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Thyroid Gland
Dr. Rabia Inam Gandapore
Assistant Professor
Head of Department Anatomy
(Dentistry-BKCD)
B.D.S (SBDC), M.Phil. Anatomy (KMU),
Dip. Implant (Sharjah, Bangkok, ACHERS) , CHPE
(KMU),CHR (KMU), Dip. Arts (Florence, Italy)
Teaching Methodology
 LGF (Long Group Format)
 SGF (Short Group Format)
 LGD (Long Group Discussion, Interactive discussion with the use of models or diagrams)
 SGD (Short Group)
 SDL (Self-Directed Learning)
 DSL (Directed-Self Learning)
 PBL (Problem- Based Learning)
 Online Teaching Method
 Role Play
 Demonstrations
 Laboratory
 Museum
 Library (Computed Assisted Learning or E-Learning)
 Assignments
 Video tutorial method
Goal/Aim (main objective)
To help/facilitate/augment the students about the:
 Describe location & extent of thyroid gland.
 Briefly explain capsules of thyroid.
 Explain parts & relations of thyroid gland.
 Describe blood, nerve & lymphatic supply of thyroid gland.
Specific Learning Objectives (cognitive)
At the end of the lecture the student will able to:
 Describe location & extent of thyroid gland.
 Briefly explain capsules of thyroid.
 Explain parts & relations of thyroid gland.
 Describe blood, nerve & lymphatic supply of thyroid gland.
Psychomotor Objective: (Guided response)
 A student to draw labelled diagram of the Thyroid Gland
Affective domain
 To be able to display a good code of conduct and moral values in the class.
 To cooperate with the teacher and in groups with the colleagues.
 To demonstrate a responsible behavior in the class and be punctual, regular, attentive and on time
in the class.
 To be able to perform well in the class under the guidance and supervision of the teacher.
 Study the topic before entering the class.
 Discuss among colleagues the topic under discussion in SGDs.
 Participate in group activities and museum classes and follow the rules.
 Volunteer to participate in psychomotor activities.
 Listen to the teacher's instructions carefully and follow the guidelines.
 Ask questions in the class by raising hand and avoid creating a disturbance.
 To be able to submit all assignments on time and get your sketch logbooks checked.
Lesson contents
Clinical chair side question: Students will be asked if they know what is the function of Thyroid Gland
Outline:
 Activity 1 The facilitator will explain the student's Thyroid Gland
 Activity 2 The facilitator will ask the students to make a labeled diagram of the Thyroid Gland
 Activity 3 The facilitator will ask the students a few Multiple Choice Questions related to it with flashcards.
Recommendations
 Students assessment: MCQs, Flashcards, Diagrams labeling.
 Learning resources: Langman’s T.W. Sadler, Laiq Hussain Siddiqui, Snell
Clinical Anatomy, Netter’s Atlas, BD Chaurasia’s Human anatomy, Internet
sources links.
Thyroid Gland
 Named after the thyroid cartilage
 (Greek: Shield shaped)
 Largest endocrine gland
 Serous acini
 Situated:
-Below: external auditory meatus
-Deep & behind: ramus of mandible
-Infront of: Sternocledomastoid muscle.
 Salivary Glands: Paired Parotid gland , Sub-
mandibular, Sub-lingual glands & numerous
small glands scattered in oral cavity.
Developmental Embryology
 1st endocrine gland to develop
 Endodermal thickening primitive pharynx ---
thyroid primordium---descend in neck---ventral
to hyoid, laryngeal cartilage---connection by
thyroglossal duct
 1st hollow than solid---divide into 2—
connected by isthmus
 At 7 week has definitive shape---reach final site
 Foramen cecum---persistance proximal
opening of thyroglossal duct
Structure Of Thyroid Gland
 Extensions of capsule within the
substance of gland form numerous
setae, which divide it into lobes &
lobules
 Each Lobule contains 40 to 60 thyroid
follicles & stroma in which blood
vessels & lymphatic ramify.
 Thyroid Follicle structural units of gland
--filled--colloid thyroglobulin as storage.
Follicle is surrounded by a single layer of
epithelial cells.
