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

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.

A Rare Case of an Artery Passing through the Median Perforating Canal of the Mandible

Along with the popularization of dental implant surgery, there has been considerable research on the lingual foramen using cone-beam computed tomography. Anatomical research has also revealed that the arteries entering the lingual foramina are branches of the submental and sublingual arteries. There have been no reports, however, of the submental or sublingual artery entering the mandible from the lingual foramen, perforating it, and then distributing to the inferior labial region. A 69-year-old man who donated his body to our department in 2015 was dissected. The mandible with overlying soft tissue of the mental region was resected and examined with microcomputed tomography, which showed that the canal perforated from the lingual foramen to the midline of the labial cortical plate. The canal was thus named the median perforating canal. To the best of our knowledge, there have been no other reports of a perforating artery of the mandible, so this case is thought to be rare. Hence, the existence of perforating arteries, such as in the present case, should be taken into consideration in preoperative diagnoses such as for dental implant surgery. Thus, the fusion of anatomical and radiological study is useful and necessary to understand surgical anatomy.