Sublingual groove. Sublingual area

The mylohyoid muscle is a flat muscular plate located between the lower jaw and this muscle is often called the diaphragm oral cavity, since it is this that forms the bottom of the cavity. The muscle provides the distinction between the face and neck.

Above muscle tissue contains the salivary gland and tongue. The origin of the mylohyoid muscle is directed back towards the midline. Back bundles the muscles are attached to the hyoid bone.

general information

The mylohyoid muscle is flat and has the shape of an irregular triangle. On the opposite side there is a similar muscle. When connected, these muscles form a suture.

The exact shape and size of the muscle depends on the characteristics bone structure body. For example, if a person has a longer lower jaw, then the muscle has a small width, but its length is greater than the average. If there is a short jaw bone, the muscle is wider. The paired craniohyoid muscles form the floor of the mouth. Contracting two muscles at the same time allows the jaw to lower.

Structural features

The mylohyoid line is the place where the muscle of the same name begins. Small gaps form between the muscle bundles. Sometimes infections and purulent accumulations from the oral cavity can spread through them. The gaps are most often located directly under the tongue, in the area of ​​the second lower molar.

How does a muscle work?

Innervation of the muscle is provided, which passes through a special depression lower jaw(mylohyoid groove). The main task of the organ is to lower the lower jaw. This occurs only with simultaneous contraction of paired muscles. Proper functioning allows a person to speak, swallow, and chew food. These paired muscles are supplied by the craniohyoid arteries, which arise from the larger lingual and facial arteries.

Abscess and other lesions in this area

Sometimes the mylohyoid muscle is involved in the inflammatory process, which often leads to tissue suppuration. The lesion quickly invades new areas, gradually spreading to the entire surface of the muscle. Since all the tissues that form the oral cavity communicate with each other blood vessels, the infection can spread to the tongue, nerves, and salivary glands. In this case, doctors talk about phlegmon.

Phlegmon most often affects the mylohyoid groove, but can also be localized in other areas of the floor of the oral cavity:

• the space under the tongue is affected on both sides;
• the space under the tongue and under the lower jaw on one side is affected;
• areas under the tongue and jaw on both sides are involved in the inflammatory process;
• the floor of the mouth is completely infected.

Causes and manifestations

If the mylohyoid muscle hurts due to phlegmon, then the reasons are most likely the following:

• tooth infection;
• periodontal disease;
• periodontitis;
• osteomyelitis.

Clinical picture usually looks like this:

• pain when trying to swallow or chew food;
• general malaise;
• painful sensations during conversation;
• difficult, rapid breathing.

Patients with phlegmon often tilt their heads forward, open their mouths slightly, and when sitting, rest their chin on a chair, as this relieves discomfort.

Infection leads to general intoxication of the body, an increase in temperature, and a change in the number of leukocytes in the blood. Cellulitis often leads to respiratory acidosis.

If the tissues located below the mylohyoid muscle are infected, small tumors form on both sides. The skin over them is tense and hot to the touch. When trying to touch the affected areas, the patient experiences discomfort, and sometimes sharp pain. Self-treatment unacceptable. If symptoms appear, you should immediately make an appointment with a doctor, as lack of treatment can lead to dangerous consequences. The inflammatory process often spreads to other tissues and organs.

Muscle training to preserve a youthful face

The mylohyoid muscle can be trained, ensuring the preservation of the natural oval of the face. There are several simple exercises:

• Chin lift is considered effective. Sitting on a chair, tilt your head back, lifting your chin up. Now tense your muscles as if you are trying to reach the ceiling with your chin.
• Stay in the same position with your head tilted back. Extend and purse your lips as if you are trying to kiss the ceiling.
• Open your eyes and mouth wide, try to reach your chin with your tongue.
• Slow tilts of the head forward, backward and to the sides are considered effective.

The key rules for training neck muscles look like this:

• breathing must be carefully controlled;
• eyes must be open;
• it is important to control arterial pressure; the fact is that static muscle tension, aggravated by head movements, leads to a sharp change in this indicator;
• sudden movements during training are prohibited; any exercises are performed smoothly, it is unacceptable to burden the chin too much;
• to achieve results, the muscles must be constantly tense; Do not allow your neck to relax completely, as this will cause a temporary loss of muscle control.

After finishing the exercises, you can relax.

Regular training of the mylohyoid and other neck muscles allows you to achieve smooth skin and maintain a clear contour of the face and chin. Exercises tone the body, improve local blood circulation and nutrition of the oral cavity.

The effect is noticeable after 2-3 weeks of regular practice. Without the opportunity to visit cosmetologists and massage therapists, you can take care of your muscles at home and even during the working day. To do this, it is enough to regularly perform 2-3 sets of simple exercises: chin lift, head rotation, bending.

