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Parotid Gland

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Parotid Gland PAROTID GLAND Dr. P. Ravisankar, Ph.D Professor of Anatomy SRMDC & Hospital SRMIST- Ramapuram Chennai-600089, Tamil Nadu, India. THE SALIVARY GLANDS INTRODUCTION ➢ Discharge the secretion into oral cavity. ➢ Major salivary glands-has extra glandular duct eg. Parotid, Submandibular & Sublingual. ➢ Minor salivary glands – Lie in the sub-mucosa of mouth open directly or indirectly Eg- Anterior lingual, Von ebner, Small labial, Buccal and palatal gland FUNCTIONS OF SALIVARY GLANDS ➢ Lubrication of food-Assisting swallowing. ➢ Moistening of the buccal mucosa – essential for speech. ➢ Provision of an aqueous solvent – necessary for taste. ➢ Provision of fluid – necessary of suckling. ➢ Secretion of digestive enzymes and hormones and other active components. CONTENTS ➢ PAROTID REGION & BED ➢ INTRODUCTION ➢ CAPSULE ➢ EXTERNAL FEATURES ➢ RELATIONS – STRUCTURES WITHIN THE GLAND ➢ STRUCTUER OF THE GLAND ➢ PAROTID DUCT ➢ BLOOD SUPPLY ➢ VENOUS DRAINAGE ➢ LYMPHATIC DRAINAGE ➢ NERVE SUPPLY ➢ DEVELOPMENT ➢ APPLIED ANATOMY ➢ REFERENCES PAROTID REGION Anteriorly – Anterior border of masseter Superiorly – Zygomatic arch Posteriorly –Mastoid process Inferiorly – line bet. Angle of mandible and mastoid process PAROTID BED PAROTID GLAND INTRODUCTION ➢ Largest of the three major salivary glands. ➢ Occupies the retromandibular space- between the ramus of the mandible in front and the mastoid process and the sternocleido-mastoid muscle behind. ➢ Type of serous salivary gland. ➢ Varies in weight from 14 to 28 gm. ➢ It lies upon the side of the face, immediately below and in front of the external ear. ➢ The main portion of the gland is superficial, somewhat flattened and quadrilateral in form. ➢ The remainder of the gland is irregularly wedge- shaped, and extends deeply inward toward the pharyngeal wall CAPSULE ➢ The gland is enclosed within a capsule continuous with the deep cervical fascia ➢ The layer covering the superficial surface is dense and closely adherent to the gland ➢ Deep portion of the fascia, is thickened to form the stylomandibular ligament which intervenes between the parotid and submaxillary glands THE PAROTID GLAND EXTERNAL FEATURES Three sided pyramid Apex – directed downward SURFACES Base or superior surface Superficial Anteromedial Posteromedial BORDERS Posterior, anterior & medial PROCESSES Facial process Post glenoid process Pterygoid process RELATIONS ➢ Apex – overlaps the post. Belly of digastric and carotid triangle ➢ Cervical branch of facial nerve and two divisions of retro-mandibular vein emerges. RELATIONS SUPERFICIAL SURFACE ➢ Slightly lobulated, ➢ Covered by the superficial fascia containing the facial branches of the great auricular nerve and some small lymph glands. ➢ The fascia which forms the capsule of the gland. ➢ Post. Fibres of platysma ➢ Few lymph nodes ANTERO-MEDIAL SURFACE ➢ The gland is moulded on the posterior border of the ramus of the mandible, ➢ Medial pterygoid and Masseter. ➢ The inner lip of the groove dips,between the two Pterygoid muscles, while the outer lip extends for some distance over the superficial surface of the Masseter; a small portion of this lip immediately below the zygomatic arch is usually detached, and is named the accessory part of the gland. POSTEROMEDIAL SURFACE ➢ Grooved longitudinally against the EAM, the mastoid process,& the anterior border Sternocleidomastoideus. ➢ Posterior belly of digastric ➢ Styloid process & its structures ➢ ECA enter and ICA lies deep to styloid process. SUPERIOR SURFACE ➢ It is concave ➢ Cartilaginous part of external acoustic meatus ➢ Posterior surface of the temporomandibular joint ➢ Superficial temporal vessels and auriculotemporal nerve. BORDERS ANTERIOR BORDER ➢ Parotid duct ➢ Transverse facial vessels ➢ Most of the terminal branches of facial nerve ➢ Accessory parotid gland POSTERIOR BORDER ➢ Overlop the sternocleiodmastoid ➢ Medial border – lateral wall of pharynx STRUCTURES WITHIN THE GLAND FROM DEEP TO SUPERFICIAL ➢ ECA lies at first on the deep surface, and then in the substance