Histology
 Epithelial cells are of 2 types:
1. Principal cells (i.e.,follicular): formation
of colloid
2. Parafollicular cells (i.e. C-clear, light
cells): hormone calcitonin depending on
the state of activity, the cells are flattened
with colloid abundant (resting state) or
cuboidal (secretory state) with colloid
diminished
Site /Location/Topography
 Is anterior in neck below & lateral to
thyroid cartilage
 Deep to: sternothyroid &
sternohyoid muscles
 Present in visceral compartment of
neck surrounded by pretracheal
fascia
 Extending from level of C5-T1
 Isthmus: overlying the second to
fourth tracheal rings
Shape, Weight & Size
 Shape: wedge shape (H or U)
 25-30g
 Lobe: 50-60 mm long
 Isthmus: average height of
12-15 mm
 Normal gland has
Consistency of muscle tissue
Parotid Duct
 Parotid Duct: passes forward over lateral surface of masseter muscle (One finger below
zygomatic arch).
 At anterior border of muscle, it turns sharply medially & pierce buccal pad of fat & buccinator
muscle.
 It then passes forward for a short distance between muscle & mucous membrane and finally
opens into vestibule of mouth on small papilla, opposite upper second molar tooth.
 The oblique passage of duct forward between the mucous membrane & buccinators serve
as a valve-like mechanism & prevents inflation of duct system during violent blowing (e.g. as
in glass blowing or trumpet playing)
 Accessory part of gland: drained by small duct that opens into upper border of parotid duct.
Coverings (Capsule)
 Lobulated mass surrounded by connective
tissue capsule & dense fibrous capsule
A. True Capsule: Surrounded by a inner true
thin, fibrous capsule of connective tissue which
adheres closely to gland Extensions of this
capsule within the substance of gland form
numerous septae, which divide it into lobes &
lobules
B. False Capsule: External to this is a “false
capsule” formed by pretracheal fascia of
cervical fascia
Attachment
 Above: Pretracheal fascia is attached to
hyoid bone & thyroid cartilage on each side
 Below: it enters thoracic cavity & blends with
fibrous pericardium of heart
 Pretracheal fascia is thickened to form the
ligament of Berry which connects each lobe
of thyroid with cricoids cartilage (of larynx).
These attachments of thyroid gland make it
move up & down with swallowing.
Parts
 Facial nerve & its branches pass forward within parotid
gland divides it into:
1. Superficial Part
2. Deep Part or Lobes
A. Two lateral lobes RT & LT (Pyramidal)
B. Two Superior & Inferior poles
C. Connected by narrow Isthmus
-(ant surface of 2 & 3 tracheal cartilage)
-average height of 12-15 mm
D. In some people a third “pyramidal lobe” exists,
ascending from isthmus towards hyoid bone
Lateral Lobes
APEX (behind angle of Mandible)
 Upward, sandwiched between inferior constrictor (of pharynx) & sternothyroid muscles.
 Superior thyroid artery & external laryngeal nerve closely related
 Artery lies superficial
 Nerve passes deep to apex so ligated away from thyroid gland during surgery.
BASE (above)
 Extends up to 5, 6 Tracheal ring
 Related to inferior thyroid artery & recurrent laryngeal nerve.
 RLN either anteriorly or posteriorly to ITA,artery is ligated away laterally to gland to avoid injury to RLN
SUPERFICIAL SURFACE is overlapped by neck muscles
DEEP SURFACE related with larynx, trachea, pharynx, oesophagus & parathyroid glands.
Processes of Gland
 Superior Margin of Gland: extends
upward behind TMJ into posterior part of
mandibular fossa called Glenoid Process
 Anterior Margin of Gland: extends
forward superficial to masseter muscle to
for Facial Process. Small part of facial
process maybe separate from the main
gland called Accessory Par of gland.
 Deep part of Gland: extend forward
between medial pterygoid muscle & ramus
of mandible to form Pterygoid Process
Structures within Parotid Gland
 From Lateral to Medial are:
1. Facial nerve: Emerges from stylomastoid foramen & enters gland. It passes forward
superficial to retromandibular vein & external carotid artery & divided into 5 terminal
branches. The branches of nerve leave gland on its antero-medial surface.
