A cadaveric study on mylohyoid herniation of the sublingual gland

Imaging of salivary gland cancers derived from a sublingual gland herniated into the submandibular space: a report of three cases

Sublingual gland herniation into the submandibular space through a mylohyoid muscle defect is a common anatomical variation; however, salivary gland cancers that arise from a herniated sublingual gland have not been described yet. Here, we report three patients with salivary gland cancers originating from a herniated sublingual gland. All tumors were detected as palpable submandibular masses, located anterior to the submandibular gland, medial to the mandible, and lateral to the mylohyoid muscle, with contact with the sublingual gland through a mylohyoid muscle defect. Intraoperative findings confirmed that the masses were derived from herniated sublingual glands. Pathological examination showed one case of mucoepidermoid carcinoma and two cases of adenoid cystic carcinoma. Imaging findings of the tumor location, in addition to the continuity with the sublingual gland through the mylohyoid muscle defect, are crucial for accurately diagnosing the tumor origin, which is essential for determining the appropriate clinical management.

Mylohyoid Muscle: Current Understanding for Clinical Management-Part I: Anatomy and Embryology

The mylohyoid is one of the suprahyoid muscles, along with the geniohyoid, digastric, and stylohyoid muscles. It lies between the anterior belly of the digastric muscle inferiorly and the geniohyoid superiorly. In Part I, the anatomy and embryology of the mylohyoid muscle will be reviewed in preparation for the clinical discussion in Part II.

Mylohyoid Muscle: Current Understanding for Clinical Management Part II: Clinical Anatomy, Radiology, and Surgical/Clinical Relevance

The mylohyoid is one of the suprahyoid muscles along with the geniohyoid, digastric, and stylohyoid muscles that lies between the anterior belly of the digastric muscle inferiorly and the geniohyoid superiorly. In Part II, the radiology and clinical/surgical importance of the mylohyoid muscle will be discussed.

Structural analysis of the mylohyoid muscle as a septum dividing the floor of the oral cavity for the purposes of dental implant surgery: variety of muscle attachment positions and ranges of distribution

OBJECTIVES

The objective was to investigate the details of the attachments of the mylohyoid muscle to the mandible anterior to the hyoid and mylohyoid lines to understand the positional relationship between the sublingual space and the mylohyoid, knowledge that is essential for dental implant surgery in the incisal region, as well as the routes of communication between the sublingual space and other spaces.

METHODS

While evaluating the presence or absence of an anterior mylohyoid muscle fiber attachment to the mandible, sublingual gland herniation, spaces between muscle fascicles were also recorded as sites of penetration. The mean muscle thickness in each of these areas was also calculated.

RESULTS

In all specimens, the mylohyoid originated not only from the mylohyoid line but also from the lingual surface of the center of the mandibular body (the mandibular symphysis) below the mental spines. The mylohyoid muscle fascicles were thickest in the posterior region, and further anterior to this, they tended to become thinner. Sublingual gland herniations passing through the mylohyoid were noted in the anterior and central regions, but not in the posterior region. Penetration between the muscle fascicles was most common in the central region, and no such penetration was evident in the posterior region.

CONCLUSIONS

These results suggest that the mylohyoid functions only incompletely as a septum, and that routes of communication from the sublingual space to the submandibular space may be present in both the anterior and central muscle fascicles of the mylohyoid. Therefore, bleeding complications during dental implant placement in the anterior mandible can be serious issues. There is a potential for sublingual hematoma that could compromise the airway by pressing the tongue against the soft palate into the pharynx.

Amylase as a Diagnostic Tool for Plunging Ranula: Clinical Series and Description of the Technique

OBJECTIVES

This study describes a technique of measurement for neck cyst amylase content and reviews the experience of a tertiary referral center for cases of suspected plunging ranula.

METHODS

A retrospective study was performed at the Manukau Surgical Center in Auckland, New Zealand. Patients with a possible diagnosis of plunging ranula based on clinical presentation and diagnostic aspiration of the cyst contents were included. Demographic data, imaging and laboratory findings were collected, along with findings from surgery and histology. The technique for measuring the amylase of the aspirated cyst contents was also carefully recorded.

RESULTS

The 37 cases of confirmed plunging ranula included in this study had a submandibular cystic swelling that was aspirated. Imaging features consistent with a plunging ranula were seen in 89% of the study group. All cases had detectable levels of amylase of ≥3 U/L in the ranula contents. There was large variability (range: 5-560 U/L) in the concentration of amylase, with 70% of the cases demonstrating an amylase concentration below 200 U/L. Aspirates were typically described as viscous (87.5%) and yellow or straw-colored.

CONCLUSION

The combination of clinical presentation, imaging and the presence of amylase in the cyst contents is diagnostic for plunging ranula.

LEVEL OF EVIDENCE

4 Laryngoscope, 133:535-538, 2023.

A large sublingual glandular branch of the lingual nerve: a rare case report

While the route, location, and pathology of the lingual nerve has been detailed extensively in reports in the literature, its terminal branch to the sublingual gland is often overlooked. It is known, via both gross and histological observation, that the sublingual glandular branch terminates at the posterior aspect of the sublingual gland. Upon routine cadaveric dissection of a male cadaver, one of the lingual nerve branches was found to terminate at the anteroinferior portion of a herniated sublingual gland. This specific course has not previously been discussed or reported via gross or histological observation. Therefore, a timely review of the lingual nerve’s terminal sublingual glandular branch’s anatomy and clinical significance pertaining to this case is warranted. Surgeons who treat patients with submental masses should be aware of the anatomy of this nerve and the potential variance described here in order to avoid postprocedural complications.

Submandibular swelling, pulsations and otalgia due to sublingual gland and blood vessels herniation through mylohyoid boutonnière: Case report

Background/Aim: Mylohyoid boutonnière is a common anatomical variant with extremely rare clinical manifestations. We report two cases of symptomatic unilateral mylohyoid boutonnière with sublingual gland herniation. Case report: The first was a 34-year-old female with a two months history of a left submandibular swelling, intermittent pulsations, and otalgia. The second 67-year-old female presented with a left submandibular pain six months after total thyroidectomy due to papillary carcinoma. After detailed clinical and radiological evaluation by ultrasonography (US) and computed tomography (CT), the mylohyoid gap with sublingual gland herniation was diagnosed in both patients. The dynamic US with a tongue pressed down on the mouth floor revealed blood vessel compression by a herniated sublingual gland in the first patient. Conclusions: This is the first case of a mylohyoid boutonnière related intermittent vascular compression. Dynamic US and CT may help to differentiate intermittent and persistent sublingual gland herniation through the mylohyoid boutonnière from other pathological lesions in the submandibular region.

Ten must know pseudolesions of the head and neck

Patients may present in the emergency setting for a variety of head and neck complaints such as fever, trouble swallowing, or a newly palpable mass. When reviewing radiologic head and neck exams for etiology of complaints, it is important to be familiar with the multiple pseudolesions that may mimic pathology. These may be normal variant anatomy, normal anatomy located in an atypical location, as well as iatrogenic or self-introduced foreign bodies. This review article discusses ten common pseudolesions encountered in the head and neck and their typical imaging appearance so that one does not mistake them for ominous pathology, thus preventing unnecessary follow-up, biopsy, or continued concern for the patient.