Transcript Slide 1

PAROTID REGION
STEVEN J. ZEHREN, PH.D.
GENERAL REMARKS
GENERAL REMARKS AND RELATIONSHIPS
Sublingual fold
Parotid gland
Cervical branch of VII
Sublingual gland
Mylohyoid m. (cut)
Digastric m. (anterior belly)
Submandibular gland
Digastric m.
(posterior belly)
Facial vein
SALIVARY GLANDS (HISTOLOGY)
PAROTID GLAND:
Totally serous
SUBMANDIBULAR GLAND:
Mostly serous; partly mucous
SUBLINGUAL GLAND:
Almost completely mucous
Palatine glands
Molar minor
salivary glands
RELATIONSHIPS
OF THE PAROTID GLAND
(PAROTID BED)
PAROTID BED (RELATIONSHIPS OF PAROTID GLAND)
Ext. auditory meatus
Mastoid process
Styloid process
Sternocleidomastoid m.
Post. belly of digastric m.
Carotid sheath
(& contents)
Ramus of mandible
Stylohyoid m.
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
Oropharynx
Superior constrictor
of pharynx
Lateral pharyngeal space
Medial pterygoid
Parotid gland
STRUCTURES WITHIN
THE PAROTID GLAND
Facial n.
Retromandibular v.
External carotid a.
FACIAL NERVE (VII) WITHIN PAROTID GLAND
Temporal branches
Zygomatic branches
Main trunk of VII
TO ZANZIBAR BY MOTOR CAR
Buccal branches
Marginal mandibular branch
Cervical branch
Medial pterygoid m.
Ramus of mandible
Main trunk of facial n.
Masseter m.
Mastoid process
Parotid gland
Temporofacial division
Temporal br.
Zygomatic brs.
Main trunk of facial n.
Buccal brs.
Cervicofacial division
Marginal mandibular br.
Cervical br.
Superficial temporal v.
Maxillary v.
Facial v.
Posterior auricular v.
External jugular v.
Retromandibular v.
Common facial v.
(to IJV)
Superficial temporal a.
Maxillary a.
External carotid a.
PAROTID FASCIA
PAROTID FASCIA
Parotid fascia
Investing layer of
deep cervical fascia
Stylomandibular lig.
Stylomandibular lig.
Submandibular fossa
PAROTID DUCT
(STENSON’S DUCT)
RELATIONSHIPS OF PAROTID DUCT
Zygomatic arch
Transverse facial a.
Accessory parotid gland
Parotid duct
Buccinator m.
Masseter m.
Parotid gland
TERMINATION OF PAROTID DUCT
Parotid papilla
(opposite maxillary 2nd molar)
NERVE SUPPLY TO THE
PAROTID GLAND
AUTONOMIC INNERVATION OF PAROTID GLAND
Otic ganglion
V3
Auriculotemporal n.
Lesser petrosal n.
IX (Glossopharyngeal n.)
Inf. salivatory nucleus
Parotid gland
Medulla
Tympanic plexus
Tympanic n.
Presynaptic parasympathetic
Postsynaptic parasympathetic
AUTONOMIC INNERVATION OF PAROTID GLAND
(DISSECTION, MEDIAL VIEW)
Tympanic cavity
V3 (Mandibular n.)
Otic ganglion
Auriculotemporal n.
Lesser petrosal 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.
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
From Mosby, “Clinical Anatomy Interactive Lesson”
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.
TYMPANIC NEURECTOMY
Promontory of middle ear cavity with
tympanic nerve (branch of IX) and plexus
under mucosa
Mastoid process
STERNOCLEIDOMASTOID MUSCLE FLAP ROTATED
ONTO THE DEEP LOBE OF THE PAROTID GLAND
BLOOD SUPPLY &
LYMPHATIC DRAINAGE
OF THE PAROTID GLAND
Superficial temporal a.
Maxillary a.
External carotid a.
Superficial temporal v.
Maxillary v.
Facial v.
Posterior auricular v.
External jugular v.
Retromandibular v.
Common facial v.
(to IJV)
Parotid nodes
Deep cervical nodes
END OF LECTURE