Head and Neck Imaging

Sublingual space

space between the mylohyoid muscle and the geniohyoid and genioglossal muscles, containing a number of vessels and nerves, such as the lingual artery and nerve, and the hypoglossal and glossopharyngeal nerve, Whartons duct and some extrinsic tongue muscle fibres. The sublingual space also contains the sublingual salivary gland. Secretions from the sublingual gland drain through several small excretory ducts in the floor of the mouth; sometimes a more distinctive duct can be recognized, known as Bartholin's duct.

Pathology related to Whartons duct is common, mainly sialolithiasis.

Squamous cell carcinoma head and neck arising in the anterior floor of the mouth or gingivobuccal sulcus commonly spreads into the sublingual space; such extension can be readily recognized on CT or MRI studies as loss of the normal symmetrical appearance of the sublingual spaces.

Pathology arising from the sublingual gland is rare; however, sublingual gland neoplasms are predominantly malignant and thus important to recognize. Most patients present with a submucosal mass under the tongue causing discomfort (Fig.1). Adenoid cystic carcinoma and mucoepidermoid carcinoma are the types most frequently encountered.

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Fig.1

Axial (a) and coronal (b) gadolinium-enhanced T1-weighted spin-echo images of the floor of the mouth and tongue. An enhancing soft tissue mass is seen in the right sublingual space, growing through the mylohyoid muscle (white arrow); superomedial extension into the tongue with invasion of the genioglossal muscle (white arrowhead); posterior extension between the mylohyoid and hyoglossal muscle (black arrowheads). Adenoid cystic carcinoma, arising from sublingual gland. Normal sublingual gland is seen on opposite side (black arrow).
Sublingual space, Fig.1 (a)
Sublingual space, Fig.1 (b)