The hypoglossal nerve in the submandibular triangle is crossed by a variable number of lingual veins that drain the lingual area toward the internal jugular vein (Fig. 5-13). The anatomical distribution of the lingual veins is unpredictable, thus preventing a systematic approach to the area. These veins are a frequent source of troublesome bleeding because of their thin wall and the proximity to the main trunk of the hypoglossal nerve. This area must be approached carefully; it is important to avoid the placement of clamps and ligatures without clear identification of the hypoglossal nerve. Bipolar coagulation may be useful at this stage of the operation.
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