Question

MC (Most Common) nerve injured during Submandibular gland surgery?

• A. Lingual nerve
• B. Inferior alveolar nerve
• C. Hypoglossal nerve
• D. Nerve to mylohyoid

Hint:

The nerve that wraps around Wharton's duct is most at risk during submandibular gland excision.

Answer 1

The Correct Option is A

Step 1: Recall the anatomy of the submandibular region. The submandibular gland lies in the submandibular triangle below the mandible. The following nerves are in close proximity during surgery:
- Lingual nerve: runs above and medial to the gland, hooking around Wharton's duct
- Hypoglossal nerve: runs deep and inferior on the hyoglossus muscle
- Inferior alveolar nerve: within the mandibular canal, not directly in the operative field
- Marginal mandibular branch of facial nerve: runs superficial to the gland along the inferior border of the mandible

Step 2: Identify the most vulnerable nerve. The lingual nerve has an intimate relationship with the submandibular duct (Wharton's duct). It initially lies above the duct, then wraps around it inferiorly and medially (the classic teaching: 'the lingual nerve winds twice around Wharton's duct'). During submandibular gland excision, the duct must be ligated and divided close to the gland, and the lingual nerve is at greatest risk during this step. The hypoglossal nerve is the second most commonly injured nerve.

Conclusion: The lingual nerve is the most commonly injured nerve during submandibular gland surgery, followed by the hypoglossal nerve.