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