II – Submandibular and sublingual salivary glands + CN

SUBMANDIBULAR GLAND
The submandibular gland is one of the three pairs of paired
salivary glands. This large salivary gland, about the size of a
walnut, is situated partly below and partly deep to the
posterior half of the mandible. It is half the size of the parotid
gland and weighs about 10–20 g. It is a mixed type of gland
(that is both mucus and serous in nature) but predominantly
serous.

Parts
It consists of two parts: (a) a large superficial part and (b) a
small deep part. The superficial part lies superficial to the
mylohyoid muscle, while deep part lies deep to the mylohyoid
muscle. The two parts are continuous with each other around
the posterior border of the mylohyoid muscle (Fig. 9.13).
Superficial Part
This part of the gland is quite large and fills the anterior part
of the digastric triangle extending upwards up to the
mylohyoid line. The superficial part presents two ends—
anterior and posterior and three surfaces—inferior, lateral,
and medial.
The anterior end extends up to the anterior belly of the
digastric muscle.
The posterior end extends up to the stylomandibular
ligament, which separates the submandibular gland from the
parotid gland. This end presents a groove produced by
ascending limb of the cervical loop of the facial artery.
Fascial covering or capsule (Fig. 9.14)
The superficial part is partially enclosed between the two
layers of investing layer of deep cervical fascia. At the greater
cornu of hyoid bone the investing layer of deep cervical fascia
splits into two laminae to enclose the superficial part. The
superficial layer covers the inferior surface of the gland and is
attached to the base of the mandible. The deep layer covers
the medial surface of the gland and is attached to the
mylohyoid line of the mandible.
Relations
The three surfaces of the superficial part have important
relations:
Superficial surface (inferior surface) from superficial to
deep is covered by the following structures (Fig. 9.15):

– Skin.
– Superficial fascia containing platysma and cervical
branch of facial nerve.
– Deep fascia.
– Facial vein.
– Submandibular lymph nodes.
Lateral surface is related to (Fig. 9.16):
– Submandibular fossa on the inner aspect of the body
of mandible.
– Medial pterygoid muscle (near its insertion).
– Facial artery.
It is important to note that the facial artery loops
downwards and forwards between the bone and the gland,
and then winds around the lower border of the body of
the mandible at the anteroinferior angle of the mandible
to reach the face

Medial surface is extensive and divided into three parts:

anterior, middle, and posterior (Fig. 9.17):
(a) Anterior part is related to:
– Mylohyoid muscle.
– Submental branch of facial artery.
– Mylohyoid nerve and vessels.
(b) Middle (intermediate) part is related to:
– Hyoglossus muscle.
– Styloglossus muscle.
– Lingual and hypoglossal nerves.
– Submandibular ganglion.
(c) Posterior part is related to:
– Styloglossus muscle.
– Stylohyoid ligament.
– Glossopharyngeal nerve.
– Wall of pharynx.

Deep Part
The deep part is small and lies on the hyoglossus muscle
deep to the mylohyoid; posteriorly it is continuous with
superficial part around the posterior border of the
mylohyoid, and anteriorly it extends up to the sublingual
salivary gland (Fig. 9.13).
Relations (Fig. 9.18)
Medial: Hyoglossus.
Lateral: Mylohyoid.
Superior: Lingual nerve and submandibular ganglion.
Inferior: Hypoglossal nerve accompanied by a pair of veins
(Venae comitantes nervi hypoglossi).
Submandibular duct (Wharton’s duct; Fig. 9.19)
The submandibular duct is about 5 cm long and emerges at
the anterior end of the deep part. It runs forwards on the
hyoglossus between the lingual and hypoglossal nerves. Near
the anterior border of the hyoglossus, it is crossed by lingual
nerve. It continues running forward between the sublingual
gland and the genioglossus. Here it lies just deep to the
mucus membrane of the oral cavity. Finally, it opens into the
oral cavity on the summit of a sublingual papilla at the side
of the frenulum of the tongue.
Blood supply
The gland is supplied by sublingual and submental arteries
and drained by common facial and lingual veins.
Lymphatic drainage
The lymphatics from submandibular gland first drain into
submandibular lymph nodes and subsequently into jugulodigastric
lymph nodes.

Nerve supply
The gland is supplied by parasympathetic, sympathetic,
and sensory fibres (Fig. 9.21):
1. Parasympathetic (secretomotor) supply:
(a) The preganglionic parasympathetic fibres arise from
superior salivatory nucleus in the pons and pass
successively through facial, chorda tympani, and
lingual nerves; and terminate in the submandibular
ganglion, which serves as a relay station.
(b) The postganglionic fibres arise from this ganglion
and directly supply the submandibular gland.
2. Sympathetic supply: The preganglionic fibres arise from
T1 spinal segment and enter the cervical sympathetic
trunk to relay in its superior cervical sympathetic
ganglion. The postganglionic fibres arise from superior
cervical sympathetic ganglion, form plexus around facial
artery, and thus reach gland through this artery.
3. Sensory supply: The gland gets its sensory supply by the
lingual nerve.

CN
The formation of calculi in the submandibular gland
and its duct is more common than in the parotid duct for
two reasons:
(a) Its secretion is more viscid.
(b) Its duct takes a tortuous and upward course, which
hampers its smooth drainage (against gravity) into
the floor of the mouth.
• The excision of the submandibular gland for calculus or
tumor is done by skin incision below the angle of the
mandible. Since the marginal mandibular branch of facial
nerve passes one inch posteroinferior to the angle of the
mandible before crossing its lower border, the incision
therefore should be given 4 cm below the angle to avoid
injury to this nerve.
• The swellings of the submandibular gland can be
palpated bimanually by putting an index finger in the
mouth and thumb below the angle of the jaw in relation to
the position of gland (Fig. 9.20), because part of the gland
lies in the oral cavity above the floor of the mouth and part
outside the oral cavity below the floor of the mouth. The
submandibular lymph nodes lying on the surface of the
gland cannot be palpated bimanually as they lie below the
floor of the mouth (oral diaphragm). Thus an enlarged
submandibular gland can be differentiated from a mass of
the submandibular lymph nodes by bimanual palpation.

The stone in the submandibular duct can also be pal pated

manually within the mouth and can even be seen if
sufficiently large.
• The stone is removed from within the mouth by incis ing
the mucus membrane and duct over the stone.

SUBLINGUAL GLAND
This is smallest of the three pairs of large salivary glands. It
lies in the floor of the mouth between the mucus membrane
and the mylohyoid muscle. It is almond shaped and
rests in the sublingual fossa of the mandible. It is separated
from the base of the tongue by the submandibular duct. It
is mostly mucus in nature and weighs about 3–4 g. The
gland pours its secretion by a series of ducts, about 15 in
number, into the oral cavity on the sublingual fold, but a
few of them open into the submandibular duct.
N.B. The gland actually possesses about 20 ducts. Most of
these ducts (ducts of Rivinus) open separately on the
sublingual fold, while some ducts from anterior part of the
gland unite to form the sublingual duct (duct of Bartholin),
which opens into the submandibular duct.
Nerve supply
It is similar to that of submandibular salivary gland.
Blood supply
The gland is supplied by the sublingual and submental
arteries.

Lymphatic drainage
The lymphatics from the sublingual gland drain into
submental and submandibular lymph nodes.
A ranula is a large mucus retention cyst in the floor of mouth
arising from sublingual salivary gland. Some times it may
arise from accessory salivary glands, called glands of
Blandin and Nuhn, present in the floor of mouth. The
swelling is soft, bluish in color, and transilluminates. It looks
like the belly of frog (Rana hexadactyla), hence the name
ranula.