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PAROTID REGION
STEVEN J. ZEHREN, PH.D.
GENERAL REMARKS
Cervical branch of VII
Facial vein
GENERAL REMARKS AND RELATIONSHIPS
Parotid gland
Sublingual gland
Mylohyoid m. (cut)Digastric m. (anterior belly)
Digastric m.(posterior belly)
Submandibular gland
Sublingual fold
PAROTID GLAND: Totally serous
SUBMANDIBULAR GLAND:Mostly serous; partly mucous
SUBLINGUAL GLAND:Almost completely mucous
SALIVARY GLANDS (HISTOLOGY)
Palatine glands
Molar minorsalivary glands
RELATIONSHIPS OF THE PAROTID GLAND (PAROTID BED)
PAROTID BED (RELATIONSHIPS OF PAROTID GLAND)Ext. auditory meatus
Ramus of mandible
Stylohyoid m.
Mastoid processStyloid process
Sternocleidomastoid m.Post. belly of digastric m.
Carotid sheath (& contents)
PAROTID BED (HORIZONTAL SECTION)
Masseter m.
Ramus of mandible
Medial pterygoid m.
Facial n. (VII)Retromandibular v.
Ext. carotid a.
Parotid gland
Stylohyoid m.
Sternocleidomastoid m.Post. belly of digastric m.
Carotid sheath & contents
LATERAL PHARYNGEAL SPACE
Parotid gland
Medial pterygoid
Superior constrictor of pharynx
Oropharynx
Lateral pharyngeal space
STRUCTURES WITHINTHE PAROTID GLAND
Facial n.Retromandibular v.External carotid a.
Temporal branchesZygomatic branches
Buccal branches
Marginal mandibular branch
Cervical branch
Main trunk of VII
TO ZANZIBAR BY MOTOR CAR
FACIAL NERVE (VII) WITHIN PAROTID GLAND
Medial pterygoid m.
Ramus of mandible
Masseter m.
Parotid gland
Main trunk of facial n.
Mastoid process
Temporal br.
Zygomatic brs.
Marginal mandibular br.
Cervical br.
Buccal brs.
Main trunk of facial n.
Temporofacial division
Cervicofacial division
Retromandibular v.
Superficial temporal v.Maxillary v.
Facial v.
Common facial v.(to IJV)
Posterior auricular v.
External jugular v.
External carotid a.
Superficial temporal a.
Maxillary a.
PAROTID FASCIA
Parotid fascia
Investing layer ofdeep cervical fascia
PAROTID FASCIA
Stylomandibular lig.
Stylomandibular lig.
Submandibular fossa
PAROTID DUCT(STENSON’S DUCT)
RELATIONSHIPS OF PAROTID DUCT
Parotid gland
Transverse facial a.Accessory parotid gland
Parotid ductBuccinator m.
Masseter m.
Zygomatic arch
Parotid papilla(opposite maxillary 2nd molar)
TERMINATION OF PAROTID DUCT
NERVE SUPPLY TO THE PAROTID GLAND
AUTONOMIC INNERVATION OF PAROTID GLAND
Medulla
Inf. salivatory nucleusIX (Glossopharyngeal n.)
Tympanic n.
Tympanic plexus
Lesser petrosal n.V3Otic ganglion
Auriculotemporal n.
Parotid gland
Presynaptic parasympatheticPostsynaptic parasympathetic
AUTONOMIC INNERVATION OF PAROTID GLAND (DISSECTION, MEDIAL VIEW)
Tympanic cavity
V3 (Mandibular n.)
Otic ganglion
Lesser petrosal n.
Auriculotemporal n.
SENSORY INNERVATION TO THE PAROTID GLAND
Auriculotemporal n. (V3)
FREY’S SYNDROME(GUSTATORY SWEATING)
FREY’S SYNDROME
Auriculotemporal n. (V3)
Great auricular n.(C2,3)
Gustatory Sweating (Frey's Syndrome)
This woman had undergone a parotidectomy for a benign mixed tumor of the parotid gland a year before this photo was taken. The picture was taken just as she was taking some food by mouth.
From Mosby, “Clinical Anatomy Interactive Lesson”
Note that upon gustatory stimulation there is localized sweating over the area where the skin flap was raised for the parotidectomy. With removal of the parotid the secretory fibers carried by the auriculotemporal nerve were cut. These unsatisfied nerve ends regrew to join the sympathetic nerve ends on the elevated skin flap. When parotid secretion is called for the sweat glands respond.
TREATMENT & PREVENTION OF FREY’S SYNDROME
MEDICAL
1. Topical anticholinergic creams/lotions. 2. Intracutaneous injection of Botulinum toxin A.
SURGICAL
1. Transmeatal tympanic neurectomy. 2. Procedures which involve the interposition of a tissue barrier (eg., fascia lata or fat grafts). 3. Sternocleidomastoid muscle flap.
Promontory of middle ear cavity withtympanic nerve (branch of IX) and plexusunder mucosa
Mastoid process
TYMPANIC NEURECTOMY
STERNOCLEIDOMASTOID MUSCLE FLAP ROTATED ONTO THE DEEP LOBE OF THE PAROTID GLAND
BLOOD SUPPLY & LYMPHATIC DRAINAGE OF THE PAROTID GLAND
External carotid a.
Superficial temporal a.
Maxillary a.
Retromandibular v.
Superficial temporal v.Maxillary v.
Facial v.
Common facial v.(to IJV)
Posterior auricular v.
External jugular v.
Parotid nodes
Deep cervical nodes
END OF LECTURE