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Submental triangle

The submental triangle, also known as the suprahyoid triangle, is the unpaired midline division of the anterior triangle of the neck, located immediately inferior to the chin and bounded by the anterior bellies of the digastric muscles laterally, the body of the hyoid bone inferiorly, and the inferior border of the mandible superiorly.^[1] This region serves primarily as a lymphatic drainage pathway for structures including the floor of the mouth, tip of the tongue, lower lip, and incisor teeth, containing several small submental lymph nodes that filter lymph before it proceeds to the submandibular or deep cervical nodes.^[1] Its roof is formed by the skin, superficial fascia, and the mylohyoid muscles meeting at a median fibrous raphe, while the floor is the superior surface of the hyoid bone.^[1]^[2] Key anatomical contents of the submental triangle include the submental lymph nodes (typically 2–6 in number), which are clinically vital for assessing metastasis from oral cavity malignancies, as their enlargement—defined by a short axis/long axis ratio exceeding 0.5—may indicate pathology such as squamous cell carcinoma.^[1]^[3] Vascular structures within the triangle comprise small submental veins that unite to form the anterior jugular vein, along with the submental artery, a branch of the facial artery that supplies the mylohyoid muscle and anastomoses with branches of the maxillary artery.^[1]^[4] The mylohyoid nerve (a branch of the inferior alveolar nerve from the mandibular division of the trigeminal nerve) innervates the mylohyoid and anterior belly of the digastric muscles, facilitating elevation of the hyoid bone and floor of the mouth during swallowing and speech.^[1] Embryologically, the submental triangle develops from the first pharyngeal arch around the fourth week of gestation, with the anterior digastric and mylohyoid muscles deriving from mesoderm in this region.^[1] Clinically, the triangle holds significance beyond its lymphatic role; it is a potential site for congenital cysts (e.g., thyroglossal duct cysts), odontogenic abscesses that can spread from the submandibular space, and tumors requiring fine-needle aspiration or surgical excision for diagnosis and management.^[1]^[3] Additionally, the submental artery's reliable pedicle makes this area a donor site for the submental island flap in head and neck reconstructive surgery, particularly for oral cavity defects, due to its proximity and vascular robustness.^[1] Despite these applications, the triangle itself is not a major surgical landmark compared to adjacent regions like the submandibular triangle.^[5]

Anatomy

Definition and Location

The submental triangle is defined as the unpaired median subdivision of the anterior triangle of the neck, situated superficially in the central midline region below the chin and above the hyoid bone.^[1] It represents the central portion of the larger anterior cervical triangle, which is subdivided by the digastric muscle and the superior belly of the omohyoid muscle.^[6] This anatomical region is also known as the suprahyoid triangle.^[7] In standardized nomenclature, it is identified as trigonum submentale in Latin, with codes in the Terminologia Anatomica (TA98: A01.2.02.006; TA2: 233) and the Federative International Programme on Anatomical Terminologies (FMA: 61604).^[8] The triangle is positioned with its superior limit at the mandible and inferior extension to the hyoid bone, forming a distinct median space within the superficial neck anatomy.^[1]

Boundaries

The submental triangle constitutes the unpaired, central subdivision of the anterior triangle of the neck, located superficially beneath the chin.^[1] Its lateral boundaries are formed by the anterior bellies of the left and right digastric muscles, which diverge superiorly toward the mandible and converge inferiorly at the midline intermediate tendon of the digastric muscle near the hyoid bone.^[1]^[9] The inferior boundary is defined by the body of the hyoid bone, serving as the base of the triangle.^[1]^[6] Superiorly, the triangle lacks a distinct osseous boundary and remains open toward the inferior border of the mandible, with its extent limited by the insertion of the mylohyoid muscle along the mylohyoid line.^[1] The apex of the triangle is located at the chin, where the lateral boundaries approach the midline.^[1] The roof of the submental triangle consists of the skin, superficial fascia (which includes the platysma muscle), and the investing layer of the deep cervical fascia.^[6] The floor is primarily formed by the mylohyoid muscles from both sides, which meet in the midline and provide muscular support anteriorly.^[1]^[6]

