Nerves and vessels of parotid gland

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Course,formation,extent and formation of various nerves and vessels supplying parotid gland along with its clinical aspects

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Nerves and vessels of parotid gland

  1. 1.  Largest of the salivary glands  Serous type  Average weight of 25 gm  Extent : lies below the external acoustic meatus between the mandible and sternocleidomastoid  Location : Retromandibular fossa
  2. 2.  Shape : inverted pyramidal  It has 4 surfaces:  Superior surface  Superficial surface  Anteriomedial surface  Posteriomedial surface  It tapers inferiorly to a blunt apex  It secretes saliva through Stenson Duct or Parotid Duct in the oral cavity
  3. 3.  It comes out of the cranial cavity through the stylomastoid foramen at the base of the skull between the styloid and mastoid processes of temporal bone  It immediately gives off the branches :  Nerve to Posterior belly of digastric  Nerve to Stylohyoid  Posterior auricular nerve
  4. 4.  Next the nerve enters the parotid gland from its posteriomedial aspect and passes forwards and downwards behind the mandibular ramus
  5. 5.  Within the substance of the gland it branches into:  Temporofacial trunk (superior)- runs upwards and divide into o Temporal branch - crosses the zygomatic arch to supply the auricularis anterior and superior, intrinsic muscles on the lateral aspect of the ear, frontal belly of occipitofrontalis muscle, orbicularis oculi and corrugator supercilli o Zygomatic branch - runs below and parallel to the zygomatic arch to supply the orbicularis oculi
  6. 6.  Cervicofacial trunk (inferior) – passes downwards and forwards and divides into: o Buccal branches - 2 in number 1. Upper buccal nerve - runs above the parotid duct -Supply zygomaticus major and levator labii superioris -Form an infra orbital plexus with superior labial branches of infraorbital nerve -Also supply levator anguli oris, zygomaticus minor and levator labii superioris aleque nasi 2. Lower buccal nerve - runs below the parotid duct - Supply buccinator and orbicularis oris - Communicate with buccal branch of mandibular nerve
  7. 7. o Marginal mandibular branch – Run forwards towards the angle of mandible under platysma - Crosses the body of mandible to supply risorius and muscles of lower lip and chin - Communicates with the mental nerve o Cervical branch – Emerges from the lower part of parotid gland and runs anterioinferiorly under platysma to the front of the neck - Supplies platysma - Communicates with transverse cutaneous cervical nerve  These 5 terminal branches radiate like a goose foot through the anterior border of the gland, this branching pattern is termed as pes- anserinus
  8. 8.  The parotid gland is supplied by:  PARASYMPATHETIC(SECRETOM OTOR)SUPPLY-derived from auriculo temporal nerve Its stimulation produces watery secretion  SYMPATHETIC SUPPLY-derived from the sympathetic plexus around the external carotid artery Stimulation produces thick sticky secretion  SENSORY SUPPLY- derived from Auriculo-temporal nerve Great auricular nerve
  9. 9.  Arise from the cells of the ganglion and pass through the auriculo-temporal nerve to supply the parotid gland
  10. 10.  From the external carotid artery and its branches and superficial temporal arteries  It pierces the lower part of posteriomedial surface to enter the gland where it occupies the deep zone of the gland  Within the gland it divides into  Maxillary artery- emerges from the anteriomedial surface  Superficial temporal artery- gives off its transverse facial branch which emerges through the anterior border and it ascends to leave its upper limit  Posterior auricular artery may also branch from it and leave by its posteriomedial surface
  11. 11.  Into retromandibular vein and external jugular vein  The retromandibular vein is formed by the union of  Maxillary veins  SuperficialTemporal veins  It lies superficial to external carotid artery  It descends in the parotid gland and emerges behind the apex of the gland
  12. 12.  Here it usually divides into :  Anterior branch – passes forward to join the facial vein and form the common facial vein  Posterior branch – joins the posterior auricular vein to form the external jugular vein
  13. 13. CONNECTED BY ISTHMUS PAROTID GLAND SUPERFICIAL LOBE(LARGE) DEEP LOBE(SMALL)  The branches of facial nerve passes forward through the isthmus .  The plane in between the superficial and deep lobes in which nerves and veins lie has been designated as ‘Patey’s Faciovenous Plane’.  SIGNIFICANCE: This plane helps the surgeons to remove the parotid tumor without damaging the nerve.
  14. 14.  Also known as gustatory sweating or auriculo-temporal nerve syndrome  Commonly occurs after parotid surgery or trauma  It reflects the aberrant innervation of sweat glands on the face by regrowing parasympathetic secretomotor axons that would have previously innervated the parotid gland  It is characterized by o Sweating o Warmth o Redness of the face as a result of salivary stimulation by the smell or taste of food

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