Submandibular transverse skin incision

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SUBMANDIBULAR RETROPHARYNGEAL APPROACH

• Submandibular transverse skin incision
• Mobilize anterior border of SCM after identifying
  marginal branch of CN VII
• Divide digastric tendon
• Retract hypoglossal nerve superiorly
• Dissect bluntly down to retropharyngeal space
• Identify superior laryngeal nerve
• Divide prevertebral muscles down to Longus colli
  muscles bordering upper cervical vertebrae

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Skin incision for submandibular retropharyngeal
approach.
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HYOGLOSSUS MUSCLE
MYLOHYOID MUSCLE
DIGASTRIC MUSCLE (ANTERIOR BELLY)
STYLOHYOID MUSCLE
FIBROUS LOOP FOR INTERMEDIATE DIGASTRIC TENDON
POSTERIOR BELLY OF DIGASTRIC MUSCLE
THYROHYOID MUSCLE
OMOHYOID MUSCLE
STERNOHYOID MUSCLE
STERNOCLEIDOMASTOID MUSCLE
Submandibular upper cervical anatomy.
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POSTERIOR BELLY OF DIGASTRIC MUSCLE
SUBMANDIBULAR GLAND
HYOGLOSSAL NERVE
LONGUS COLLI MUSCLE
HYOID
SUPERIOR THYROID ARTERY AND VEIN
SUPERIOR LARYNGEAL NERVE
Exposure of the C 2-3 disk space following
surgical dissection.