title: [Anatomic study of the submental artery relationships for submental flap raising].
abstract: BACKGROUND
  Submental flap is useful for intra-oral reconstructions and reconstructions of the lower two thirds of the face. Dissection is delicate because of a difficult exposure under the lower rim of the mandible, numerous collateral arterial branches and the proximity of the marginal branch of the facial nerve. The aim of our work was to propose anatomical landmarks in order to facilitate the submental flap raising.
  
  
  METHODS
  Ten bodies preserved in Biomet liquid were dissected bilaterally. The anatomic relationships between the marginal branch of the facial nerve and the mandible, the relationships of the submental artery, the amount and the location of its collateral branches were measured by means of a caliper.
  
  
  RESULTS
  The highest marginal branch observed was located 0.5 cm above the mandibular lower rim, while the lower one was located 0.6cm below this rim. The mean length measured between the facial artery at its crossing over the mandibular rim at the level of the pre-angular notch and the origin of the submental artery was 1.5cm. The average number of collateral branches was 3.6.
  
  
  CONCLUSIONS
  A skin incision made directly under the mandibular lower rim, as mentioned by some authors, may endanger the mandibular marginal branch of the facial nerve. Three positions of the submental artery in relation to the sub-maxillary gland are reported. The collateral branches are intended for gland, muscle, skin and bone. It is necessary to pay particular attention to the sub-lingual artery, an artery of big diameter that arises at 2.8cm on average from its origin and plunges towards the mouth's floor. It must not be followed at risk of clamping the thin pedicle destined to the digastric muscle. It is important to preserve the fat tissue around the submental pedicle in order to avoid venous congestion of the flap.
authors.affiliation: Service de chirurgie maxillo-faciale, CHRU de Lille, rue Émile-Laine, 59000 Lille, France. Electronic address: cyprien.ricour@gmail.com.
authors.forename: C
authors.initials: C
authors.lastname: Ricour
authors.affiliation: Service de chirurgie maxillo-faciale, CHRU de Lille, rue Émile-Laine, 59000 Lille, France.
authors.forename: J
authors.initials: J
authors.lastname: Ferri
authors.affiliation: Service de chirurgie maxillo-faciale, centre hospitalier, hôpital d'instruction des armées Lavéran, 34, boulevard Laveran, 13013 Marseille, France.
authors.forename: G
authors.initials: G
authors.lastname: Thiery
authors.affiliation: Service de chirurgie orthopédique et traumatologique, laboratoire d'anatomie, CHRU de Lille, rue Émile-Laine, 59000 Lille, France.
authors.forename: C
authors.initials: C
authors.lastname: Fontaine
authors.affiliation: Service de chirurgie maxillo-faciale, CHRU de Lille, rue Émile-Laine, 59000 Lille, France.
authors.forename: G
authors.initials: G
authors.lastname: Raoul
mesh_terms: D001158:Arteries / Q000033:anatomy & histology* / Q000473:pathology / Q000601:surgery*; D002102:Cadaver; D002680:Chin / Q000098:blood supply / Q000473:pathology / Q000601:surgery*; D006801:Humans; D019651:Plastic Surgery Procedures / Q000379:methods*; D012867:Skin / Q000033:anatomy & histology / Q000098:blood supply; D016038:Skin Transplantation / Q000379:methods; D013524:Surgical Flaps
keywords: Facial reconstruction; Lambeau sous-mentonnier; Oral reconstruction; Reconstruction faciale; Reconstruction orale; Submental island flap