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PAROTID REGION

PAROTID REGION. BY. STEVEN J. ZEHREN, PH.D. GENERAL REMARKS. GENERAL REMARKS AND RELATIONSHIPS. Sublingual fold. Parotid gland. Cervical branch of VII. Sublingual gland. Digastric m. (posterior belly). Mylohyoid m. (cut). Digastric m. (anterior belly). Facial vein.

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PAROTID REGION

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  1. PAROTID REGION BY STEVEN J. ZEHREN, PH.D.

  2. GENERAL REMARKS

  3. GENERAL REMARKS AND RELATIONSHIPS Sublingual fold Parotid gland Cervical branch of VII Sublingual gland Digastric m. (posterior belly) Mylohyoid m. (cut) Digastric m. (anterior belly) Facial vein Submandibular gland

  4. SALIVARY GLANDS (HISTOLOGY) PAROTID GLAND: Totally serous SUBLINGUAL GLAND: Almost completely mucous SUBMANDIBULAR GLAND: Mostly serous; partly mucous

  5. Palatine glands Molar minor salivary glands

  6. RELATIONSHIPS OF THE PAROTID GLAND (PAROTID BED)

  7. PAROTID BED (RELATIONSHIPS OF PAROTID GLAND) Ext. auditory meatus Mastoid process Ramus of mandible Styloid process Sternocleidomastoid m. Stylohyoid m. Post. belly of digastric m. Carotid sheath (& contents)

  8. 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

  9. LATERAL PHARYNGEAL SPACE Oropharynx Superior constrictor of pharynx Lateral pharyngeal space Medial pterygoid Parotid gland

  10. STRUCTURES WITHIN THE PAROTID GLAND

  11. Facial n. Retromandibular v. External carotid a.

  12. 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

  13. 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.

  14. Superficial temporal v. Maxillary v. Facial v. Posterior auricular v. Retromandibular v. Common facial v. (to IJV) External jugular v.

  15. Superficial temporal a. Maxillary a. External carotid a.

  16. PAROTID FASCIA

  17. PAROTID FASCIA Parotid fascia Investing layer of deep cervical fascia

  18. Stylomandibular lig. Stylomandibular lig. Submandibular fossa

  19. PAROTID DUCT (STENSON’S DUCT)

  20. RELATIONSHIPS OF PAROTID DUCT Zygomatic arch Transverse facial a. Accessory parotid gland Parotid duct Buccinator m. Masseter m. Parotid gland

  21. TERMINATION OF PAROTID DUCT Parotid papilla (opposite maxillary 2nd molar)

  22. NERVE SUPPLY TO THE PAROTID GLAND

  23. AUTONOMIC INNERVATION OF PAROTID GLAND V3 Otic ganglion Lesser petrosal n. IX (Glossopharyngeal n.) Auriculotemporal n. Inf. salivatory nucleus Parotid gland Medulla Tympanic plexus Tympanic n. Presynaptic parasympathetic Postsynaptic parasympathetic

  24. AUTONOMIC INNERVATION OF PAROTID GLAND (DISSECTION, MEDIAL VIEW) Tympanic cavity V3 (Mandibular n.) Otic ganglion Auriculotemporal n. Lesser petrosal n.

  25. SENSORY INNERVATION TO THE PAROTID GLAND Auriculotemporal n. (V3)

  26. FREY’S SYNDROME (GUSTATORY SWEATING)

  27. FREY’S SYNDROME Auriculotemporal n. (V3) Great auricular n. (C2,3)

  28. TREATMENT & PREVENTION OF FREY’S SYNDROME • MEDICAL • Topical anticholinergic creams/lotions. • Intracutaneous injection of Botulinum toxin A. • SURGICAL • Transmeatal tympanic neurectomy. • Procedures which involve the interposition of a tissue barier (eg., fascia lata or fat grafts). • Sternocleidomastoid muscle flap.

  29. TYMPANIC NEURECTOMY Promontory of middle ear cavity with tympanic nerve (branch of IX) and plexus under mucosa Mastoid process

  30. STERNOCLEIDOMASTOID MUSCLE FLAP ROTATED ONTO THE DEEP LOBE OF THE PAROTID GLAND

  31. BLOOD SUPPLY & LYMPHATIC DRAINAGE OF THE PAROTID GLAND

  32. Superficial temporal a. Maxillary a. External carotid a.

  33. Superficial temporal v. Maxillary v. Facial v. Posterior auricular v. Retromandibular v. Common facial v. (to IJV) External jugular v.

  34. Parotid nodes Deep cervical nodes

  35. POP TEST

  36. IDENTIFY THESE STRUCTURES D B C A E

  37. ANSWERS • RAMUS OF MANDIBLE • MEDIAL PTERYGOID M. • POSTERIOR BELLY OF DIGASTRIC M. • VAGUS N. • EXTERNAL CAROTID A.

  38. Extra Slides

  39. POSITIVE MINOR’S TEST SHOWING IODINE REACTION WITH STARCH FOLLOWING GUSTATORY SWEATING (FREY’S SYNDROME)

  40. PAROTID BED & STRUCTURES PIERCING GLAND

  41. 0 Secretion of the parotid gland would be affected by a lesion in the • Greater petrosal nerve. • Auriculotemporal nerve. • Facial nerve. • Pterygopalatine ganglion. • None of the above.

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