The submandibular retropharyngeal approach involves: 1. Making a transverse skin incision below the mandible. 2. Mobilizing the anterior border of the sternocleidomastoid muscle after identifying the marginal branch of the facial nerve. 3. Dividing the digastric tendon and retracting the hypoglossal nerve superiorly to dissect down to the retropharyngeal space and identify the superior laryngeal nerve.

1. SUBMANDIBULAR
RETROPHARYNGEAL APPROACH
1) Submandibular transverse skin incision
2) Mobilize anterior border of SCM after identifying marginal branch of CN VII
3) Divide digastric tendon
4) Retract hypoglossal nerve superiorly
5) Dissect bluntly down to retropharyngeal space
6) Identify superior laryngeal nerve
7) Divide prevertebral muscles down to Longus colli muscles bordering upper
cervical vertebrae

2. Skin incision for submandibular retropharyngeal approach.

4. MYLOHYOID MUSCLE HYOGLOSSUS MUSCLE
STYLOHYOID MUSCLE
POSTERIOR BELLY
OF DIGASTRIC MUSCLE
STERNOCLEIDOMASTOID
DIGASTRIC MUSCLE
(ANTERIOR BELLY)
FIBROUS LOOP FOR
INTERMEDIATE
DIGASTRIC TENDON
Submandibular upper cervical anatomy.
MUSCLE
THYROHYOID
MUSCLE
OMOHYOID
MUSCLE
STERNOHYOID
MUSCLE

6. SUPERIOR
LARYNGEAL NERVE
POSTERIOR BELLY
OF DIGASTRIC
MUSCLE
HYOGLOSSAL
NERVE
LONGUS COLLI
MUSCLE
SUPERIOR THYROID
ARTERY AND VEIN
SUBMANDIBULAR
GLAND
HYOID
Exposure of the C 2-3 disk space following surgical dissection.

7. SUPERIOR
LARYNGEAL NERVE
POSTERIOR BELLY
OF DIGASTRIC
MUSCLE
HYOGLOSSAL
NERVE
LONGUS COLLI
MUSCLE
SUPERIOR THYROID
ARTERY AND VEIN
SUBMANDIBULAR
GLAND
HYOID
Exposure of the C 2-3 disk space following surgical dissection.