A surgeon operating for a submandibular calculus identifies the lingual nerve in the floor of the mouth. Which statement about its relationship to the submandibular duct is correct?
- A The nerve hooks around the duct, crossing it twice, passing from lateral below to medial above ✓
- B The nerve crosses lateral to medial below the duct at the third molar level
- C The nerve lies lateral to the duct throughout its course
- D The nerve never comes into contact with the duct, remaining deep to hyoglossus
Correct answer: A. The nerve hooks around the duct, crossing it twice, passing from lateral below to medial above
Explanation
At the third molar the lingual nerve lies lateral to the duct; further forward it crosses inferior to the duct and then ascends on its medial side to reach the tongue, so it winds twice around the duct, the classic double cross. The submandibular ganglion hangs from the nerve at this site. C purely lateral relationship (option C) describes the nerve only at the molar level, which makes it the best distractor.
Reference: Last's Anatomy: Regional and Applied Anatomy, 12th ed.
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Written and medically reviewed by the StethoPrep medical team.