The submental triangle, defined by its boundaries of the anterior bellies of the digastric muscles laterally, the hyoid bone inferiorly, and the midline superiorly, houses a collection of small structures primarily embedded in loose connective tissue.^[1] The primary contents include the submental lymph nodes, which consist of 2 to 6 small, oval-shaped nodes situated within the superficial fascia of the triangle. These nodes are embedded in fatty areolar tissue between the roof (formed by the investing layer of the deep cervical fascia and skin) and the floor (mylohyoid muscle).^[1]^[10]^[4] Vascular structures within the triangle comprise the submental artery, a small branch of the facial artery that arises near the anterior edge of the submandibular gland and courses forward along the inferior border of the mandible to supply adjacent tissues, running parallel to the mylohyoid muscle. Accompanying this are submental veins, which are small tributaries that converge in the midline to form the anterior jugular vein, typically coursing superficially through the fatty tissue. Small lymphatic vessels also traverse the region, interconnecting with the submental lymph nodes.^[1]^[5]^[4] Additional elements include loose adipose and areolar connective tissue filling the space, with no major muscles or glands primarily residing within the triangle. Small nerves, such as branches from the cervical plexus providing cutaneous innervation, may pass through the superficial layers, while the mylohyoid nerve (a branch of the inferior alveolar nerve) runs within the triangle parallel to the submental vessels, innervating the mylohyoid muscle and anterior belly of the digastric. These structures are generally superficial, lying just beneath the skin and platysma muscle.^[1]^[5]^[11]

Clinical Significance

Lymphatic Drainage

The submental lymph nodes, located within the submental triangle superficial to the mylohyoid muscle, serve as the primary collectors of lymph in this region.^[12] These nodes receive afferent lymphatic drainage from the central portion of the lower lip, the skin of the chin, the anterior part of the floor of the mouth, the tip (apex) of the tongue, and the anterior gingival mucosa associated with the mandibular incisors.^[1]^[12] Efferent drainage from the submental nodes primarily flows to the ipsilateral submandibular lymph nodes (level Ib) or directly to the deep cervical lymph nodes, including the jugulodigastric node (level II).^[1] Due to the midline position of the submental triangle, lymphatic drainage can occur bilaterally, reflecting the bilateral nature of midline structures in the oral cavity.^[13] In clinical imaging, submental nodes are often the first site of visualization for metastases from midline oral cavity tumors, appearing as enlarged or abnormal structures on computed tomography (CT) or magnetic resonance imaging (MRI) scans.^[14] This makes them critical for staging head and neck cancers originating in the oral cavity.^[13]

Associated Pathologies

The submental triangle is a common site for infections originating from odontogenic sources, such as dental abscesses in the lower incisors or canines, which can lead to submental cellulitis or abscess formation due to the direct drainage of these teeth into the submental space.^[15] These infections present with localized swelling, pain, and erythema in the submental region, often requiring incision and drainage along with antibiotic therapy to prevent spread to adjacent spaces.^[1] Additionally, the submental space is frequently involved in Ludwig's angina, a severe bilateral cellulitis that extends from the sublingual space to the submental and submandibular spaces, typically arising from infections of the mandibular second and third molars and characterized by woody induration and potential airway compromise.^[16] Malignancies affecting the submental triangle primarily involve the submental lymph nodes (level Ia), which serve as first-echelon drainage sites for squamous cell carcinoma (SCC) of the oral cavity, particularly the floor of the mouth and lower lip.^[17] Metastatic involvement can occur in early-stage oral SCC cases (with occult nodal metastasis rates of 20–40% in clinically node-negative necks), with detection often facilitated by sentinel lymph node biopsy to assess occult nodal spread.^[17] Lymphomas, such as non-Hodgkin lymphoma, can also manifest as submental nodal masses, accounting for a subset of neoplastic pathologies in this region. Other conditions include reactive lymph node enlargement due to infectious processes like mononucleosis, caused by Epstein-Barr virus, which leads to generalized cervical lymphadenopathy including the submental nodes, presenting as tender, bilateral swelling.^[18] Lymphomas may similarly cause submental node hypertrophy as part of systemic disease.^[18] Rare congenital anomalies, such as thyroglossal duct cysts, arise from remnants of the thyroglossal duct in the midline submental area and typically present as painless, movable masses that move with tongue protrusion.^[19] Diagnostic evaluation of submental triangle pathologies relies on clinical palpation, where tender, mobile lymph nodes suggest infectious or inflammatory etiologies like abscesses or mononucleosis, whereas firm, fixed, nontender nodes raise suspicion for malignancy such as metastatic SCC.^[20] Imaging modalities, including ultrasonography, further aid in differentiating these features by assessing node size, shape, and vascularity.^[1]

