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Surgery

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Salivary Gland

Question
64 out of 80
 

Nerve which lies in association to Wharton's duct is:



A Hypoglossal
B Lingual

C Facial
D Spinal accessory

Ans. B Lingual (Ref Bailey 26/e p726, 25/e p755)

Lingual nerve lies in a close association with submandibular duct and most prone to damage during submandibular gland surgery.

Submandibular Gland

• The deep part of the gland lies on the hyoglossus muscle closely related to the lingual nerve and inferior to the hypoglossal nerve,

• Submandibular duct lies between the lingual and hypoglossal nerves on hyoglossus, but, at the anterior border of the muscle, it is crossed laterally by the lingual nerve, terminal branches of which ascend on its medial side.

Management Of Sialolithiasis

• If the stone is lying within the submandibular duct in the floor of the mouth anterior to the point at which the duct crosses the lingual nerve (second molar region), the stone can be removed by incising longitudinally over the duct",

• Once the stone has been delivered, the wall of the duct should be left open to promote free drainage of saliva.

• Suturing the duct will lead to stricture formation and the recurrence of obstructive symptoms.

• Where the stone is proximal to the lingual nerve, .i.e. at the hilum of the gland, stone retrieval via an intraoral approach should be avoided as there is a high risk of damage to the lingual nerve during exploration in the posterior lingual gutter. Treatment is by simultaneous submandibular gland excision and removal of the stone and ligation of the submandibular duct under direct visions.

Salivary Gland Flashcard List

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