Anat Cell Biol.  2021 Sep;54(3):304-307. 10.5115/acb.21.019.

Localizing the nerve to the mylohyoid using the mylohyoid triangle

• Iwanaga J
• Kim HJ
• Wysiadecki G
• Obata K
• Harazono Y
• Ibaragi S
• Tubbs RS

• KMID: 2521042
• DOI: http://doi.org/10.5115/acb.21.019

Abstract

The nerve to the mylohyoid muscle has been well studied but there are no specific anatomical landmarks for identifying it. Therefore, we aimed to identify anatomical landmarks for localizing the nerve to the mylohyoid muscle in the submandibular region. Sixteen sides from eight embalmed Caucasian cadaveric heads were used in this study. The mean age at the time of death of the specimens was 80.3 years. The anterior and posterior bellies of the digastric muscle, submental artery, and mylohyoid muscle were dissected to verify their relationships with the nerve to the mylohyoid muscle. The nerve to the mylohyoid muscle was found medial to the submental artery, lateral to the anterior belly of the digastric muscle, and anterior to the posterior border of the mylohyoid muscle on all sides. Herein, we identified what we term the mylohyoid triangle. This anatomical region can help localize the nerve to the mylohyoid muscle.

Keyword

Nerve to mylohyoid muscle; Submental island flap; Reconstructive surgery; Head and neck surgery; Submental artery

Figure

• 

  Fig. 1 The mylohyoid triangle (B) and the adjacent anatomical structures that form its borders (A).

Reference

References

1. Ryu EJ, Kim DH. 2021; Anatomical insights of the mylohyoid for clinical procedures in dentistry. Clin Anat. 34:461–9. DOI: 10.1002/ca.23675. PMID: 32893917.

2. Koga S, Sato I, Li ZL, Miyaso H, Kawata S, Itoh M. 2021; Analysis of the mylohyoid nerve in elderly Japanese cadavers for dental implant surgery. Clin Exp Dent Res. 7:20–32. DOI: 10.1002/cre2.341. PMID: 33230980. PMCID: PMC7853905.

3. Standring S. 2020. Gray's anatomy: the anatomical basis of clinical practice. 42nd ed. Elsevier;Amsterdam:

4. Kikuta S, Iwanaga J, Kusukawa J, Tubbs RS. 2019; Triangles of the neck: a review with clinical/surgical applications. Anat Cell Biol. 52:120–7. DOI: 10.5115/acb.2019.52.2.120. PMID: 31338227. PMCID: PMC6624334.

5. Adjei SS, Hammersley N. 1989; Mylohyoid nerve damage due to excision of the submandibular salivary gland. Br J Oral Maxillofac Surg. 27:209–11. DOI: 10.1016/0266-4356(89)90146-0. PMID: 2742806.

6. Guyot L, Layoun W, Richard O, Cheynet F, Gola R. 2002; Alteration of chin sensibility due to damage of the cutaneous branch of the mylohyoid nerve during genioplasty. J Oral Maxillofac Surg. 60:1371–3. DOI: 10.1053/joms.2002.35753. PMID: 12420278.

7. Oth O, Louryan S, Van Sint Jan S, Rooze M, Glineur R. 2013; Impact of the mandibular divergence on the position of the inferior alveolar nerve and mylohyoid nerve: a computed tomography study and its relevance to bilateral sagittal split osteotomy. Surg Radiol Anat. 35:241–7. DOI: 10.1007/s00276-012-1010-3. PMID: 22926343.

8. Choi P, Iwanaga J, Dupont G, Oskouian RJ, Tubbs RS. 2019; Clinical anatomy of the nerve to the mylohyoid. Anat Cell Biol. 52:12–6. DOI: 10.5115/acb.2019.52.1.12. PMID: 30984446. PMCID: PMC6449580.

9. Hu S, Fan C, Pecchia B, Rosenberg JD. 2020; Submental island flap vs free tissue transfer in oral cavity reconstruction: systematic review and meta-analysis. Head Neck. 42:2155–64. DOI: 10.1002/hed.26121. PMID: 32092220.

10. Bayon R, Davis AB. 2019; Submental flap for soft tissue reconstruction following radical parotidectomy. Otolaryngol Head Neck Surg. 160:1130–2. DOI: 10.1177/0194599819827822. PMID: 30717640.

11. Pirogov NI. 1852. Anatome topographica: sectionibus per corpus humanum congelatum: triplici directione ductis illustrata. Typis Jacobi Trey;Petropoli:

12. Varol A, Sencimen M, Kocabiyik N, Gulses A, Ozan H. 2009; Clinical and anatomical aspects of possible mylohyoid nerve injury during genioplasties. Int J Oral Maxillofac Surg. 38:1084–7. DOI: 10.1016/j.ijom.2009.06.019. PMID: 19625167.

13. Altug HA, Sencimen M, Varol A, Kocabiyik N, Dogan N, Gulses A. 2012; The efficacy of mylohyoid nerve anesthesia in dental implant placement at the edentulous posterior mandibular ridge. J Oral Implantol. 38:141–7. DOI: 10.1563/AAID-JOI-D-10-00037. PMID: 20662675.

14. Potu BK, D'Silva SS, Thejodhar P, Jattanna NC. 2010; An unusual communication between the mylohyoid and lingual nerves in man: its significance in lingual nerve injury. Indian J Dent Res. 21:141–2. DOI: 10.4103/0970-9290.62792. PMID: 20427927.

15. Tubbs RS, Loukas M, Shoja MM, Acakpo-Satchivi L, Wellons JC 3rd, Blount JP, Oakes WJ. 2007; The nerve to the mylohyoid as a donor for facial nerve reanimation procedures: a cadaveric feasibility study. J Neurosurg. 106:677–9. DOI: 10.3171/jns.2007.106.4.677. PMID: 17432721.

16. Iwanaga J, Kikuta S, Oskouian RJ, Tubbs RS. 2019; Nerve to mylohyoid branched from the lingual nerve: previously undescribed case. Anat Sci Int. 94:266–8. DOI: 10.1007/s12565-019-00476-4. PMID: 30710312.

17. Shen D, Do Q, Ohyama H, Tubbs RS, Iwanaga J. 2021; Dual innervation of the mylohyoid muscle by the trigeminal and hypoglossal nerves: a case report. Morphologie. 105:72–4. DOI: 10.1016/j.morpho.2020.08.005. PMID: 32891510.

18. Ryumon S, Hage D, Ibaragi S, Okui T, Tubbs RS, Iwanaga J. 2020; Dec. 4. Dual innervation of the submandibular gland by nerve to mylohyoid and chorda tympani. Morphologie. [Epub]. https://doi.org/10.1016/j.morpho.2020.11.004. DOI: 10.1016/j.morpho.2020.11.004. PMID: 33288421.

19. Kim SD, Loukas M. 2019; Anatomy and variations of digastric muscle. Anat Cell Biol. 52:1–11. DOI: 10.5115/acb.2019.52.1.1. PMID: 30984445. PMCID: PMC6449592.

20. Iwanaga J, Singh V, Ohtsuka A, Hwang Y, Kim HJ, Moryś J, Ravi KS, Ribatti D, Trainor PA, Sañudo JR, Apaydin N, Şengül G, Albertine KH, Walocha JA, Loukas M, Duparc F, Paulsen F, Del Sol M, Adds P, Hegazy A, Tubbs RS. 2021; Acknowledging the use of human cadaveric tissues in research papers: recommendations from anatomical journal editors. Clin Anat. 34:2–4. DOI: 10.1002/ca.23671. PMID: 32808702.