Lecfure 3

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Parotid region
The parotid region is the region that located in the posterolateral
part of the facial regiory bounded by the:
. Superiorly: Zygamatic arch.

' Inferiorly: Angle and inferior border of the mandible.

'Posteriorly: External ear and anterior border of the
sternocleidomastoid.
'. Anteriorly: posterior border of the masseter muscle.
Medially: Ramus of the mandible.
The parotid region includes the parotid gland and duct,
the facial
nerve (CN VII), the retromandibular veiry the' exf€rnal "carotid
artety, and the masseter muscle.

il Parotid gland and duet

w Eygomatic arch {superior border)

T $ternocleidoniastEid {posterior border}

I Maeseter {anterior berder}

t Buccinator

PAROTID GLAND
The parotid gland is- the largest of three paired sarivary
glands. It
composed mostly of serous acini. Although the facial-rrJrrru
(CN
VII) is embedded within the parotid gland, the branches extending

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encountered during the dissection of the face. The "*pr"rrii,ii
?acial nerve
divides the gland into superficial and deep lobes.
The parotid gland is enclosed within a 6"tn, unyielding, fascial
capsule, the parotid sheath (capsule), derived from the investing
layer of deep cervical fascia. The parotid gland has an irregulai
shape because the area occupied by the gland, the parotid bJd, is
anteroinferior to the external acoustic meatus, where it is wedged
befween the ramus of the mandible and the mastoid process.
The apex of the parotid gland is posterior to th" angle of the
mandible, and its base is related to the zygamatic arch.

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The parotid duct Passes horizontally from the anterior edge of the
gland. At the anterior border of the masseter, the duct turns
medially, pierces Buccal pad of fat, the buccinator muscle,
Buccopharyngeal fascia und B,r.cal mucosa and enters the oral
cavity through a small orifice opposite the2nd maxillary molar
tooth.

2-
The oblique passage of the duct in the buccinator muscle acts as a
valve-like mechanism & prevents inflation of the duct during
blowing. About a fingerbreadth below the zygomatic arch the duct
dccompanied by the: transverse facial vessels above and buccal
branch of facial nerve below

The duct is represented by the middle 1/3 of a line extending from

the tragus of the auricle to a point midway between the ala of nose
& upper lip

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Embedded within the substance of the parotid gland, from

superficial to deep, are the facial nerve (cN vII) and itr brur-r.hes
,
the retromandibular vein, and the external carotid artery. On the
parotid sheath and within the gland are parotid lymph nodes.

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Structures Present Within the Parotid Gland

1-. Facial nerve and its branches: -Facral
L. nerve emerges lrom
Facial nerve from lrre
the
stylomastoid foramen and entefs the gland by piercing upper part
oi itr posteromedial surface.It then divides into two trunks:
a. Temporo-facial trunk: This gives rise to:
- Temporal nerve
- Zygomatic nerve
b. Cervico-facial kunk: This further divides into
three branches:
- Buccal
- Marginal mandibular
- Cervical
."**'The"five
terminal branches leave through the anterior border of the
gland in a radiating manner that resembles the foot of a goose.
Hu^.u, this pattern is known as pes hnserinus

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and lies #i"a li
below the facial nerve. :'
xillary veins,
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It occupies the d*p
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i. Deep parotid lymph nodes.
4. part or grand.

Although the CN vII is embedded

within rhe gland the cN wI
does not provide innervati"i
,r. *t- giu"a Theiuriculotemporal
nerver a branch of cN v3, is closely
,"fir*a,to the parotid grand and
passes superior to it with- the
superficial temporar vessers. The
auriculotemporal nerve and the
great urrri",rtur nerve, a branch
the cervicar plexus composed o] of
nerves/ innervates the parotid
fibu* from cz u'o cg spinar
sheath as we,l as the overrying
skin.
The parasympathetic component
of
(cN IX) u'ppries presyrrp"ti. secretorythe grossopharyngear nerve
fibers to ihe o*i. gu'glion.
The postsynaptil purury*pathetic
ganglion to
fibu* are conveyed from the
---urriculotemporar
.the gland by tr,u
(Parasympathetic siretomotor suppry arises fromnerve
glossopharyngeal nerve. The the
nerves'i"u.h the gland via the
tympanic branclu the lesser petrosal
nerve, the otic ganglioru and
the auriculotemporal nerve).

stimulation of the parasympathetic

fibers produces a thin watery
saliva' sympathetic riuers are ,
derived from the cervical ganglia
through the external carotid
nervg ni*", on the externar
artery' The vasomotor activity carotid
of these fibers may reduce secretion
from the gland. sensory nerve
fibers p"r, to the gland through..the
great auricular and auriculotemporal
nerves.

