Anatomical Variations of the Structures of the Submandibular Triangle: A Systematic Review and Clinical Significance

Relevance. The submandibular triangle is an anatomically complex region containing several clinically significant structures, whose variability can substantially affect the course and outcome of surgical interventions. Given the increasing number of procedures in the cervical region – including oncological, inflammatory, and reconstructive surgeries – the systematization of data on anatomical variations is of growing importance. Objective. To conduct a systematic review of anatomical variations of the submandibular. Material and methods. The review included publications from PubMed, Scopus, and eLibrary databases for the period 2010–2025 (March), meeting PRISMA criteria. Cadaveric studies, case reports, and literature reviews describing anatomical variations of the submandibular region were analyzed.
Results. A high degree of anatomical variability was identified in key structures of the submandibular triangle. The most clinically significant variations include atypical courses of the facial artery and vein, altered innervation of the mylohyoid muscle, variations in digastric muscle structure, and differences in the morphology of the submandibular gland. Certain branches, such as the cervical branch of the facial nerve, show diverse anatomical trajectories, including passage through the platysma or near the gland. These features are critical for transcervical, transoral, and combined surgical procedures, as well as neck dissection.
Conclusion. The anatomical variability of the submandibular region necessitates mandatory preoperative evaluation using imaging modalities used in the evaluation of the submandibular region. Awareness of potential anatomical variants enhances surgical planning, reduces the risk of intraoperative complications, and improves treatment outcomes.
Keywords: submandibular triangle, anatomical variations, submandibular gland, facial nerve, facial artery, PRISMA
Conflict of interest. The authors declare no conflict of interest.
Financing. The work was completed without sponsorship.