Deep Neck Contouring with a Focus on Submandibular Gland Vascularity: A Cadaver Study

Abstract Background Opening the neck through submental incision allows accurate management of deep neck structures and obtain exceptional neck contours. Objectives The authors aimed to evaluate the distribution of deep neck structures and investigate the detailed vascular anatomy of the submandibular gland. Methods A total of 26 fresh frozen cadaver heads (15 female, 11 male) were used. The authors evaluated the weights of the excised tissues simulating cosmetic resections including subcutaneous fat, subplatysmal fat, anterior belly of digastric muscle and submandibular glands. The vascular supply of the submandibular gland and intracapsular vessel diameters were also investigated. Results While female cadavers had greater mean tissue weight removed from the supraplatysmal plane (mean 20.9 g, 56.6%) than subplatysmal plane (16 g, 43.4%), male cadavers had higher mean tissue weight removed from subplatysmal plane (10.5 g, 60.7%) than supraplatysmal plane (mean 6.8 g, 39.3%). The mean subcutaneous (6.8 g) and subplatysmal (6.4 g) fat weights were almost equal in male cadavers, mean subcutaneous fat weight (20.9g) was 3 times higher than subplatysmal fat weight (6.8 g) in female cadavers. There was a statistically significant relationship between body mass index and fat removed. The intraglanduler vessel diameters increased as resections approached the main feeding vessels located posterosuperior (facial artery) and anterosuperior (submental artery) of the submandibular gland. Conclusions The results suggest that in order to achieve exceptional neck contour, the structures deep to platysma often need to be addressed. The submandibular gland reduction can be safely performed with comprehensive understanding of its vascular anatomy.