Variation of the mylohyoid: implications for Ludwig angina, cervical contouring, and digastric muscle transfer

Bender‐Heine, Adam; Zdilla, Matthew J.

doi:10.1007/s00276-017-1868-1

Cited by 5 publications

(10 citation statements)

References 8 publications

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“…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].…”

Section: Discussionmentioning

confidence: 99%

“…Likewise, variations of the ABDM may be unilateral or bilateral; however, there are more reports of unilateral variations [25]. Indeed, some variations, usually considered variants of the ABDM, connect the ABDM and mylohyoid musculature [1,33].…”

Section: The Anterior Digastric Musclementioning

confidence: 99%

“…Other authors have documented variant mylohyoid musculature to have diverse insertions including the contralateral hyoid and also midway between the chin and hyoid at the geniohyoid via a dense fibrous "pseudohyoid" [28,40]. Indeed the mylohyoid may not reach the hyoid but, rather, insert at the ABDM or geniohyoid forming mylo-digastric and mylo-geniohyoid muscles, respectively [1].…”

Section: The Mylohyoid Musclementioning

confidence: 99%

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

et al. 2018

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Purpose-Submental anatomical variation is of clinical importance with regard to head and neck surgeries. One such anatomical variation is that of additional musculature joining the intermediate tendon of the digastric muscle to the midline of the mylohyoid musculature-a variation which this report refers to, accordingly, as an arrowhead variation. Though the arrowhead variation has been described in several case reports, it has not been subject to cross-sectional study. The purpose of this study is to determine the prevalence of the arrowhead variation. Methods-Prevalence of the arrowhead variation was assessed in 19 cadavers via gross dissection. Results-Two of the 19 cadavers (10.5%) were found to have arrowhead variations. The arrowhead variation was found in one male (1:11; 9.1%) and one female (1:8; 12.5%), respectively. Conclusions-This report demonstrates that the submental arrowhead variation of the anterior digastric and mylohyoid musculature has been reported in isolated case reports since the nineteenth century. This report is the first cross-sectional study of the arrowhead variant, identifying it in approximately one in ten individuals and in both sexes. Therefore, the presence of an arrowhead variation should be regularly considered with regard to diagnosis of submental masses. Likewise, the arrowhead variation should be considered in the preoperative planning of the myriad operations performed in the submental region.

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Section: Discussionmentioning

confidence: 99%

Section: The Anterior Digastric Musclementioning

confidence: 99%

Section: The Mylohyoid Musclementioning

confidence: 99%

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

et al. 2018

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“…The possibility for dehiscence of the anterior and posterior parts of the mylohyoid leading to a boutonnière, through which a branch of the submental artery is likely to pass, is highlighted by reports of mylohyoid variations. For example, studies have documented distinct anterior mylohyoid bellies that formed mylogeniohyoid muscles and distinct posterior bellies, which formed mylodigastric muscles 22 . Moreover, the aforementioned mylogeniohyoid and mylodigastric muscles were separated by boutonnières 22 .…”

Section: Discussionmentioning

confidence: 99%

Clinical Implications of the Submental and Sublingual Arteries in Relation to the Mylohyoid Boutonnière

Zdilla

Bender‐Heine

Lambert

et al. 2020

Otolaryngol.--head neck surg.

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Objective Mylohyoid musculature may be included in the submental artery flap to protect perforators. However, blood vessels may pass through the mylohyoid muscle and therefore cause bleeding and risk to pedicle or perforator injury when a mylohyoid-containing flap is lifted. The objectives of this study were to identify the prevalence of the submental and sublingual arteries that traverse the mylohyoid and to assess relationships between vasculature transmitted through mylohyoid muscles and mylohyoid boutonnières. Study Design Cross-sectional human cadaveric study. Setting The West Virginia University School of Medicine human gross anatomic laboratories. Subjects and Methods A total of 43 intact mylohyoid muscles from 22 cadavers were dissected. The prevalence of submental vasculature perforating the mylohyoid was recorded in addition to the prevalence and contents of mylohyoid boutonnières. Results Of 43 mylohyoid muscles, 21 (48.8%) transmitted the submental or sublingual arteries, and 30 (69.1%) possessed boutonnières. One muscle had 2 boutonnières. Of 31 mylohyoid boutonnières, 21 transmitted blood vessels (67.7%). Specifically, 9 transmitted an artery and a vein (29.0%), and 12 transmitted an artery (38.7%). Ten boutonnières (32.3%) were exclusively occupied by fascia. Conclusion This report identifies the importance of identifying and carefully ligating branches of the submental artery that pierce the mylohyoid during elevation of the submental island flap. This report also identifies that a boutonnière is often present where a submental or sublingual artery is traversing the mylohyoid to supply sublingual glands, tongue, and anterior mandible.

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“…The MH is a partial barrier between the submandibular and sublingual spaces; therefore, it can be related to the spread of odontogenic infection, such as Ludwig's angina. It can also lead to infection in the upper neck region in presence of a mylohyoid defect (Bender‐Heine & Zdilla, 2018; Zdilla, Mangus, Swearingen, Miller, & Lambert, 2018). The MH with herniation of the sublingual gland and fat tissue can cause difficulty in establishing the differential diagnosis (Yang et al, 2016).…”

Section: Introductionmentioning

confidence: 99%

Anatomical insights of the mylohyoid for clinical procedures in dentistry

Ryu

Kim

2020

Clinical Anatomy

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Introduction The purpose of this study is to provide useful data by conducting a comprehensive study of the mylohyoid muscle and its related structures. Materials and methods Fifty‐eight mandibles and 30 mylohyoid muscles from Korean adult cadavers were used. The shape and location of the mylohyoid line were analyzed by using digital calipers. The mylohyoid muscle and its herniation were observed using ultrasonography. After dissection, morphometric measurements of the muscle and herniation were conducted. The distribution pattern of the nerve to mylohyoid muscle was confirmed. Results The proportion of the distance between the cementoenamel junction and the mylohyoid line decreased from the mesiolingual cusp of the mandibular first molar (1:0.57) to the distolingual cusp of the mandibular second molar (1:0.41). The mylohyoid muscle was large, thick, and deep in men. Herniation was observed in 16 (53.3%) cases, and it was concentrated in the anterior one‐third (52.2%) of the muscle. The richest arborization of the nerve to mylohyoid muscle was in the middle one‐third (52.9%) of the muscle. Conclusions The results of the mylohyoid line can be applied in the reconstruction of the occlusal plane in edentulous patients. Differences between the sexes should be considered in the morphological characteristics of the mylohyoid muscle. Differential diagnosis of herniation is particularly important in the anterior one‐third of the muscle. In the case of treatment with botulinum toxin in the mylohyoid muscle, it is recommended to inject into the middle one‐third area considering the depth and thickness of the muscle in that area.

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Variation of the mylohyoid: implications for Ludwig angina, cervical contouring, and digastric muscle transfer

Cited by 5 publications

References 8 publications

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

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

Clinical Implications of the Submental and Sublingual Arteries in Relation to the Mylohyoid Boutonnière

Anatomical insights of the mylohyoid for clinical procedures in dentistry

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