Anterior facial vein and submandibular gland together: Predicting the histology of submandibular masses with CT or MR imaging

PURPOSE: To test the hypothesis that the relationship of the anterior facial vein to the submandibular salivary gland and a mass in the submandibular fossa could help identify the origin of the mass at computed tomography (CT) or magnetic resonance (MR) imaging. MATERIALS AND METHODS: Thirteen patients with 14 palpable submandibular masses, surgical and histologic confirmation, and contrast material-enhanced CT images (12 patients) or MR images tone patient) that showed the anterior facial vein were identified with review of files from 1985 to 1997. Six patients had submandibular gland disease: three with primary neoplasms, two with metastatic tumors invading the gland, and one with chronic sialoadenitis. Eight patients had masses arising outside the gland (seven with lymphadenopathy, one with a plexiform neurofibroma). RESULTS: The anterior facial vein did not separate primary tumors, tumors invading the gland, or lobulations of the enlarged gland from the body of the gland. The vein was identified between enlarged lymph nodes and the gland. The vein did not separate the gland from the neurofibroma, but this tumor was medial to the gland; the vein runs lateral to the gland. CONCLUSION: The anterior facial vein is a useful landmark in determining the origin of a submandibular mass. Primary disease of the gland is never separated from the gland by the vein. The vein does separate lymphadenopathy from the gland and, theoretically, separates the gland from soft-tissue tumors lateral to the gland.