The sublingual ridge (more precisely, the sublingual fold - plica sublingualis) is formed by the sublingual salivary gland, which envelops it in loose fiber and is covered on top with a thin mucous membrane. The base, or bottom, of the sublingual ridge is the diaphragm of the mouth with numerous vessels, nerve branches and the submandibular excretory duct. salivary gland.

A blockage can simulate an abscess of the sublingual ridge excretory duct submandibular salivary gland salivary stone. With an abscess of the hyoid ridge, there is inflammatory infiltration and softening of the tissue at the top or base of the ridge. The pain is not intense, mouth opening is free.

To open an abscess of the sublingual ridge, the mucous membrane and submucosal layer are dissected at the base of the ridge or along the top of the largest bulge of the mucous membrane and then the tissue is pushed apart bluntly to avoid damage to blood vessels and nerves.

The maxillo-lingual groove, or more precisely, the maxillo-lingual groove (sulcus mandubulolingualis), is a depression at the bottom of the mouth between the inner surface of the body of the lower jaw in the area of ​​the molars and the lateral surface of the tongue, mainly its root. The top of the groove is covered with mucous membrane, and the bottom of the groove is the diaphragm of the mouth.

In the space between the mucous membrane and the diaphragm of the mouth there are loose connective tissue tissue, the lingual nerve, primary department the excretory duct of the submandibular salivary gland with the process of the gland itself, the lingual artery and vein, as well as the hypoglossal nerve. The lingual artery is separated from all these formations by the hyoglossus muscle.

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"Clinical operational
maxillofacial surgery”, N.M. Alexandrov

See also:

The sublingual region (regio sublingualis) is located between the lower surface of the two anterior thirds of the tongue, the mucous membrane of the oral cavity and the internal surfaces of the body of the lower jaw, and is limited from below by the diaphragm of the oral cavity - the mylohyoid muscle (m. mylohyoideus).

Within the sublingual region lie the sublingual salivary glands with ducts, ducts of the submandibular glands, genioglossus, hyoglossus and styloglossus (mm. genioglossus, hyoglossus, styloglossus) muscles, lingual vessels (a. et v. lingualis), sublingual artery and vein (a. et v. sublingualis), lingual and hypoglossal nerves (nn. lingualis, hypoglossus), The lymph nodes and the fiber surrounding these formations. Through the fiber and lymphatic pathways, this area communicates with the submandibular, submental areas, pterygomaxillary, peripharyngeal spaces and areas of the neck (color. Fig. 2).

Rice. 2. Sublingual area (part of the mucous membrane has been removed).
1 - lingua;
2 - chapter. lingualis ant.;
3 - a. profunda linguae;
4 - ductus submandibularis;
5 - gl. sublingualis;
22 - v. profunda llngyiae;
24 - n. lingualis;
25 - caruncula sublingualis;
26 - plica sublingualis;
27 - frenulum linguae

Pathology. In the sublingual region, isolated abscesses of the maxillo-lingual groove (sulcus mandibulolingualis), located between the inner surface of the body of the lower jaw, within the lower molars, and the posterolateral surface of the tongue root on both sides are most often observed; Less common are abscesses of the sublingual ridge, phlegmon of the floor of the mouth (see Ludwig's tonsillitis), retention cysts of the mucous membranes (see Ranula), salivary gland cysts and dermoid cysts.

In case of an abscess of the maxillo-lingual groove, the mucous membrane and submucosal layer are dissected with a 3-4 cm long incision from the side of the oral cavity, and then the abscess area is penetrated bluntly. The operation ends with the introduction of a rubber strip into the wound. To avoid injury to the lingual nerve and the duct of the submandibular gland, the cross of which is located at the level of the second lower molar, when making an incision, you should stay close to inner surface bodies of the lower jaw.

Long-term conservative treatment and delay in surgery may lead to spread inflammatory process into deeper tissues. With phlegmon of the floor of the mouth due to swelling of the larynx, asphyxia may occur, so the surgeon must be prepared for a tracheotomy operation (see).

Treatment of retention and dermoid cysts is surgical, consisting of their total removal. Cysts of the sublingual salivary gland often recur, so when repeated operations the tumor should be removed along with the gland.

Main sources and routes of infection
Foci of odontogenic infection in the area of ​​the lower molars (including pericoronitis with difficult eruption lower third molars), infectious and inflammatory lesions and infected wounds mucous membrane of the floor of the mouth. Secondary damage occurs as a result of the spread of a purulent-inflammatory process from the sublingual area.

Rice. 10-20. The main stages of the operation of opening an abscess in the sublingual region: a - projection of the abscess onto the floor of the oral cavity, b - topography of the abscess ( cross section), c-e - stages of the operation.