2. Retromandibular vein: formed within parotid gland by union of superficial temporal &
maxillary vein. Divides into anterior & posterior divisions, which leave lower border of
gland . Anterior division join facial vein & posterior division unites with posterior
auricular vein to form external jugular vein
3. External Carotid Artery: having left carotid triangle by passing deep to posterior belly of
diagastric ascends & enters the substance of parotid gland. At the level of the neck of
mandible, it divides into superficial temporal artery & maxillary artery
4. Lymph nodes
Relations of Parotid Gland (Parotid Bed)
3. Postero-medial Relations:
 Mastoid Process
 Sternocleidomastoid muscle
 Posterior belly of digastric muscle
 Styloid process & its attached muscles
 Carotid sheath (Internal carotid artery, Vagus, Internal
Jugular vein, glossopharyngeal, accessory, hypoglossal &
facial nerves)
4. Antero-medial Relations:
 Posterior border of ramus of mandible
 Masseter
 Medial Pterygoid muscle
 TMJ
1. Superficial Relations:
 Skin
 Fascia
 Parotid lymph nodes
 Great auricular nerve
2. Superior Relations:
 External auditory meatus
 Posterior surface TMJ
 At union of Antero & Postero-
Medial gland lies in contact
with pharyngeal wall
Arterial Supply
 Highly vascular ( External carotid artery & terminal
branches)
a. Superior Thyroid Arteries
b. Inferior Thyroid Arteries
c. Occasionally Thyroidea Ima, branch of arch of
aorta or bracheocephalic trunk
d. Accessory thyroid arteries, from oesophageal &
tracheal branche
 These arteries lie between the true capsule &
pretracheal layer of deep cervical fascia
a. Superior Thyroid Artery
 First anterior branch of external carotid artery
 Descend to superior pole divides into anterior & posterior branches after piercing
pretracheal fascia.
a. Anterior branch: supplies anterior surface both sides anastomose across midline
b. Posterior branch: supplies posterior surface anastomose with inferior thyroid
artery.
 High ligation of superior thyroid artery during thyroidectomy places this nerve at risk of
inadvertent injury, which would produce dysphonia by altering pitch regulation
b. Inferior Thyroid Artery
 Inferior thyroid--thyrocervical--subclavian
artery
 Ascends vertically curves medially to enter
the tracheoesophageal groove in a plane
posterior to carotid sheath---penetrate
posterior aspect of lateral lobe
 Closely associated with recurrent laryngeal
nerve
Venous Drainage
 Drains into retromandibular vein
 Veins do not accompany the arteries
 Arise from venous plexus which is present
deep to true capsule & are drained by 3 pairs
of veins:
1. Superior thyroid veins: drain superior pole
of gland
2. Middle thyroid veins: drain middle of lobe
3. Inferior thyroid veins: drain inferior pole of
gland
Venous Drainage
 3 pairs of veins
1. Superior thyroid vein: (superior thyroid
artery)--internal jugular vein
2. Middle thyroid vein: directly--internal jugular
vein
3. Inferior thyroid vein---- brachiocephalic vein
 occationally inferior veins form a common
trunk called thyroid ima vein, which empties
into left brachiocephalic vein
Lymphatic Drainage
 Drains into Parotid & Deep cervical lymph nodes
 Extensive & flows multidirectionally : Accompanying
arteries & form a capsular network of lymphatic vessels.
 Lymphatic vessels: Periglandular nodes--- to
prelaryngeal (Delphian)--- pretracheal----paratracheal
nodes along recurrent laryngeal nerve---to mediastinal---
deep cervical LN--- brachiocephalic lymph nodes or
thoracic duct
 Regional metastases of thyroid carcinoma--- laterally,
higher in neck along internal jugular vein , tumor invasion
of pretracheal & paratracheal nodes causing an
obstruction of normal lymph flow.
Innervation
A. Vasomotor: from ANS. Vasomotor & cause constriction of blood vessels
 Parasympathetic fibers: come from vagus nerves.
B. Secretomotor
1. Parasympathetic fibers: Parasympathetic secretomotor fibers from inferior salivary nucleus
of glossopharyngeal nerve supply parotid gland
 Pre-ganglionic parasympathetic Nerve fiber pass to otic ganglion via tympanic branch of
glossopharyngeal nerve & lesser petrosal nerve.
