There is both a transoral and transcervical approach to accessing the tongue in surgery. Injury to the lingual artery during surgery can lead to life-threatening hemorrhage, and if both lingual arteries are damaged, necrosis of the tongue can result. Understanding the location of the lingual artery is imperative for decreasing intraoperative complications. Resecting the tongue base needs to be done with care for the lingual artery due to the susceptibility of damage during surgery. Otolaryngologists utilize the base of the tongue for treating sleep apnea, neoplasms, and dysphagia. The lingual artery is an important component in various head and neck procedures. The chorda tympani appear traversing the middle ear in between the malleus and incus and eventually joining the lingual nerve. The nerve fibers that make up the chorda tympani are special visceral afferents. The lingual nerve provides general sensation from the anterior two-thirds of the tongue. The chorda tympani is a branch of the facial nerve (CN VII) and provides taste sensation from the anterior two-thirds of the tongue. Some several surgical implications and considerations require attention when dealing with the HLNVB. The hypoglossal-lingual neurovascular bundle (HLNVB) is located at the base of the tongue and is an important contributor to proper tongue structure and function. The function of the hypoglossal nerve is to innervate the intrinsic and three extrinsic muscles of the tongue: the genioglossus, the styloglossus, and the hyoglossus. The hypoglossal nerve then makes a horizontal turn toward the greater horn of the hyoid bone and subsequently comes into proximity of the lingual artery. The hypoglossal nerve then descends deep to the sternocleidomastoid muscle and superficial to the external carotid artery. The hypoglossal nerve exits the skull in the posterior fossa via the hypoglossal canal. The hypoglossal nerve (CN XII) is the last cranial nerve in the body, located on the posterior portion of the medulla oblongata. The most voluminous of these are the right and left primitive aortas, from which the fetal arterial tree originates and develops parallel to the heart tube and its subsequent evolution.The formation of an anastomosis between the intra- and extra-embryonic vessels completes the circulatory system. The further development of the vascular system consists of the formation of larger caliber ducts with a primitive plexiform network. At the same time, two groups of angioblastic cells, in a dorsal paramedian position, form two parallel vessels, the dorsal aorta, which connect cephalically connect to the plexiform network. The intra-embryonic vessels originate from blood islands in the splanchnic mesoderm in front of the protocordal disc, where a plexiform horseshoe-shaped network forms surrounding the cephalic portion of the embryo. The external carotid artery develops from the 3rd aortic arch and gives rise to the lingual artery. The lingual artery has a diameter of about 2 to 5 mm, which increases as it approaches the external carotid artery.ĭuring the 4th and 5th weeks of embryological development, the aortic sac gives rise to the aortic arches. The accessibility of the lingual artery in Lesser’s triangle makes it a perfect target for surgery. The floor of Lesser’s triangle is the hyoglossus muscle, and the lingual artery is found deep to it. Lesser’s triangle is bound by the anterior belly of digastric muscle inferiorly, the posterior belly of the digastric muscle posteriorly, and the hypoglossal nerve superiorly. Lesser’s triangle, which is inside the submandibular triangle, contains the lingual artery as it courses toward the apex of the tongue from its origin of the external carotid artery. Of relevance, there is an anatomical triangular landmark where the lingual artery can be located with consistency. The deep lingual artery is the terminal branch of the lingual artery, and it supplies the body and tip of the tongue. The end branches of the right and left sublingual arteries anastomose in the lingual foramen on the posterior side of the mandible. The sublingual artery is the third branch and supplies the sublingual gland, the genioglossus, the geniohyoid, the mylohyoid, the buccal and gingival mucosa, and the mandible. The next branch is the dorsal lingual artery, which supplies the posterior portion of the tongue, palatoglossal arch, lingual tonsil, soft palate, and epiglottis. The first branch of the lingual artery is the suprahyoid artery, which courses along the hyoid bone, a sesamoid bone, while supplying the muscles attached to it. The lingual artery has multiple branches and subsequently supplies many structures in the lingual and sublingual regions.
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