Abstract
The mylohyoid (MH) musculature separates the sublingual and submandibular spaces and is, therefore, important with regard to the spread of infection and space occupying lesions. Moreover, the MH may be elevated and included in the myocutaneous submental island flap or sutured in conjunction with the platysmas and the anterior bellies of the digastric muscles (ABDMs) to add stability to submental muscular medialization procedures. Therefore, variation in the anatomy of the MH musculature must be considered in the management of the spread of infection and space occupying lesions as well as in surgical planning. This report reviews mylohyoid variations and documents a unique case in which several suprahyoid muscular variations occurred concurrently. The variations included isolated anterior bellies of the mylohyoid inserting into the geniohyoid thereby forming mylo-geniohyoid muscles as well as isolated posterior bellies of the mylohyoid inserting into the ABDM and the intermediate tendon of the digastric muscle thereby forming mylo-digastric muscles. Surgeons operating in the suprahyoid region should be aware of potential anatomical variation of the mylohyoid to develop contingency plans.
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References
Macalister A (1875) Macalister on muscular anomalies in human anatomy. Trans R Ir Acad 25:34
Saadeh FA, El-Sabban M, Hawi JS (2001) Rare variations of the mylohyoid muscle: case study. Clin Anat 14:285–287
Sehirli U, Cavdar S (1996) An accessory mylohyoid muscle. Surg Radiol Anat 18:57–59
White DK, Davidson HC, Harnsberger HR, Haller J, Kamya A (2001) Accessory salivary tissue in the mylohyoid boutonnière: a clinical and radiologic pseudolesion of the oral cavity. AJNR Am J Neuroradiol 22:406–412
Zdilla MJ, Lambert HW (2015) Mylohyoid insertion at the mid-belly of a combined geniohyoid via a fibrous pseudo-hyoid: an observation with implications for submental flap surgery. J Plast Reconstr Aesthet Surg Open 5:1–3
Zdilla MJ (2015) Exclusion of musculature from the submental flap: a contingency plan for facial nerve palsy. Plast Reconstr Surg Glob Open 2:e266
Zdilla MJ (2014) Variant anterior digastric muscle transfer for marginal mandibular branch of facial nerve palsy. Plast Reconstr Surg Glob Open 2:e110
Zdilla MJ, Pancake AR, Lambert HW (2016) Morphometrics of the anterior belly and intermediate tendon of the digastric muscle: sexual dimorphism and implications for surgery. J Craniofac Surg 27:1321–1326
Zdilla MJ, Swearingen JV, Miller KD, Bender-Heine A, Lambert HW (2017) The retaining ligament of the anterior digastric muscle. J Craniofac Surg 28:534–538
Zhao YF, Jia Y, Chen XM, Zhang WF (2004) Clinical review of 580 ranulas. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 98:281–287
Acknowledgements
The authors would like to acknowledge the gross anatomical facility at West Liberty University, the West Virginia Anatomical Board, and the WVU Human Gift Registry. Most importantly, the authors would like to acknowledge the individual who donated their body for the advancement of science, and without whom, this work would not have been possible.
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Bender-Heine, A., Zdilla, M.J. Variation of the mylohyoid: implications for Ludwig angina, cervical contouring, and digastric muscle transfer. Surg Radiol Anat 40, 221–225 (2018). https://doi.org/10.1007/s00276-017-1868-1
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DOI: https://doi.org/10.1007/s00276-017-1868-1