ARRS 2022 Abstracts


E1075. Sublingual and Submandibular Space Lesions
  1. Maram Alafif; University of California - San Diego
  2. Charles Coffey; University of California - San Diego
  3. Julie Bykowski; University of California - San Diego
The sublingual and submandibular spaces in the oral cavity are relatively small areas with complex anatomy that accounts for various pathologic processes. Familiarity with this complexity and its radiological appearance is crucial for accurate diagnosis and treatment planning. This exhibit aims to review the sublingual and submandibular spaces landmarks, boundaries, and content with revision of different pathological entities, including infectious/inflammatory, vascular, other benign and malignant processes using a group of cases with implementation of clinical and pathological highlights.

Educational Goals / Teaching Points
Recognizing normal anatomy and variants is key to identifying pathology and avoiding unnecessary imaging or procedures. The genioglossus and mylohyoid muscles are imaging landmarks for the sublingual space and may be distorted by artifact, disease, or prior surgery. Communication between the spaces at the posterior margin of the mylohyoid muscle through defects in the mylohyoid and between the submandibular and lateral pharyngeal space. Submandibular (1B) nodes drain the central face, oral cavity, facial and submental (1A) nodes. Sublingual nodes are rarely seen and should prompt a careful search for pathology.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
The exhibit includes: 1) "do not miss" Ludwig's angina; 2) floor of mouth squamous cell carcinoma (SCC) and mimics (sublingual synovial sarcoma, adenocarcinoma); 3) dermoid and epidermoid cysts; 4) benign processes and tumours of the glands and ducts (sialoliths and complications, ranula, boutonniere defect, Stafne lesion, systemic sialadenitis including IgG4-related disease [IgG4RD], salivary gland carcinoma, salivary ductal carcinoma); 5) SMG transfer for sparing radiation dose; 6) salivary gland uptake on PET and review of parasympathetic and sympathetic innervation; 7) regional nerves and pathology (denervation from hypoglossal injury, lingual nerve peripheral nerve sheath tumour [PNST]); 8) vascular malformations, venolymphatic malformations, and lymphatic malformations; and 8) review of lymphatic drainage, abnormal node characteristics, and staging.

In conclusion, a variety of pathology occurs within the sublingual and submandibular spaces. Promoting knowledge of the anatomical details and relationships to the surrounding structures and the imaging characteristics of the different disease processes can help the radiologist provide an accurate diagnosis, help treatment planning, and prevent unnecessary interventions.