Clinical implications of aberrant neurovascular structures coursing through the submandibular gland.

Kelsey J Eaton,Heather F Smith

doi:10.7717/peerj.7823

Abstract

BackgroundVariation within the submandibular triangle, including variant paths of facial neurovasculature, could increase risk of neurovascular derangement during submandibular gland (SMG) dysfunction, enlargement, interventions, or removal.MethodsFrequency of anatomical variants enveloped within or piercing the SMG, including facial artery, vein, or branches of CN VII, were assessed in 70 cadaveric submandibular glands (39M/31F).ResultsEighteen of 70 SMGs (25.7%) were pierced by at least one aberrant neurovasculature structure: Facial artery most frequently (n = 13), followed by facial vein (n = 2), inferior labial artery and vein (n = 1), and CN VII cervical branch (n = 1). This study demonstrated the high variability of neurovasculature within submandibular parenchyma. These aberrant neurovascular structures, especially facial artery, are in danger of compromise during surgical and other medical procedures on the SMG. To avoid potential neurovascular compromise, ultrasonographic or other imaging is recommended prior to procedures involving the SMG.

Highlights

The submandibular triangle contains a complex interaction of anatomy and physiology, allowing for numerous health conditions and procedures to occur
Seventy cadaveric submandibular glands (39M/31F) from the gross anatomy teaching laboratories at Midwestern University were assessed to determine the frequency of variance in submandibular gland neurovasculature within the submandibular triangle (Fig. 1)
Neurovascular structures excluded from consideration were minor branches directly off the facial artery and the marginal mandibular nerve of CN VII, as these are considered known and accepted variants

Summary

Introduction

The submandibular triangle contains a complex interaction of anatomy and physiology, allowing for numerous health conditions and procedures to occur. This well-defined region is outlined by the inferior border of the mandible and the anterior and posterior bellies of the digastric muscle (Fig. 1). Variation within the submandibular triangle, including variant paths of facial neurovasculature, could increase risk of neurovascular derangement during submandibular gland (SMG) dysfunction, enlargement, interventions, or removal. This study demonstrated the high variability of neurovasculature within submandibular parenchyma These aberrant neurovascular structures, especially facial artery, are in danger of compromise during surgical and other medical procedures on the SMG. To avoid potential neurovascular compromise, ultrasonographic or other imaging is recommended prior to procedures involving the SMG

Methods

Results

Discussion

Conclusion