A 35-year-old man is admitted to the hospital with severe pain in the area of his right submandibular gland. Radiographic examination reveals a tumor of the gland. An incision is made and the submandibular gland and its duct are removed. Which of the following nerves is most commonly injured in this type of procedure?
The lingual nerve initially courses directly underneath the mucosa of the floor of the mouth and superficial to the submandibular gland, specifically the submandibular duct. This nerve is therefore at risk for ligation, division, or trauma during excision of the gland and duct. The lingual nerve is part of the mandibular division of the trigeminal nerve and carries fibers from the chorda tympani. These latter fibers supply taste to the anterior two thirds of the tongue and preganglionic parasympathetic axons involved in salivary gland secretion. Fibers of the trigeminal nerve supply general sensation to the anterior two thirds of the tongue. The lingual nerve passes deep both to the lateral pterygoid muscle and the ramus of the mandible and subsequently travels deep to the submandibular gland itself. The buccal nerve, also a branch of the mandibular division of the trigeminal nerve, supplies the mucosa of the cheek and is not in close proximity to the gland or duct. The inferior alveolar nerve, though close in proximity to the submandibular gland, travels deep to the lateral pterygoid muscle and later enters the mandibular canal to supply the lower teeth. The nerve to the mylohyoid, a branch of the inferior alveolar nerve, supplies the mylohyoid muscle and the anterior belly of the digastric. Neither of these nerves is at risk for damage during excision of the submandibular gland and duct.
Buccal
Lingual
Inferior alveolar
Nerve to mylohyoid
Head & Neck