 Post-ganglionic parasympathetic fibers reach parotid gland via auriculotemporal nerve which
lies incontact with deep surface of gland
2. Sympathetic fibers: are distributed from superior, middle, & inferior ganglia of sympathetic
trunk
 Post ganglionic sympathetic fibers reach gland as plexus of nerves around external carotid
artery
Endocrine Function
 Regulated by pituitary gland ,TSH.
 Thyroid hormone, controls rate of metabolism & calcitonin ,
controlling calcium metabolism.
 Thyroid gland affects all areas of body except itself, spleen,
testes, & uterus
Clinical Correlation
Clinical Corelation
Thyroid Ima Artery
 Potential source of bleeding “Tracheostomy,”
Thyroglossal Duct Cyst
 Normally disappears-- remnants of epithelium
may remain -- form a thyroglossal duct cyst at
any point along path of its descent
 Usually in neck, close or just inferior to hyoid,
 Forms a swelling in anterior part of neck
Aberrant Thyroid Gland
 Found anywhere along path of
embryonic thyroglossal duct.
 Uncommon
 At root of tongue: posterior to foramen
cecum, resulting in lingual thyroid
gland in neck at or just inferior to hyoid
Accessory Thyroid Glandular Tissue
 Portions of thyroglossal
duct may persist to form
thyroid tissue.
 appear anywhere
Enlargement Of Thyroid Gland
 Non-neoplastic,non-inflammatory enlargement
GOITER, which results from a lack of iodine
 Swelling in neck--may compress trachea, esophagus
& recurrent laryngeal nerves
 Enlarge gland extend anteriorly, posteriorly, inferiorly,
or laterally NOT superiorly because of superior
attachments of overlying sternothyroid & sternohyoid
muscles
 Substernal extension of goiter is also common
Parotid gland infection
 Acutely inflamed: retrograde bacterial
infection from mouth via parotid duct
 Gland may be infected via bloodstream i.e
Mumps
 Gland swollen, painful because fascial capsule
derived from investing layer of deep cervical
fascia is strong & limits swelling of gland
 Swollen glenoid process which extends
medially behind TMJ is responsible for pain
experienced in acute parotitis when eating
Frey’s Syndrome
 Develops after penetrating wounds of parotid gland
 When patient eats, beads of perspiration appears on
skin covering parotid caused by damage to
auriculotemporal & great auricular nerves
 During process of healing, parasympathetic
secretomotor fibers in auriculotemporal nerve grow out
& join distal end of great auricular nerve
 Eventually these fibers reach sweat glands in facial skin
 By thus means a stimulus intended for saliva production
produces sweat secretion instead
Thyroidectomy
 Benign parotid neoplasm rare, cause facial palsy
 Malignant tumor of parotid invasive & involves
facial nerve causing unilateral facial paralysis
 Excision of malignant tumor of thyroid gland,
 Necessitates removal of part or all of gland (hemi-
thyroidectomy or thyroidectomy).
 In surgical treatment of hyperthyroidism,
posterior part of each lobe of enlarged thyroid is
usually preserved, procedure called near-total
thyroidectomy, to protect recurrent & superior
laryngeal nerves & to spare parathyroid glands.
Injury to Recurrent Laryngeal Nerves
 Ever present during neck surgery
 Near inferior pole of thyroid gland, the right recurrent laryngeal nerve is intimately related to
inferior thyroid artery & its branches
 ligated some distance lateral to thyroid gland, where it is not close to nerve
 Hoarseness is usual sign of unilateral recurrent nerve injury; temporary aphonia or
disturbance of phonation (voice production) & laryngeal spasm may occur.
 Signs result from bruising the recurrent laryngeal nerves during surgery or from pressure of
accumulated blood & serous exudate after operation.
 To avoid injury to external branch of the superior laryngeal nerve superior thyroid artery is
ligated & sectioned more superior to gland, its not as closely related to nerve
 Voice monotonous
Parotid Duct Injury
 Superficial structure: Can be damaged in injuries to
face of during surgical operations on face
 Duct 2inches (5cm) long & passes forward across
masseter about fingerbeneath below zygomatic arch.
