DOCSLIB.ORG

Surgical Anatomy, Embryology, and Physiology of the Salivary Glands John D

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Surgical Anatomy, Embryology, and Physiology of the Salivary Glands John D k Chapter 1 Surgical Anatomy, Embryology, and Physiology of the Salivary Glands John D. Langdon, FKC, MB BS, BDS, MDS, FDSRCS, FRCS, FMedSci King’s College, London, UK Outline Summary References Introduction The Parotid Gland Embryology Introduction Anatomy Contents of the Parotid Gland There are three pairs of major salivary glands The Facial Nerve consisting of the parotid, submandibular, and Auriculotemporal Nerve sublingual glands. In addition, there are numerous Retromandibular Vein minor glands distributed throughout the oral cavity External Carotid Artery within the mucosa and submucosa. Parotid Lymph Nodes k On average, about 0.5 liters of saliva are pro- k Parotid Duct duced each day but the rate varies throughout the Nerve Supply to the Parotid day. At rest, about 0.3 ml/min are produced but this The Submandibular Gland rises to 2.0 ml/min with stimulation. The contribu- Embryology Anatomy tion from each gland also varies. At rest, the parotid The Superficial Lobe produces 20%, the submandibular gland 65%, and The Deep Lobe the sublingual and minor glands 15%. On stimula- The Submandibular Duct tion, the parotid secretion rises to 50%. The nature Blood Supply and Lymphatic Drainage of the secretion also varies from gland to gland. Nerve Supply to the Submandibular Gland Parotid secretions are almost exclusively serous, the Parasympathetic Innervation submandibular secretions are mixed and the sublin- Sympathetic Innervation gual and minor gland secretions are predominantly Sensory Innervation mucinous. The Sublingual Gland Saliva is essential for mucosal lubrication, Embryology speech, and swallowing. It also performs an essen- Anatomy tial buffering role that influences demineralization Sublingual Ducts of teeth as part of the carious process. When Blood Supply, Innervation, and Lymphatic Drainage there is a marked deficiency in saliva produc- Minor Salivary Glands tion, xerostomia, rampant caries, and destructive Histology of the Salivary Glands periodontal disease ensues. Various digestive Control of Salivation enzymes – salivary amylase – and antimicrobial Salivary Gland Pathology: Diagnosis and Management, Second Edition. Edited by Eric R. Carlson and Robert A. Ord. © 2016 John Wiley & Sons, Inc. Published 2016 by John Wiley & Sons, Inc. 1 k k 2 Chapter 1 agents – IgA, lysozyme, and lactoferrin – are also exocrine gland. In the adult, the gland is composed secreted with the saliva. entirely of serous acini. The gland is situated in the space between the posterior border of the mandibular ramus and the The Parotid Gland mastoid process of the temporal bone. The exter- nal acoustic meatus and the glenoid fossa lie above EMBRYOLOGY together with the zygomatic process of the tempo- ral bone (Figure 1.1). On its deep (medial) aspect The parotid gland develops as a thickening of the lies the styloid process of the temporal bone. Infe- epithelium in the cheek of the oral cavity in the riorly, the parotid frequently overlaps the angle of 15 mm Crown Rump length embryo. This thicken- the mandible and its deep surface overlies the trans- ing extends backwards towards the ear in a plane verse process of the atlas vertebra. superficial to the developing facial nerve. The deep The shape of the parotid gland is variable. aspect of the developing parotid gland produces Often it is triangular with the apex directed inferi- bud like projections between the branches of the orly. However, on occasion it is more or less of even facial nerve in the third month of intra-uterine life. width and occasionally it is triangular with the These projections then merge to form the deep apex superiorly. On average, the gland is 6 cm in lobe of the parotid gland. By the sixth month of length with a maximum of 3.3 cm in width. In 20% intra-uterine life the gland is completely canalized. of subjects a smaller accessory lobe arises from Although not embryologically a bilobed structure, the upper border of the parotid duct approximately the parotid comes to form a larger (80%) superfi- 6 mm in front of the main gland. This accessory cial lobe and a smaller (20%) deep lobe joined by lobe overlies the zygomatic arch. an isthmus between the two major divisions of the The gland is surrounded by a fibrous capsule facial nerve. The branches of the nerve lie between previously thought to be formed from the investing layer of deep cervical fascia. This fascia passes these lobes invested in loose connective tissue. k up from the neck and was thought to split to k This observation is vital in the understanding of enclose the gland. The deep layer is attached to the the anatomy of the facial nerve and surgery in this mandible and the temporal bone at the tympanic region (Berkovitz, et al. 2003). plate and styloid and mastoid processes (McMinn, et al. 1984; Berkovitz and Moxham 1988; Williams ANATOMY 1995; Ellis 1997). Recent investigations suggest that the superficial layer of the parotid capsule is Theparotidisthelargestofthemajorsalivary not formed in this way, but is part of the superficial glands. It is a compound, tubuloacinar, merocrine, musculo-aponeurotic system (SMAS) (Mitz and Figure 1.1. A lateral view of the skull showing some of the bony features related to the bed of the parotid gland. 