Submandibular region

 The region between the mandible and body of

hyoid bone.
 It is at the Suprahyoid region.
 Consist of:
o The right digastric triangles.
o The left digastric triangles.
o The right submental triangles.
o The left submental triangles.
Submandibular (Digastric) triangle
 Between the posterior and anterior bellies of the
digastric muscle and inferior border of the mandible.
 Floor is formed by:
o Mylohyoid muscles.
o hyoglossus muscles.
o middle constrictor muscles.

Submental triangle
 Located between the 2 anterior belly of digastric
muscles.
 Submandibular region: Contents
 Glands:
o Submandibular and sublingual glands
 Muscles:
1. Suprahyoid muscles :
o Anterior bellies of digastric
o Posterior bellies of digastric
o stylohyoid
o mylohyoid
o geniohyoid
2. Extrinsic tongue muscles:
o hyoglossus
o styloglossus
o genioglossus 3
 Submandibular region: Contents

 Nerves:
o Lingual nerve
o Glossopharyngeal
o Hypoglossal nerves
o Submandibular ganglion (Parasympathetic)

 Blood vessels:
o Facial artery & Facial vein
o Lingual artery & Lingual vein

 Lymph:
o Submandibular nodes
 Submandibular gland

The large, paired salivary glands are:

 Parotid,
 Submandibular,
 Sublingual glands.

Submandibular gland has two parts:

 Larger superficial part (body)
 Smaller deep process.
o Found in submandibular triangle.
o The two parts are continuous with each other,
forming a "U" shape around the posterior
border of the mylohyoid muscle.

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.

Capsules of the Submandibular Gland

The gland is covered by:

 Connective tissue capsule.
 Partly enclosed by the investing layer of deep cervical
fascia - a portion of the fascia between the styloid
process and the angle of mandible,
 Stylomandibular ligament which intervenes between
the parotid and submandibular glands.

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 Submandibular gland
Relations of superficial part :
It has three surfaces:
 Inferior,
 Lateral
 Medial

Inferior (superficial) surface

 Skin, platysma, Investing fascia.
 Facial vein
 Cervical & marginal mandibular branches of facial nerve
 Submandibular lymph nodes
Lateral surface
 Submandibular fossa of the mandible
 Medial pterygoid
 Facial artery
 Masseter

Medial surface
 Mylohyoid and hyoglossus muscles
 Lingual nerve (CN V3)
 Submandibular ganglion
 Hypoglossal nerve

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Smaller Deep Process
 Medial- hyoglossus Lateral - mylohyoid
 Above- lingual nerve Below- hypoglossal nerve

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 Submandibular duct of Wharton Course
 Average length - 5 cm.
 Emerges
o from anterior end of the deep part of the gland
between the mylohyoid and hyoglossus.
o Crossed laterally by the lingual nerve.
o Lies bet. sublingual gland & genioglossus muscle
 Termination
o Opens into the floor of the mouth on the summit of the
sublingual papilla, on either side of the frenulum.
o Closely accompanied by lingual nerve, while CN XII
parallel the duct, running just inferior to it.
o The branches of the duct can be examined
radiographically (injection of radio-opaque medium).
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 Innervation to the submandibular gland

■ Sympathetic innervation: (vasoconstrictor) fibres

come from the plexus around the facial artery
■ Parasympathetic innervation from the
submandibular ganglion
o The postganglionic parasympathetic,
secretomotor fibers derived from the
submandibular ganglion.
o Preganglionic fibres superior salivary nucleus in
the pons.
o The preganglionic fibers leave the skull with the
chorda tympani (a branch of the facial nerve)
and then join the lingual nerve on their way to
the submandibular ganglion.
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 Innervation to the submandibular gland

The submandibular ganglion and

its connections:
 Sympathetic fibers are shown
by continuous lines.
 Parasympathetic fibers are
shown by the dotted lines.
Arterial supply:
 Branches of facial and lingual arteries.
 The facial artery forms a groove in the deep part of
the gland, then curves up around the inferior margin
of the mandible to supply the face.