 It pierces buccinators muscle to enter mouth opposite
upper second molar tooth
Thank You

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Thyroid Gland- Gross Anatomy by Dr. Rabia Inam Gandapore.pptx

  • 1. Thyroid Gland Dr. Rabia Inam Gandapore Assistant Professor Head of Department Anatomy (Dentistry-BKCD) B.D.S (SBDC), M.Phil. Anatomy (KMU), Dip. Implant (Sharjah, Bangkok, ACHERS) , CHPE (KMU),CHR (KMU), Dip. Arts (Florence, Italy)
  • 2. Teaching Methodology  LGF (Long Group Format)  SGF (Short Group Format)  LGD (Long Group Discussion, Interactive discussion with the use of models or diagrams)  SGD (Short Group)  SDL (Self-Directed Learning)  DSL (Directed-Self Learning)  PBL (Problem- Based Learning)  Online Teaching Method  Role Play  Demonstrations  Laboratory  Museum  Library (Computed Assisted Learning or E-Learning)  Assignments  Video tutorial method
  • 3. Goal/Aim (main objective) To help/facilitate/augment the students about the:  Describe location & extent of thyroid gland.  Briefly explain capsules of thyroid.  Explain parts & relations of thyroid gland.  Describe blood, nerve & lymphatic supply of thyroid gland.
  • 4. Specific Learning Objectives (cognitive) At the end of the lecture the student will able to:  Describe location & extent of thyroid gland.  Briefly explain capsules of thyroid.  Explain parts & relations of thyroid gland.  Describe blood, nerve & lymphatic supply of thyroid gland.
  • 5. Psychomotor Objective: (Guided response)  A student to draw labelled diagram of the Thyroid Gland
  • 6. Affective domain  To be able to display a good code of conduct and moral values in the class.  To cooperate with the teacher and in groups with the colleagues.  To demonstrate a responsible behavior in the class and be punctual, regular, attentive and on time in the class.  To be able to perform well in the class under the guidance and supervision of the teacher.  Study the topic before entering the class.  Discuss among colleagues the topic under discussion in SGDs.  Participate in group activities and museum classes and follow the rules.  Volunteer to participate in psychomotor activities.  Listen to the teacher's instructions carefully and follow the guidelines.  Ask questions in the class by raising hand and avoid creating a disturbance.  To be able to submit all assignments on time and get your sketch logbooks checked.
  • 7. Lesson contents Clinical chair side question: Students will be asked if they know what is the function of Thyroid Gland Outline:  Activity 1 The facilitator will explain the student's Thyroid Gland  Activity 2 The facilitator will ask the students to make a labeled diagram of the Thyroid Gland  Activity 3 The facilitator will ask the students a few Multiple Choice Questions related to it with flashcards.
  • 8. Recommendations  Students assessment: MCQs, Flashcards, Diagrams labeling.  Learning resources: Langman’s T.W. Sadler, Laiq Hussain Siddiqui, Snell Clinical Anatomy, Netter’s Atlas, BD Chaurasia’s Human anatomy, Internet sources links.
  • 9. Thyroid Gland  Named after the thyroid cartilage  (Greek: Shield shaped)  Largest endocrine gland  Serous acini  Situated: -Below: external auditory meatus -Deep & behind: ramus of mandible -Infront of: Sternocledomastoid muscle.  Salivary Glands: Paired Parotid gland , Sub- mandibular, Sub-lingual glands & numerous small glands scattered in oral cavity.
  • 10. Developmental Embryology  1st endocrine gland to develop  Endodermal thickening primitive pharynx --- thyroid primordium---descend in neck---ventral to hyoid, laryngeal cartilage---connection by thyroglossal duct  1st hollow than solid---divide into 2— connected by isthmus  At 7 week has definitive shape---reach final site  Foramen cecum---persistance proximal opening of thyroglossal duct
  • 11.
  • 12.
  • 13. Structure Of Thyroid Gland  Extensions of capsule within the substance of gland form numerous setae, which divide it into lobes & lobules  Each Lobule contains 40 to 60 thyroid follicles & stroma in which blood vessels & lymphatic ramify.  Thyroid Follicle structural units of gland --filled--colloid thyroglobulin as storage. Follicle is surrounded by a single layer of epithelial cells.
