📝 "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: ​ 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. ​ 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. ​ 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. ​ 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. ​ 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. ​ 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: ​ Wikipedia contributors. (n.d.). Transverse cervical artery. Wikipedia. Retrieved May 5, 2025, from https://lnkd.in/e4yWx4j5 ​ Miloro, M., Ghali, G. E., Larsen, P. E., & Waite, P. D. (Eds.). (2022). Peterson’s Principles of Oral and Maxillofacial Surgery (4th ed.). Springer. ​ Abubaker, A. O., Lam, D. K., & Benson, K. (2016). Oral and Maxillofacial Surgery Secrets (3rd ed.). Elsevier #podcast #dentalpodcast #doctorgallagherpodcast #doctorgallagherspodcast #doctor #dentist #dentistry #oralsurgery #dental #dentalschool #dentalstudent #doctorlife #dentistlife #oralsurgeon #doctorgallagher