The Retaining Ligament of the Anterior Digastric Muscle

Abstract

The anterior belly of the digastric muscle (ABDM) is important in numerous esthetic surgeries including rhytidectomy, alteration of the cervicomental angle via partial resection of the ABDM muscle belly, and suprahyoid muscular medialization and suspension. Recently, the connection between the ABDM and the mylohyoid muscle (MH) has been proposed as important for the mechanism of the digastric corset procedure. This report refers to the connection between the ABDM and the MH as a type of retaining ligament of the anterior digastric muscle (RLAD). This report is the first to directly demonstrate the existence of the RLAD, via photograph and video, and document variation in its attachment sites, its composition, and its behavior when traction forces are applied. In addition to the importance of the RLAD in plastic surgery, the RLAD may affect neurovascular structures between the ABDM and MH and serve as a physical barrier separating the submental fascial space from the submandibular fascial space and, therefore, influence the spread of infection.

The submental arrowhead variation of the mylohyoid and anterior belly of the digastric muscles

“…In effect, the arrowhead variation would subdivide the space into a superficial and deep compartment that would be joined posteriorly near the hyoid, and perhaps anteriorly near the mandible, where the midline junction is non-existent. Further, mylohyoid variations and the retaining ligament of the anterior digastric may further influence the spread of infection in the submental space and the pathogenesis of Ludwig angina [1,44].…”