  • 14. Histology  Epithelial cells are of 2 types: 1. Principal cells (i.e.,follicular): formation of colloid 2. Parafollicular cells (i.e. C-clear, light cells): hormone calcitonin depending on the state of activity, the cells are flattened with colloid abundant (resting state) or cuboidal (secretory state) with colloid diminished
  • 15.
  • 16. Site /Location/Topography  Is anterior in neck below & lateral to thyroid cartilage  Deep to: sternothyroid & sternohyoid muscles  Present in visceral compartment of neck surrounded by pretracheal fascia  Extending from level of C5-T1  Isthmus: overlying the second to fourth tracheal rings
  • 17.
  • 18. Shape, Weight & Size  Shape: wedge shape (H or U)  25-30g  Lobe: 50-60 mm long  Isthmus: average height of 12-15 mm  Normal gland has Consistency of muscle tissue
  • 19.
  • 20. Parotid Duct  Parotid Duct: passes forward over lateral surface of masseter muscle (One finger below zygomatic arch).  At anterior border of muscle, it turns sharply medially & pierce buccal pad of fat & buccinator muscle.  It then passes forward for a short distance between muscle & mucous membrane and finally opens into vestibule of mouth on small papilla, opposite upper second molar tooth.  The oblique passage of duct forward between the mucous membrane & buccinators serve as a valve-like mechanism & prevents inflation of duct system during violent blowing (e.g. as in glass blowing or trumpet playing)  Accessory part of gland: drained by small duct that opens into upper border of parotid duct.
  • 21.
  • 22.
  • 23. Coverings (Capsule)  Lobulated mass surrounded by connective tissue capsule & dense fibrous capsule A. True Capsule: Surrounded by a inner true thin, fibrous capsule of connective tissue which adheres closely to gland Extensions of this capsule within the substance of gland form numerous septae, which divide it into lobes & lobules B. False Capsule: External to this is a “false capsule” formed by pretracheal fascia of cervical fascia
  • 24.
  • 25. Attachment  Above: Pretracheal fascia is attached to hyoid bone & thyroid cartilage on each side  Below: it enters thoracic cavity & blends with fibrous pericardium of heart  Pretracheal fascia is thickened to form the ligament of Berry which connects each lobe of thyroid with cricoids cartilage (of larynx). These attachments of thyroid gland make it move up & down with swallowing.
  • 26.
  • 27. Parts  Facial nerve & its branches pass forward within parotid gland divides it into: 1. Superficial Part 2. Deep Part or Lobes A. Two lateral lobes RT & LT (Pyramidal) B. Two Superior & Inferior poles C. Connected by narrow Isthmus -(ant surface of 2 & 3 tracheal cartilage) -average height of 12-15 mm D. In some people a third “pyramidal lobe” exists, ascending from isthmus towards hyoid bone
  • 28.
  • 29. Lateral Lobes APEX (behind angle of Mandible)  Upward, sandwiched between inferior constrictor (of pharynx) & sternothyroid muscles.  Superior thyroid artery & external laryngeal nerve closely related  Artery lies superficial  Nerve passes deep to apex so ligated away from thyroid gland during surgery. BASE (above)  Extends up to 5, 6 Tracheal ring  Related to inferior thyroid artery & recurrent laryngeal nerve.  RLN either anteriorly or posteriorly to ITA,artery is ligated away laterally to gland to avoid injury to RLN SUPERFICIAL SURFACE is overlapped by neck muscles DEEP SURFACE related with larynx, trachea, pharynx, oesophagus & parathyroid glands.
  • 30.
  • 31.
  • 32.
  • 33. Processes of Gland  Superior Margin of Gland: extends upward behind TMJ into posterior part of mandibular fossa called Glenoid Process  Anterior Margin of Gland: extends forward superficial to masseter muscle to for Facial Process. Small part of facial process maybe separate from the main gland called Accessory Par of gland.  Deep part of Gland: extend forward between medial pterygoid muscle & ramus of mandible to form Pterygoid Process
  • 34.
