A 35-year-old man is admitted to the hospital with severe pain in the area of his right submandibular gland. Radiographic examination reveals a tumor of the gland. An incision is made and the submandibular gland and its duct are removed. Which of the following nerves is most commonly injured in this type of procedure?
## **Core Concept**
The question tests knowledge of the surgical anatomy related to the submandibular gland, specifically focusing on the nerves that are at risk during a submandibular glandectomy (removal of the submandibular gland). The submandibular gland is located in the neck and plays a role in saliva production. Surgical procedures in this area require careful consideration of the surrounding nerves to avoid injury.
## **Why the Correct Answer is Right**
The correct answer, **D. Marginal mandibular branch of the facial nerve**, is the nerve most commonly injured during a submandibular glandectomy. This is because the marginal mandibular branch of the facial nerve runs very close to the submandibular gland and its duct. The facial nerve, specifically its marginal mandibular branch, controls muscles of facial expression, particularly those around the mouth. During surgery, the proximity of this nerve to the surgical site makes it susceptible to injury, which can result in weakness or paralysis of the muscles of the lower lip and chin.
## **Why Each Wrong Option is Incorrect**
- **Option A:** The **lingual nerve** is indeed at risk during submandibular surgery but is not the most commonly injured nerve in this type of procedure. It provides sensation to the anterior two-thirds of the tongue.
- **Option B:** The **hypoglossal nerve** runs deep to the submandibular gland and is also at risk but less commonly injured than the marginal mandibular branch of the facial nerve. It provides motor innervation to the tongue.
- **Option C:** The **auriculotemporal nerve** is related to the parotid gland rather than the submandibular gland and is less likely to be injured during a submandibular glandectomy. It provides sensory innervation to the temple and the TMJ.
## **Clinical Pearl / High-Yield Fact**
A key clinical pearl is that the marginal mandibular branch of the facial nerve is often at risk during surgical procedures in the submandibular region. Surgeons take precautions to identify and protect this nerve to prevent postoperative weakness of the lower lip. A useful tip is that this nerve typically lies within 1 cm below the inferior border of the mandible, which helps in anticipating its location during surgery.
## **Correct Answer: D. Marginal mandibular branch of the facial nerve**