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The gland is an irregular roburated mass, sends ,processes, in

various directions. These include:
l-. Glenoid process that extends upward behind the temporo-
mandibular joint, in front of external auditory meatus
2. Facial process that extends anteriorly onto the masseter
muscle
3. Accessory process (part), small part of facial process lying
along the parotid duct
4. Pterygoid process that extends forward from the deeper
part,
lies between the medial pterygoid muscle & the ramus
of
mandible
5' Carotid process that lies posterior to the external carotid
artery

6
 Glensid prsces$
Access*ry
roes$s

igastric muscle proee$s

A portion of fascia extending froS the styroid process

to the angre
of mandible is called stylomandibular ligum"r,t.
parotid gland from the submandibular gland
It separates the

Arterial supply: Externar carotid artery & its

terminar branches
venous drainage: hrto the retro-mandiburar
vein
Lymph Drainage: Lrto the parotid & then into
the deep cervicar
lymph nodes

7
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The buccal pad of fat

The buccal fat is one of several encapsulated fat masses in the
cheek. It is a deep fat pad located on eiiher side of the face betyeen
the buccinator muscle and several more superficial muscles
(including the masseter, the zygomaticus ma;or, and the
zygomaticus minor).The inferior portion of the buccal fat pad is
contained within the buccal space
The buccal fat pad formation begins at 3 months in utero, and the
pad increases in size until birth. Its prominence in the midfacial
region decreases with the changes in faciar proportions brought by
aging. Traditional anatomic desc*2tions state that the buccal fat
pad has a central body and four processes: buccal, pterygoid,
pterygopalatine and temporal.
The blood supply to the buccal fat pad originates from
1, the buccal and deep temporal branches of the maxillary artery
2. the transverse facial branch of the superficial temporal artery'
3. branches of the facial artery. This ti"r, ,rus.ulJrity allows a
reliable long axial flap and explains the rapid surface re-
epithelialization.

The buccal and zygomatic branches of the facial nerve and the
parotid duct lie lateral to the fat pad and should not be injured
during flap mobilization. The buical process is located deep to
the superficial musculoaponeurotic system at the anterior
border of the masseter muscle. In childreru this lobe may
overlie the masseter muscle, producing the characteristic
cherubic fullness

8
 Clinical considera*iCIm
Frey's Syndrorne
Frey's syndrome is an interesting_comprication
developr ufl:l penerrat*g that sometimes
wounds or ihe parotid gland.
when the patient eats, f,uua,
covering the parotid. This "1 n*rniration appear on the skin
auriculotemporal and great
condititn i, caused by damage to the
auricular
healing, the puturylpathetic nerves. During the process of
auricurotemporar nerve grow
,or**o*otor fibers*, in the
r",
great auricurar nerve. Eventuaty,""J
join the distal end of the
these fibers .uu.h the sweat
glands in the facial skin. By
this *uurrr, a stimulus intended
saliva production produces for
sweat secretion instead.,-
Parotid $alivary ctand and
f,esions of tie Faciar Nerve
The parotid ruii rury gland
consists of superficiar and
deep parts, and tr* I-portant "rr"rri"lry
facial nerve ries in the interval
between these parts. A Lenign
parotid neoprasm rarerp if
causes facial palsy. A malignani ever,
to*o, th" p"rr*la is usuarly
highty invasive u"a quickly
ir,lrot.r", :f
the facial
unilateral facial paralysis. ,"rr.e, causing

Parotid "Gland Infections

The parotid
sl*d- may become acutery inflamed as a result
rekograde bacterial infection of
from thu ,rio,rth via the parotid
The gland may arso become duct.
infected via the bloodstream,
mumps' In both:u:"r, as ih
sland is swolren; it is painfur because the
fascial capsure derived-th9
rrJ* the investing layer of deep
fascia is strong and limirs cervicar
thu ,*uu;r";; the gland.
glenoid process, which extends
The sworen
temporomandiburar joint, medialry behind the
is responsible for the pain
acute parotitis when eating. experienced in