  • 35. Structures within Parotid Gland  From Lateral to Medial are: 1. Facial nerve: Emerges from stylomastoid foramen & enters gland. It passes forward superficial to retromandibular vein & external carotid artery & divided into 5 terminal branches. The branches of nerve leave gland on its antero-medial surface. 2. Retromandibular vein: formed within parotid gland by union of superficial temporal & maxillary vein. Divides into anterior & posterior divisions, which leave lower border of gland . Anterior division join facial vein & posterior division unites with posterior auricular vein to form external jugular vein 3. External Carotid Artery: having left carotid triangle by passing deep to posterior belly of diagastric ascends & enters the substance of parotid gland. At the level of the neck of mandible, it divides into superficial temporal artery & maxillary artery 4. Lymph nodes
  • 36. Relations of Parotid Gland (Parotid Bed) 3. Postero-medial Relations:  Mastoid Process  Sternocleidomastoid muscle  Posterior belly of digastric muscle  Styloid process & its attached muscles  Carotid sheath (Internal carotid artery, Vagus, Internal Jugular vein, glossopharyngeal, accessory, hypoglossal & facial nerves) 4. Antero-medial Relations:  Posterior border of ramus of mandible  Masseter  Medial Pterygoid muscle  TMJ 1. Superficial Relations:  Skin  Fascia  Parotid lymph nodes  Great auricular nerve 2. Superior Relations:  External auditory meatus  Posterior surface TMJ  At union of Antero & Postero- Medial gland lies in contact with pharyngeal wall
  • 37.
  • 38.
  • 39. Arterial Supply  Highly vascular ( External carotid artery & terminal branches) a. Superior Thyroid Arteries b. Inferior Thyroid Arteries c. Occasionally Thyroidea Ima, branch of arch of aorta or bracheocephalic trunk d. Accessory thyroid arteries, from oesophageal & tracheal branche  These arteries lie between the true capsule & pretracheal layer of deep cervical fascia
  • 40. a. Superior Thyroid Artery  First anterior branch of external carotid artery  Descend to superior pole divides into anterior & posterior branches after piercing pretracheal fascia. a. Anterior branch: supplies anterior surface both sides anastomose across midline b. Posterior branch: supplies posterior surface anastomose with inferior thyroid artery.  High ligation of superior thyroid artery during thyroidectomy places this nerve at risk of inadvertent injury, which would produce dysphonia by altering pitch regulation
  • 41. b. Inferior Thyroid Artery  Inferior thyroid--thyrocervical--subclavian artery  Ascends vertically curves medially to enter the tracheoesophageal groove in a plane posterior to carotid sheath---penetrate posterior aspect of lateral lobe  Closely associated with recurrent laryngeal nerve
  • 42.
  • 43.
  • 44.
  • 45. Venous Drainage  Drains into retromandibular vein  Veins do not accompany the arteries  Arise from venous plexus which is present deep to true capsule & are drained by 3 pairs of veins: 1. Superior thyroid veins: drain superior pole of gland 2. Middle thyroid veins: drain middle of lobe 3. Inferior thyroid veins: drain inferior pole of gland
  • 46. Venous Drainage  3 pairs of veins 1. Superior thyroid vein: (superior thyroid artery)--internal jugular vein 2. Middle thyroid vein: directly--internal jugular vein 3. Inferior thyroid vein---- brachiocephalic vein  occationally inferior veins form a common trunk called thyroid ima vein, which empties into left brachiocephalic vein
  • 47.
  • 48.
  • 49. Lymphatic Drainage  Drains into Parotid & Deep cervical lymph nodes  Extensive & flows multidirectionally : Accompanying arteries & form a capsular network of lymphatic vessels.  Lymphatic vessels: Periglandular nodes--- to prelaryngeal (Delphian)--- pretracheal----paratracheal nodes along recurrent laryngeal nerve---to mediastinal--- deep cervical LN--- brachiocephalic lymph nodes or thoracic duct  Regional metastases of thyroid carcinoma--- laterally, higher in neck along internal jugular vein , tumor invasion of pretracheal & paratracheal nodes causing an obstruction of normal lymph flow.
  • 50.
  • 51. Innervation A. Vasomotor: from ANS. Vasomotor & cause constriction of blood vessels  Parasympathetic fibers: come from vagus nerves. B. Secretomotor 1. Parasympathetic fibers: Parasympathetic secretomotor fibers from inferior salivary nucleus of glossopharyngeal nerve supply parotid gland  Pre-ganglionic parasympathetic Nerve fiber pass to otic ganglion via tympanic branch of glossopharyngeal nerve & lesser petrosal nerve.  Post-ganglionic parasympathetic fibers reach parotid gland via auriculotemporal nerve which lies incontact with deep surface of gland 2. Sympathetic fibers: are distributed from superior, middle, & inferior ganglia of sympathetic trunk  Post ganglionic sympathetic fibers reach gland as plexus of nerves around external carotid artery
  • 52.
