Atlas of the Oral and Maxillofacial Surgery Clinics
Surgical Anatomy of the Mandibular Region for Reconstructive Purposes
Section snippets
Surgical anatomy of the mandibular region for reconstructive purposes
In the current era of contemporary reconstruction of the mandible, microvascular free tissue transfer is the method of choice for large bony and soft tissue defects. As outlined in various articles in this Atlas, there are other reconstructive modalities, such as pectoralis major myocutaneous flap and costochondral free grafts. Regardless of the method of reconstruction, the surgical anatomy of the perimandibular region remains unchanged. It is imperative that the reconstructive surgeon be
Fascia of the perimandibular region
There are two basic fascias of the upper neck and the perimandibular space: superficial and deep (Fig. 1). The superficial fascia is the fibrofatty layer just deep to the dermal plexus of skin. This superficial fascia (superficial cervical fascia) overlies the platysma muscle and is continuous with the superficial fascia of the face between the inferior border of the mandible and the zygomatic arch known as the superficial musculo-aponeurotic system. The function of this fascia is to prevent
Submandibular triangle
Perhaps the most important of all cervical triangles when performing mandibular reconstruction, the submandibular triangle is bounded by the inferior border of the mandible superiorly, the anterior belly of the digastric muscle anteriorly, and the posterior belly of the digastric muscle posteriorly. The common tendinous ring of these two muscles forms the inferior border, and the floor (deep) aspect of the triangle is formed by the mylohyoid muscle. The roof or the most anterior surface of this
Structures within the submandibular triangle
The submandibular gland is the largest structure within the submandibular triangle (Fig. 2, Fig. 3). Comprised of the superficial and deep parts, it is located between the anterior and posterior bellies of the digastric muscle, lateral and medial to the mylohyoid (superficial and deep lobes) muscle. It is just deep to the platysma and is covered by the SDCF, which forms the capsule of this gland. The submandibular duct (Wharton's duct) is a 5-cm extension of the posterosuperior portion of the
Structures outside of the submandibular triangle
Although most of the pertinent anatomy for mandibular reconstruction pertains to the submandibular space, other surgically important landmarks are relative to reconstructive purposes. Just deep to the submandibular triangle and at the posterior aspect of the mylohyoid muscle, the hyoglossus muscle runs from the superior aspects of the hyoid bone to insert on the lateral aspect of the tongue. On the superficial (lateral) aspect of this muscle is the hypoglossal nerve. Deep to the muscle is the
Summary
Regardless of the reconstructive modality, one must be familiar with the pertinent anatomy of the perimandibular space. The contents of the submandibular triangle, the neurovascular relationship, and the fascial lay out of this region are unique. Familiarity with these anatomic structures should facilitate reconstruction of the mandible.
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Cited by (3)
A closer examination of the retromandibular subparotid approach: Surgical technique and anatomical considerations with a special focus on the angular tract. A cadaveric study and a technical note
2020, Journal of Stomatology, Oral and Maxillofacial SurgeryCitation Excerpt :Although for some authors the SMAS and the parotid fascia represent the same entity, it is now accepted by a majority of anatomists and surgeons that the parotid gland is enveloped by a separate dense connective “capsule” (parotid fascia) that extends downward and continues as the masseteric fascia [9,10]. The parotid fascia has also been related to the investing layer of the deep cervical fascia, which extends cervically, enclosing the sternocleidomastoid and digastric muscle and separating the sublingual and submandibular spaces [11–13]. A loose fibrous connective tissue is identifiable confined between the parotid fascia and the SMAS, which in this region is composed primarily of a dense fibrous layer with only scattered muscular fibers.
Mandibular Fractures
2015, Atlas of Operative Oral and Maxillofacial SurgeryArakeri′s reflex: An alternative pathway for dento-cardiac reflex mediated syncope
2010, Dental Hypotheses