Surgical and Radiologic Anatomy

, Volume 40, Issue 12, pp 1429–1436 | Cite as

The submental arrowhead variation of the mylohyoid and anterior belly of the digastric muscles

  • Matthew J. ZdillaEmail author
  • Kelsey R. Mangus
  • Jordan V. Swearingen
  • Kyle D. Miller
  • H. Wayne Lambert
Anatomic Variations



Submental anatomical variation is of clinical importance with regard to head and neck surgeries. One such anatomical variation is that of additional musculature joining the intermediate tendon of the digastric muscle to the midline of the mylohyoid musculature—a variation which this report refers to, accordingly, as an arrowhead variation. Though the arrowhead variation has been described in several case reports, it has not been subject to cross-sectional study. The purpose of this study is to determine the prevalence of the arrowhead variation.


Prevalence of the arrowhead variation was assessed in 19 cadavers via gross dissection.


Two of the 19 cadavers (10.5%) were found to have arrowhead variations. The arrowhead variation was found in one male (1:11; 9.1%) and one female (1:8; 12.5%), respectively.


This report demonstrates that the submental arrowhead variation of the anterior digastric and mylohyoid musculature has been reported in isolated case reports since the nineteenth century. This report is the first cross-sectional study of the arrowhead variant, identifying it in approximately one in ten individuals and in both sexes. Therefore, the presence of an arrowhead variation should be regularly considered with regard to diagnosis of submental masses. Likewise, the arrowhead variation should be considered in the preoperative planning of the myriad operations performed in the submental region.


Anatomic variation Neck muscles Plastic surgery Rhytidoplasty 



Funding for this project came from the WV Research Challenge Fund [HEPC.dsr.14.13] and [HEPC.dsr.17.06], the NASA WV Space Grant Consortium, and a WVU-INTRO grant. The authors would like to acknowledge the West Virginia Anatomical Board, the WVU Human Gift Registry, and most importantly, those individuals who gifted their bodies for the advancement of science and education, without whom, this research would not have been possible.

Compliance with ethical standards

Conflict of interest

The authors have no conflicts of interest to report.

Financial disclosure

The authors have no financial contributions.


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Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Natural Sciences and MathematicsWest Liberty UniversityWest LibertyUSA
  2. 2.Department of Graduate Health SciencesWest Liberty UniversityWest LibertyUSA
  3. 3.Department of Pathology, Anatomy, and Laboratory Medicine (PALM), Robert C. Byrd Health Sciences CenterWest Virginia University School of MedicineMorgantownUSA

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