  • 53.
  • 54. Endocrine Function  Regulated by pituitary gland ,TSH.  Thyroid hormone, controls rate of metabolism & calcitonin , controlling calcium metabolism.  Thyroid gland affects all areas of body except itself, spleen, testes, & uterus
  • 56. Clinical Corelation Thyroid Ima Artery  Potential source of bleeding “Tracheostomy,” Thyroglossal Duct Cyst  Normally disappears-- remnants of epithelium may remain -- form a thyroglossal duct cyst at any point along path of its descent  Usually in neck, close or just inferior to hyoid,  Forms a swelling in anterior part of neck
  • 57.
  • 58. Aberrant Thyroid Gland  Found anywhere along path of embryonic thyroglossal duct.  Uncommon  At root of tongue: posterior to foramen cecum, resulting in lingual thyroid gland in neck at or just inferior to hyoid
  • 59. Accessory Thyroid Glandular Tissue  Portions of thyroglossal duct may persist to form thyroid tissue.  appear anywhere
  • 60. Enlargement Of Thyroid Gland  Non-neoplastic,non-inflammatory enlargement GOITER, which results from a lack of iodine  Swelling in neck--may compress trachea, esophagus & recurrent laryngeal nerves  Enlarge gland extend anteriorly, posteriorly, inferiorly, or laterally NOT superiorly because of superior attachments of overlying sternothyroid & sternohyoid muscles  Substernal extension of goiter is also common
  • 61. Parotid gland infection  Acutely inflamed: retrograde bacterial infection from mouth via parotid duct  Gland may be infected via bloodstream i.e Mumps  Gland swollen, painful because fascial capsule derived from investing layer of deep cervical fascia is strong & limits swelling of gland  Swollen glenoid process which extends medially behind TMJ is responsible for pain experienced in acute parotitis when eating
  • 62. Frey’s Syndrome  Develops after penetrating wounds of parotid gland  When patient eats, beads of perspiration appears on skin covering parotid caused by damage to auriculotemporal & great auricular nerves  During process of healing, parasympathetic secretomotor fibers in auriculotemporal nerve grow out & join distal end of great auricular nerve  Eventually these fibers reach sweat glands in facial skin  By thus means a stimulus intended for saliva production produces sweat secretion instead
  • 63. Thyroidectomy  Benign parotid neoplasm rare, cause facial palsy  Malignant tumor of parotid invasive & involves facial nerve causing unilateral facial paralysis  Excision of malignant tumor of thyroid gland,  Necessitates removal of part or all of gland (hemi- thyroidectomy or thyroidectomy).  In surgical treatment of hyperthyroidism, posterior part of each lobe of enlarged thyroid is usually preserved, procedure called near-total thyroidectomy, to protect recurrent & superior laryngeal nerves & to spare parathyroid glands.
  • 64. Injury to Recurrent Laryngeal Nerves  Ever present during neck surgery  Near inferior pole of thyroid gland, the right recurrent laryngeal nerve is intimately related to inferior thyroid artery & its branches  ligated some distance lateral to thyroid gland, where it is not close to nerve  Hoarseness is usual sign of unilateral recurrent nerve injury; temporary aphonia or disturbance of phonation (voice production) & laryngeal spasm may occur.  Signs result from bruising the recurrent laryngeal nerves during surgery or from pressure of accumulated blood & serous exudate after operation.  To avoid injury to external branch of the superior laryngeal nerve superior thyroid artery is ligated & sectioned more superior to gland, its not as closely related to nerve  Voice monotonous
  • 65.
  • 66.
  • 67. Parotid Duct Injury  Superficial structure: Can be damaged in injuries to face of during surgical operations on face  Duct 2inches (5cm) long & passes forward across masseter about fingerbeneath below zygomatic arch.  It pierces buccinators muscle to enter mouth opposite upper second molar tooth