Venous drainage:
 Facial veins
 Lingual veins

Lymphatic drainage:
 Submandibular lymph nodes
 Deep cervical lymph nodes

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 Lingual artery

 Arises from the external carotid artery opposite the tip of

the greater cornu of the hyoid bone.
 It runs forward, forming an upward loop, on the middle
constrictor and is crossed by the hypoglossal nerve.
 It then proceeds forward deep to the hyoglossus muscle
to supply the tip of the tongue.
 At the anterior border of this muscle, it turns superiorly
and ends by becoming the deep lingual artery.
 The lingual nerve and submandibular duct pass through
a gap between the hypoglossal and mylohyoid muscles
and the lingual artery passes deep to the hyoglossus
muscle.

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 Lingual artery: Branches

 Dorsal lingual branches are two or three in number and

ascend to the dorsum of the tongue.
 Sublingual artery - supplies the sublingual salivary
gland and neighboring structures.
 Suprahyoid artery - from the beginning of the artery and
runs superficial to hyoglossus.
 Deep lingual artery - runs on the under surface of the
tongue under its mucous membrane.

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 Sublingual gland
 Position:
o It is inferior to the mucosa of the floor of the mouth,
o in the sublingual fossa of the mandible.
 These are the smallest of the three paired salivary glands and the
most deeply situated under the tongue.
 Almond-shaped (ovoid) and lie on the floor of the oral cavity proper.
 Contribute to only 3-5% of overall salivary volume.
 Producing mixed secretions - predominately mucous in nature.
 Sublingual fold extends from posterolateral position and traverses
anteriorly to join the sublingual papillae midline to lingual frenulum.
 Secretions drain into oral cavity by minor sublingual ducts (of
Rivinus) – 10 - 15 excretory ducts per gland,
 Each duct opening out onto the sublingual folds but a few may
open into the submandibular duct and out through the sublingual
papillae.

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 Sublingual gland
Relations
 Anterior: gland of the
opposite side
 Posterior: deep part of the
submandibular gland
 Superior: sublingual fold
 Inferior: mylohyoid muscle
 Medial: genioglossus
muscle, lingual nerve &
submandibular duct
 Lateral: sublingual fossa of
the medial surface of the
mandible Mylohyoid m Sublingual gland

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 Sublingual gland

 Arterial supply:
o Sublingual branch of the lingual artery
o Submental branch of the facial artery
 Venous drainage: lingual and facial veins
 Lymphatic: submandibular and deep cervical nodes
 Innervation to the Sublingual gland:
o Sympathetic innervation from the cervical chain
ganglia via the facial artery
o Parasympathetic innervation, like the submandibular
gland, is derived from the submandibular ganglion.

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 Submandibular region: Muscles

Extrinsic tongue muscles Suprahyoid muscles

1. Hyoglossus, 1. Geniohyoid
2. Genioglossus 2. Mylohyoid
3. Styloglossus, 3. Digastric
(anterior belly)
4. Digastric
( posterior belly)
5. Stylohyoid
 Digastric muscle

Anterior belly: digastric

fossa of mandible. Attaches
to the post. belly of digastric
by the intermediate tendon
Posterior belly: mastoid
notch of temporal bone

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 Mylohyoid muscle

Superficial relations
Anterior belly of digastric, superficial part of submandibular
gland, mylohyoid nerve & vessels
Deep relations
Deep part of submandibular gland, submandibular duct,
genioglossus muscle, hyoglossus muscle, sublingual gland,
hypoglossal nerve, lingual nerve, submandibular ganglion.
Innervation of tongue muscles

• The hypoglossal nerve (CN XII) provides motor innervation to

the intrinsic and extrinsic muscles of the tongue.
• The only exception is palatoglossus, which is supplied by the
pharyngeal branch of the vagus nerve, via the pharyngeal
plexus