Clinical picture
Complaints of pain in the throat or under the tongue, aggravated by talking, chewing, swallowing and opening the mouth.
Objective examination. The maxillo-lingual groove is smoothed due to the infiltrate occupying the space between the root of the tongue and the lower jaw. The infiltrate extends to the anterior palatine arch and can push the tongue to the opposite side. The mucous membrane over the infiltrate is hyperemic, palpation causes pain. Mouth opening is moderately limited (due to pain).
Ways of further spread of infection
Cellular spaces of the root of the tongue, sublingual, submandibular regions, pterygomaxillary space.
Technique for opening a maxillo-lingual abscess
groove

1. Anesthesia - local infiltration anesthesia in combination with conduction mandibular, torusal (according to Weisbrem) anesthesia.
2. An incision is made in the mucous membrane of the floor of the mouth at the level of the molars in the space between the base of the tongue and the alveolar edge of the lower jaw parallel to and closer to the latter.
3. Layering with a mosquito hemostatic clamp soft fabrics along the inner surface of the mylohyoid muscle (i.e. mylohyoideus), move towards the center of the infiltrate, open the purulent-inflammatory focus, evacuate the pus, and introduce drainage into the wound.

The boundaries of the sublingual area are:

• upper - mucous membrane of the floor of the mouth;
• lower - mylohyoid muscle or oral diaphragm;
• outer - inner surface of the body of the lower jaw;
• internal geniohyoid muscle and genioglossus muscle.

ciration from the adjacent peripharyngeal, iodmandibular and pterygomandibular spaces.
The sublingual space contains the lingual veins, artery and nerve, hypoglossal nerve, hypoglossal salivary gland, the duct of the submandibular salivary gland, which are enclosed in the tissue of this area. The section of the hyoid region, located between the body of the lower jaw at the level of the large molars and the lateral surface of the tongue, is distinguished as the maxillolingual groove.
Suppurative processes in the sublingual region are divided into abscesses, which are localized in its anterior and posterior sections (maxillo-lingual groove), and phlegmon of the sublingual region.
Clinic. For abscess anterior section In the sublingual region, patients note moderate local pain, which intensifies with tongue movement and swallowing. There is swelling in the jaw and submental areas. Opening the mouth is not difficult. The mucous membrane of the sublingual ridge is hyperemic, swollen, and the ridge itself is hard and painful when touched. The swelling spreads to the mucous membrane of the lower surface of the tongue, sublingual fold and alveolar process.
Abscess of the maxillofacial groove is characterized by complaints of severe pain when moving the tongue and swallowing, to a sharp limitation of mouth opening due to inflammatory contracture of the muscles in this area. The skin of the submandibular triangle is of normal color. There is pronounced swelling, and enlarged, painful lymph nodes are palpable.
Using a metal spatula, moving the tongue to the opposite side, inspect the affected sublingual area. Its mucous membrane is hyperemic, smoothed, and swollen. Infiltration and tissue tenderness are determined by palpation; fluctuations are detected on the 3-4th day of the disease.
Phlegmon of the sublingual region is more often unilateral and much less often bilateral. The clinic of unilateral phlegmon is manifested by local moderate constant pain, intensifying when swallowing, with a sharp limitation in opening the mouth and moving the tongue. Due to collateral edema, moderate swelling is observed in the anterior parts of the mandibular triangles and in the submental region. The color of the skin here is changed. Regional lymph nodes are enlarged and painful on palpation.

When examining the oral cavity, the sublingual fold is raised due to edema, swelling of the tissues lateral to the tongue on the side of the phlegmon, and the tongue is shifted to the healthy side.
With bilateral phlegmon, pronounced swelling of the tissues of the submandibular region and local constant moderate pain appear. Intraoral changes are more pronounced: hyperemia of the mucous membrane, sublingual folds are covered with fabric, smoothed, infiltrated, reaching the level of the proximal parts of the anterior teeth; the tongue is significantly enlarged in size, sometimes does not fit in the oral cavity and the patient keeps his mouth half open; tongue movement, swallowing and speech are sharply painful and in some patients impossible.
Surgical treatment. For an abscess of the anterior sublingual region, an incision is made in the mucous membrane of the floor of the mouth up to 2 cm long parallel to the inner surface of the lower jaw. Then the tissues are divided bluntly with an instrument towards the bulging area of ​​the sublingual fold, emptying and draining the abscess. The operation is carried out taking into account the location of the duct and its outlet of the submandibular salivary gland in this area, trying not to damage them.
The jaw abscess along the facial groove is opened in the area of ​​greatest tissue protrusion. In this case, the abdomen or the tip of the scalpel is directed to the alveolar process so as not to damage the lingual nerve, artery and veins located in this area. Next, the tissues are bluntly pulled apart to reach the abscess cavity.
One-sided phlegmon is opened using intraoral access, dissecting the mucous membrane of the alveolar process with an incision up to 5 cm long, and then bluntly reaching purulent focus. When localization of phlegmon is closer to skin use a skin incision in the submandibular region with the intersection of part of the fibers of the jaw
but-hyoid muscle. For bilateral phlegmon, both intraoral and percutaneous incisions are used, sometimes resorting to a combination of them (Fig. 6).