References

[1]
Anatomy, Head and Neck, Submental Triangle - StatPearls - NCBI
The submental triangle is clinically relevant because tumors and cysts develop within its limits, and abscesses from other regions extend to the area.
[2]
Anterior Triangle of the Neck - Subdivisions - TeachMeAnatomy
### Submental Triangle Summary
[3]
Triangles of the Neck - Physiopedia
Clinical Significance: Neoplasms, infectious and immunologic ... Anatomy, Head and Neck, Submental Triangle. InStatPearls [Internet] 2022 Jun ...
[4]
Superficial structures of the neck: Anterior triangle - Osmosis
The submental triangle sits right below the chin and contains several small submental lymph nodes and small veins that unite to form the anterior jugular vein.
[5]
Submental triangle: Anatomy and contents - Kenhub
The submental triangle defines a sub-region of the anterior cervical region (anterior triangle of the neck). It is one of four smaller triangles within the ...
[6]
Anatomy, Head and Neck, Neck Triangle - StatPearls - NCBI Bookshelf
The submental triangle is demarcated by the hyoid bone, the anterior belly of the digastric muscle, and the midline of the neck.[1] The muscular triangle is ...Missing: textbook | Show results with:textbook
[7]
Anatomy, Head and Neck, Neck - StatPearls - NCBI Bookshelf
The submental triangle, also called the suprahyoid triangle, contains the mylohyoid muscle as its floor. · The submandibular triangle, or the submaxillary ...Missing: textbook | Show results with:textbook
[8]
trigonum submentale - TA2 Viewer
FMA, 61604. UMLS, C0931905. Gray's Anatomy (20th ed.) page 565. Wikipedia, Submental triangle. Wikidata, Q7631656. Wikipedia sites (5). Wikidata translations (7).
[9]
Triangles of the neck: a review with clinical/surgical applications - PMC
The submental triangle is unpaired and bounded by the anterior bellies of both digastric muscles and the body of the hyoid bone. Its floor consists of the ...
[10]
Submental lymph nodes | Kenhub
The submental lymph nodes are small lymph nodes found in the submental triangle of the neck. Learn their anatomy at Kenhub!
[11]
Anterior & Posterior Triangles of the Neck - Geeky Medics
Mar 16, 2022 · Contents of the submental triangle include submental lymph nodes that receive lymphatic drainage from the chin, the tip of the tongue, lower ...<|control11|><|separator|>
[12]
Anatomy, Head and Neck, Lymph Nodes - StatPearls - NCBI Bookshelf
These nodes drain the efferent lymphatics from the frontal and temporal skin, eyelids, conjunctivae, auricles, external acoustic meatus, tympanum, nasal ...
[13]
Cervical Lymph Node Map - The Radiology Assistant
Jul 11, 2022 · II - Upper jugular. Level II receives lymphatics from the face, the parotid gland, and the submandibular, submental and retropharyngeal nodes.
[14]
18F-FDG PET and CT/MRI in Oral Cavity Squamous Cell Carcinoma
Jul 1, 2005 · The calculated sensitivity of CT and MRI for detecting lymph node metastases ... Level I corresponds to the submental and submandibular nodes.F-Fdg Pet And Ct/mri In Oral... · Materials And Methods · Metastatic Neck Disease
[15]
Anatomy, Lymph Nodes - StatPearls - NCBI Bookshelf - NIH
Jul 25, 2023 · The medullary sinus drains the lymph into the efferent lymphatic vessels. ... These drain the submental and facial nodes, the cheeks, the ...Introduction · Structure and Function · Embryology · Blood Supply and Lymphatics
[16]
Histology of lymph nodes - Kenhub
This article will review the embryology and gross anatomy of lymph nodes. However, the primary focus will be on the histological composition of these ...
[17]
Submental Space - an overview | ScienceDirect Topics
This space is usually involved in odontogenic infections from the anterior mandibular teeth as benign or malignant lesions in this area are rare. Surgical ...<|control11|><|separator|>
[18]
Ludwig Angina - StatPearls - NCBI Bookshelf - NIH
Jun 22, 2025 · Ludwig angina is a rare, life-threatening condition characterized by diffuse cellulitis that involves the soft tissues of the floor of the mouth ...Missing: malignancies | Show results with:malignancies
[19]
Lymph node metastasis in oral squamous cell carcinoma: Where we ...
Aug 13, 2023 · This study suggested that draining lymph nodes of OSCC include submandibular nodes, facial nodes, submental nodes, superior deep cervical nodes, ...
[20]
Unexplained Lymphadenopathy: Evaluation and Differential Diagnosis
Dec 1, 2016 · Benign causes of generalized lymphadenopathy are self-limited viral illnesses, such as infectious mononucleosis, and medications. Other causes ...Abstract · History · Physical Examination · Localized Lymphadenopathy
[21]
Thyroglossal duct cysts and site-specific differential diagnoses - NIH
Feb 12, 2020 · This review aims to summarize the imaging findings of TGDCs and their main differential diagnoses with emphasis on ultrasound assessment.Imaging Techniques · Malignancy Of Tgdcs · Midline Lesions
[22]
The Adult Neck Mass - AAFP
Sep 1, 2002 · This article reviews the differential diagnosis of neck masses in adults and provides a framework for clinical decision-making.