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Structures superficial
to hyoglossus muscle

■ Styloglossus muscle
■ Lingual nerve
■ Submandibular
ganglion
■ The deep process of
the submandibular
gland and the
submandibular duct
■ Hypoglossal nerve
■ Suprahyoid artery

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 Structures deep to hyoglossus muscle
■ Glossopharyngeal nerve
■ Stylohyoid ligament
■ Lingual artery

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 Suprahyoid Muscles
( all act to elevate the hyoid bone)

1. Digastric - opens mouth

2. Stylohyoid - splits to surround digastric tendon
3. Mylohyoid - forms muscular floor of mouth
4. Geniohyoid - During the first act of deglutition,
when the food is being driven into the pharynx,
the hyoid bone and the tongue, is carried upward
and forward and It assists in depressing the
mandible
 The Extrinsic Muscles
(originate from bone and extend to the tongue)

1. The genioglossus, arises from the mandible and

protrudes the tongue. "safety muscle" - the only
muscle that propels the tongue forward.
2. The hyoglossus, arises from the hyoid bone and
retracts and depresses the tongue.
3. The styloglossus, arises from the styloid process
of the temporal bone and draws the sides of the
tongue up to create a trough for swallowing.
 Digastric muscle

The intermediate tendon pierces the stylohyoid insertion

and is tied down by a fascial sling to the body and
greater horn of hyoid of the hyoid.
N: Posterior belly: facial nerve VII (developed from the
2nd pharyngeal arch
Anterior belly: nerve to the mylohyoid (branch of the
mandibular division of the trigeminal nerve V)
(developed from the1st pharyngeal arch)
A: Depress the mandible (open the mouth); elevates and
steadies hyoid during swallowing and speaking.

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 Mylohyoid

O:Mylohyoid line of mandible

I: Mylohyoid raphe (extends from the symphysis
menti to the body of the hyoid bone)and body of
hyoid
N: Nerve to mylohyoid, a branch of inferior alveolar
nerve (from mandibular nerve, CN V3)
A: Depresses the mandible (opening of the
mouth), elevates the hyoid bone (during
swallowing), muscles of the two sides form the
oral diaphragm.

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 Geniohyoid muscle
A slender muscle, superior to the mylohyoid.
O: inferior mental spine, behind the
symphysis menti.
I: anterior surface of the body of the hyoid
bone.
N: first cervical nerve through the hypoglossal
nerve. C1(superior root of ansa cervicalis)
A: Protracts and elevates the hyoid bone in
swallowing, depresses the mandible.

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 Stylohyoid muscle
It is nearly parallel to the
posterior belly of the digastric
muscle.
O: styloid process of the temporal bone
I: At the junction of the body
& the greater cornu of
hyoid.
Near its insertion, it is
pierced by the intermediate
tendon of the digastric
muscle.
N: cervical branch of facial
nerve (CN VII)
A: It elevates and retracts the hyoid bone

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 Genioglossus
A fan-shaped muscle
O: Superior mental spine of the mandible
I: Superior fibers – tip of tongue, middle fibers – dorsum of
tongue, a few of inferior fibers – body of the hyoid bone
N: Hypoglossal nerve
A: Protrudes the tip of tongue so that it points to the opposite
side. When the two muscles act together protrudes the tongue
in the mid line.

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 Hyoglossus muscle
A flat, quadrilateral muscle, superficial to the mylohyoid.
O: Upper border of the body and greater cornu of the hyoid
bone.
I: inferior surface of the side of the tongue
N: Hypoglossal nerve
A: Depression of tongue Hyoglossus muscle

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 Styloglossus muscle
A long, slender muscle
O: from the styloid
process
I: At the interval
between the superior
and the middle
constrictor muscles, it
passes forward to
enter the sides of the
tongue
N: Hypoglossal nerve.
A: Draws the tongue
upward and
backward 33