rhombold hy shape, and arises from the upper_s_urface of ihe greater corny and partly fromjhe body of hyoid bone. It passes upward and slightly forward under coyer ofthe mylohyoid and is inserted into the side of the tongue between the styloglossus laterally and longitudinal is^linguae inferior medially, Close to the origin, lower and posterior part of the muscle overlaps themiddlei constrictor muscle of pharynx.

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Actions: It depresses the side of the tongue and makes the dorsaTsurface convex.

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RELATIONS: J Superficial or lateral - a) overlapped by the mylohyoid, in thcf an tern-superior part; Structures intcrveningjbctwccn the! myfohyoid and hyoglossus" are as, follows from above downwards: i) Mucous membrane of the side. iii) iv) of the tongue; Styloglossus; Lingual nerve; Submandibular which is suspended from the lingual nerve by two rootsT y) Deep part of submandibular gland and itsjhici; the lingual nerve winds round the lower bordeToTthe djKt from lateral to medial side, and then ascends obliquely to supply the mucous m'c_njbrane"bT flic'anteri orlwo-thirdsjTthc tongue. vi) Hypoglossal .nerve and vena comitanshypgglos,si - The nerve passes forward and upward beneath the mylohyoid. crosses superficial to the third part of lingual artery, pierces the genioglossus and supplies all extrinsic and intrinsic muscles of__longue except the palatogloisusT vii) Suprahyoid branch of the first part of lingual artery.

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Deep _pr_mcdial - a) Middle constrictor muscle and second part of the lingual artery close to the origin; b) Longitudinalis linguae inferior, close to the insertion; c) Gcniogjossus and thirdpart of lingual artery, along and deep to the anterior border; d) Deej)._to_ the posterior border -Stvlopharyngcus muscle, glosso-pharyngeal nerve, stylo-hyoid lig"ament junction of first and second parts of the lingual artery

Lingual nerve :

Lingual nerve It is a branch of the posterior Hyision of mandibular nerve (from trigeminai) and lies initially in_thc infraj.emporaljbssa between the lateral pterygoid and tensor veli palatini muscles, where the chorda tympani joins the poslcrini^ hordcr of lingual np.rvp at an acute angle. The lingual jieryc passes downward and forward betwecnthe ramus of the mandible and the medial pterygoid. and then below the mandibular origin of superior constrictor where it comes in direct contact with the mandible medial to the third molar tooth and is coverecTonly by the mucous membrane of the gum. The nerve then recedes from the gum, crosses the styloglossus and appears on theside of the tongue resting on the hyoglossys. Here the submandihuliu^angfion is suspended from the lower border oflingualjiervc by two roots. Finally the lingual nerve winds round the lower border of subrnandinbular duct from lateral to mcdial__sjcle,'and provides sensory supply to the mucousmcmbrane of the pre-sulcal part of the . tongucTFloor of the mouth and the mandibular gunTT)n the hyoglossus muscle, it "receives a j communication from thejiypoglossal nerve through whTcfi u possibly conveys , proprioceptive fibres from the tongue muscles.

Submandibular ganglion:

Submandibular ganglion It is a small fusiform ""ganglion of the parasympathctic system. It is topographically connected with the lingual nerve, but functionally connectedI with the 1 facial nerve and its chordatympani branch. The gangliorTrests on the hyoglossus muscle

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Relations: "Above, lingual nerve which is connected to the ganglion by two roots, rK)ste_rjor and aptefipn —————• * Below, deep part of the submandibular gland;

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The ganglion presents parasympathgtic and sympathetic roots, and distributing branches. PqrasvmDathetic or motor root - The posterior root connecting the ganglion with the lingual nerve forms the parasympathetic root. The pregangltonic secreto-motor fibres arise from the superior salivatory nudeus in the pons and pass successively through the facial. chorda tympani and lingual nerves and reach the submandibular ganglion via the posterior root where tHe Fibres arc relayed. The postgangl ionic fibres arising the gangjioncells suppTydirecUv thcsubmandibular gland by five or more branches; some fibres join the lingual nerve through the anterior root and supply the sublingual and anterior lingual glands. Sympathetic root - It is derived from a plexus around the facial artery, which conveys postgangl ionic sympathetic fibres from the superior cervical ganglion of the sympathetic trunk. The fibres pass through the ganglion without interruption and supply primarily vasomotor tibres To the blood-vessels of submandibular and sublingual glands.

Genioglossus:

Genioglossus It is a fan-shaped extrinsic muscle "^oijongue, lies under cover of the mylohyoid and fills up the intej and hyoglossus muscleshe forms the bulk of the tongue and is traversed by the intrinsic tongue muscles. The superficial surface" of gcnioglossus is related to submandibularduct, sublingual gland, lingual and hypoglossal nerves, third part of lingual artery and its sublingual branch. The muscle arises from the superior genial tubercle of symphysis mcnti. The fibres spread backwards fan-wise for insertion. The lower fibres are attached to the body of hyoid bone and form the root of the tongue. The intermediate fibres pass beneath the anterior border of the hyogbssus and reach as far behind as the nyoglossal membrane. The upper fibres turn forward, and upward, and reach the substance of the tongue extending upto the tip.

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Actions^ a) The muscles of both sides protrude the tongue and make the dorsal surface concave from side topside. b) In unilateral contraction, the tongue tip is protruded to the opposite side. c) In paralysis of both eeniofilossi. the tongue wITT fall back to the oropharynx due to unopposed^ action of retractoFmuscles ariff mignt cnokc the airpassages/Therefore the integrity" 01 _the_actions of genjogiossi saves the life of the individual; hence called the safety muscle of the tongue.

Styloglossus and stylopharyngeus:

Styloglossus and stylopharyngeus Styloglossus and stylopharyngeus muscles -The Styloglossus arises from the anterior surface of the tip of the styloid process and stylpmandibuTar "ligament, passes downward and forward, and is inserted into the side of the tongue by dividing into objigjie ami longitudinaLgets ofjibres. The obligue fibres interdigitate with the hyoglossus; the longitudinal' fibres are continuous with the inferior longitudinal mUSCTeTJfTOngue. Action^: It retracts the tongue backward and upward, and is antagonistic to the genioglossus.

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The stylopharyngeus arises from the medial sorface^of the base of the stvloid process, proceeds downward and forward between the external and internal carotid arteries, and enters the pharynx beneath the-posterior border of the hyoglossus through the gap betwee'rP'the superior and middle constrictor muscles of pharyjix. Here it is accompanied by the stylohyoid ligament and glossopharyngeal nerve. The further course and insertion of the stylopharyngeus are described in the chapter of ^ pharynx

Glossopharvngeal nerve (10th cranial"):

Glossopharvngeal nerve (10 th cranial") - It leavesthe skull through the intermediate compartment of jugular foramen accompanied by the vagus and accessory nerves. Initially the aforesaid nerves intervene between the internal carotid artery in front and the internal jugular vein behind In the subsequent extracranial course, the glossopharyngeal nerve runs downward and forward Jytweenlfie' internal and external % carotid arteries, deep to the styloid process and stylopharyngeus muscle. It then winds forward wl superficial to that muscle and enters the .pharynx through the gap between the superior " and middle constrictor muscles. * In this part of its course, the nerve provides the « following branches - tympanic, carotid, pharyngeal and "muscular