A presentation on the topic Parotid Region By: Anslin Jerbiha.E BHMS 1 ST YEAR ( 2022 Batch )

2. PAROTID REGION contains,
• Largest serous salivary gland (Parotid gland)
• Facial nerve (Queen of the face)

3.  Parotid gland
 Submandibular gland
 Sublingual gland

4.  Largest salivary gland
 Weight - 25g
 Location : Below external acoustic meatus
Between ramus of mandible and sternocleidomastoid
 Anteriorly the gland overlaps the master muscle
 Shape : Pyramidal
 Nerve supply: For the skin over the gland – Great auricular nerve

5.  Capsule – A tough sheath or membrane that encloses an organ
or other structure in the body
 Capsule of Parotid gland – Investing layer of deep cervical fascia
 Nerve supply – Auricular nerve
 Fascia splits and encloses the gland
# Superficial lamina
# Deep lamina

6.  Superficial lamina – Parotidomasseteric fascia
Thick
Adherent to the gland
Attached to zygomatic arch
 Deep lamina – Thin
Attached to Tympanic plate
A portion of deep lamina extend between
Styloid process and mandible – thickened – forms
Stylomandibular
Ligament

7.  Three-sided pyramid
 Apex – Directed downwards
 Four surfaces
1) Superior ( Base )
2) Superficial
3) Anteromedial
4) Posteromedial
 Three borders
1) Anterior
2) Posterior
3) Medial

8.  Apex
Related to,
- Posterior belly of digastric
- Cervical branch of facial nerve
- 2 divisions of retromandibular vein
 Surfaces
# Superior surface
- Superficial temporal vessel
- Auriculo temporal nerve
- External acoustic meatus
- Posterior surface of temporomandibular joint

9. # Superficial surface
- Skin
- Superficial fascia
- Parotid fascia
- Deep Parotid lymph node
# Antero medial surface
- Ramus of Mandible
- Masseter
- Medial pterygoid
- Lateral surface of temporomandibular joint
# Posteromedial surface
- Mastoid process
- Styloid process

10.  Borders
# Anterior Border
Related to,
- Terminal branch of facial nerve
- Parotid duct
- Transverse facial vessel
Anterior Border separates superficial surface from Anteromedial surface
# Posterior Border
Separates superficial surface from Posteromedial surface
#Medial Border
Separates Anteromedial surface from Posteromedial surface

11.  ARTERIES
-External carotid artery enters through Posteromedial surface
-Maxillary artery leave through Anteromedial surface
-Superficial temporal artery gives transverse facial artery

12. ARTERIES

13.  VEINS
-Superficial temporal vein and maxillary vein units to form retromandibular
vein
- Retromandibular vein divides into Anterior and posterior divisions

14.  FACIAL NERVE

15.  The facial Nerve (VII) exists the skull through the stylomastoid foramen and then
passes into parotid gland where it usually divides into upper , & lower trunk.
 Five terminal groups of branches of facial Nerve
1) Temporal branch
2) Zygomatic branch
3) Buccal branch
4) Marginal mandibular branch
5) Cervical branch

16.  Sudden paralysis of facial nerve at the stylomastoid foramen,
results in
asymmetry of corner of mouth,
inability to close the eye,
disappearance of nasolabial fold and
loss of wrinkling of skin of forehead on the same side

17.  Arterial supply
External carotid artery and its branches
 Venous drainage
External jugular vein
Internal jugular vein

18.  Parasympathetic supply – Secretomotor
The stimulation produces the secretion watery.
 Sympathetic Supply- Vasoconstrictor
The stimulation produces thick sticky secretion.
 Sensory supply
a)Auriculotemporal Nerve (temporal Region)
b)Great Auricular Nerve (Parotid fascia)

19.  Parotid nodes
 Deep cervical nodes

20.  Stenson’s duct
 5 cm long
 Emerge from anterior border

21. Origin – Emerge from anterior border
Course -
• Runs forward over Masseter between upper and lower buccal branches of
facial nerve
• At the anterior border of Masseter, duct turns inward, almost 90° ( 1 st bend)
• Pierces buccal pad of fat
• Pierces buccopharyngeal fascia
• Pierces buccinator muscle
• Second bend
• Run forward for about 1 cm between buccinator and buccal mucosa
• Duct turns medially ( 3 Rd bend)
Termination
• Opens into the vestibule of mouth opposite the crown of upper second molar
teeth

22. 1. Parotid fascia – Fascia over the parotid is tough & is supplied by the great
auricular nerve. Because of the tough fascia, fluctuations cannot be obtained
even in the presence of the pus.
2. Parotitis - Inflammation of the parotid gland is known as parotitis. In mumps
the parotid swelling is painless. It must be remember that in mumps the testes
are affected which may cause testicular atrophy causing sterility. Bacterial
parotitis is the result of bacterial infection reaching the gland through the duct.
In case of infection of the oral cavity the incidence of parotitis is more due to
reduced salivary flow in prolonged illness due to the blockage of the parotid
duct.

23. 3. Parotid abscess is very painful due to the tough sensitive parotid fascia.
Fluctuations cannot be obtained due to the tough nonyielding fascia, unless the
fascia perforates. Parotid abscess is opened by giving a vertical incision starting
infront of the tragus curved below the lobule of the ear & carried forwards over the
mastoid around the posterior aspect of the lower pole of the parotid. Finally the pus
is drained by thrusting the mosquito forceps into the abscess.

24. 4. Tumours of parotid – Tumours of the parotid can be benign or malignant. A slow
growing benign tumour may undergo malignant change involving the facial nerve.
A swelling of the parotid with facial nerve involvement is the sure sign of
malignancy. Testing the facial nerve function mandatory. Commonest tumour of the
parotid gland is the mixed salivary tumour, which mostly occur in the superficial
lobe of the gland. It can be excised by following the facio-venous plane, without
damaging the facial nerve

25. THANK YOU