of the gland. ➢ It gives its posterior auricular branch from the gland behind- divides into its terminal branches, maxillary and superficial temporal ➢ Maxillary artery runs forward deep to the neck of the mandible ➢ Superficial temporal artery- upward across the zygomatic arch and gives off its transverse facial artery. RETROMANDIBULAR VEIN ➢ Superficial temporal and Maxillary veins- posterior facial vein - this vein splits into anterior and posterior divisions. ➢ The AD unite with the anterior facial to form the common facial vein ➢ The PD unites in the gland with the posterior auricular to form the EJV. PATEY’S FACIOVENOUS PLANE FACIAL NERVE ➢ The facial nerve enters to the gland through upper part of posteromedial surface and divides into its terminal branches within the gland. ➢ Branches leave the gland through antero-medial surface and then anterior border. ➢ Branches of the great auricular nerve pierce the gland to join the facial. STRCTURE OF PAROTID GLAND ➢ Has capsule ➢ Compound tubulo-alveolar gland ➢ The glandular tissue made up of mainly serous acini less mucous acini ➢ Connective tissue containing adipose tissue, blood vessels and inter lobular and intralobular ducts are seen THE PAROTID DUCT ➢ Also known as “STENSON’S DUCT” ➢ About 5 cm in length ➢ Runs forwards, downwards and peirces the following structures Buccal pad of fat Buccopharyngeal fascia Buccinator Oral mucosa – vestibule of mouth opposite the crown of the upper second molar tooth. STRUCTURE OF PAROTID DUCT ➢ It is dense, wall being of considerable thickness ➢ Its canal is about the size of crow-quill, but at its orifice on the oral surface of the cheek its lumen is greatly reduced in size. ➢ It consists of a thick external fibrous coat which contains contractile fibers and ➢ An internal or mucous coat lined with short columnar epithelium. BLOOD SUPPLY ECA- branches given off by that vessel in or near its substance VENOUS DRAINAGE The veins empty themselves into the EJV, through some of its tributaries. LYMPHATIC DRAINAGE The lymphatics -superficial and deep cervical lymph nodes, passing in their course through two or three nodes, placed on the surface and in the substance of the parotid Upper deep cervical lymph nodes NERVE SUPPLY The nerves are derived from the plexus of the sympathetic on the ECA, the facial, the auriculotemporal, and the great auricular nerves. Parasympathetic nerve – secretomotor Inferior salivary nucleus 9th cranial nerve (tympanic branch) Tympanic plexus Lessor petrousal nereve Otic ganglion Auriculotemporal nerve Parotid gland NERVE SUPPLY DEVELOPMENT It arise as ectodermal diverticulum from the lining epithelium of the mouth First it appear as an elongate furrow between the mandibular and maxillary processes Then it converted into tube and loses its connection with the epithelium of mouth The ventral end grows dorsally into the substance of the cheek. APPLIED ANATOMY 1. External fistulae of parotid duct Obstruction of duct due strictures or tumors Due to injury OR sialolith (calculus) Can be observed by x-ray- sialography During the surgery the facial nerve, retromandibular vein & external carotid artery should be borne in mind. 2. FREY’S SYNDROME OR AURICULO- TEMPORAL SYNDROME After the surgery of parotid or Parotidectomy the skin of temple appear as redness and sweating due to injury to auriculo-temporal nerve. 3.PAROTID ABSCESS Due to spread of infection from mouth cavity because of defective oral hygiene. It may press on the facial nerve – cause paralysis. 4. PAROTID SWELLINGS Very painful due to the unyielding nature of parotid fascia. 5. Mumps Infectious disease of parotid gland caused by specific virus 6. Mixed parotid tumors In initial stage it is painless later it may be as malignant inducing pain and cause hardness of the gland leads enlargement of lymph nodes and involvement of facial nerve REFERENCES 1. TEXT BOOK OF ANATOMY 3rd VOLUME 3RD ED. VISHRAM SINGH 2. GRAY’S ANATOMY 40TH ED. – SUSAN & SANDRING 3. BD CHAURASIA’S HUMAN ANATOMY 3RD VOLUME ,8TH ED- KRISHNA GARG 4. CLINICALLY ORIENTED ANATOMY 3RD ED. KEITH L.MORE THANK YOU.
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