1: Mandibular fossa; 1 2 2: Articular eminence; 3: Tympanic 9 4 plate; 4: Mandibular condyle; 5: Styloid process; 6: Ramus of 3 8 mandible; 7: Angle of mandible; 6 5 8: Mastoid process; 9: External acoustic meatus. Source: Surgical Management of the Infratemporal 7 Fossa. (J. Langdon, B. Berkovitz & B. Moxham). ISBN 9781899066797. Reproduced with permission of Taylor & Francis Books UK. k k Surgical Anatomy, Embryology, and Physiology of the Salivary Glands 3 Peyronie 1976; Jost and Levet 1983; Wassef 1987; and the parotid duct lie within a loose cellular Thaller, et al. 1989; Zigiotti, et al. 1991; Gosain, layer between these two sheets of fascia. This et al. 1993; Flatau and Mills 1995). Anteriorly, observation is important in parotid surgery. When the superficial layer of the parotid capsule is thick operating on the parotid gland, the skin flap can and fibrous but more posteriorly, it becomes a either be raised in the subcutaneous fat layer or thin translucent membrane. Within this fascia are deep to the SMAS layer. The SMAS layer itself can scant muscle fibers running parallel with those of be mobilized as a separate flap and can be used to the platysma. This superficial layer of the parotid mask the cosmetic defect following parotidectomy capsule appears to be continuous with the fascia by reattaching it firmly to the anterior border of the overlying the platysma muscle. Anteriorly, it forms sternocleidomastoid muscle as an advancement a separate layer overlying the masseteric fascia, flap (Meningaud, et al. 2006). which is itself an extension of the deep cervical The superior border of the parotid gland fascia. The peripheral branches of the facial nerve (usually the base of the triangle) is closely molded 1 k k 2 2 3 Figure 1.2. The parotid gland and 4 associated structures. 1: Auriculotem- poralnerve;2:Superficialtemporal 8 vessels; 3: Temporal branch of facial nerve; 4: Zygomatic branch of facial 9 nerve; 5: Buccal branch of facial nerve; 5 6: Mandibular branch of facial nerve; 10 7: Cervical branch of facial nerve; 8: Parotid duct; 9: Parotid gland; 10: Mas- 6 seter muscle; 11: Facial vessels; 12: 11 Platysma muscle; 13: External jugular 11 vein; 14: Sternocleidomastoid muscle; 15 15: Great auricular nerve. Source: Sur- 14 gical Management of the Infratempo- 7 12 13 ral Fossa. (J. Langdon, B. Berkovitz & B. Moxham). ISBN 9781899066797. Reproduced with permission of Taylor & Francis Books UK. k k 4 Chapter 1 around the external acoustic meatus and the tem- poromandibular joint. An avascular plane exists Lateral pterygoid muscle between the gland capsule and the cartilaginous Medial pterygoid and bony acoustic meatus (Figure 1.2). The infe- muscle Superior pharyngeal rior border (usually the apex) is at the angle of constrictor muscle the mandible and often extends beyond this to overlap the digastric triangle where it may lie very close to the posterior pole of the submandibular Stylopharyngeus muscle salivary gland. The anterior border just overlaps the posterior border of the masseter muscle and Styloid process the posterior border overlaps the anterior border Middle pharyngeal Stylomandibular constrictor muscle of the sternocleidomastoid muscle. ligament The superficial surface of the gland is cov- Mandibulo-stylohyoid ered by skin and platysma muscle. Some terminal ligament Inferior pharyngeal constrictor muscle branches of the great auricular nerve also lie super- Masseter muscle Posterior border ficial to the gland. At the superior border of the of ramus parotid lie the superficial temporal vessels with the Facial vein and artery artery in front of the vein. The auriculotemporal Submandibular gland branch of the mandibular nerve runs at a deeper level just behind the superficial temporal vessels. The branches of the facial nerve emerge from the anterior border of the gland. The parotid duct also emerges to run horizontally across the Figure 1.3. The mandibulostylohyoid ligament and masseter muscle before piercing the buccinator surrounding anatomy. muscle anteriorly to end at the parotid papilla. The k transverse facial artery (a branch of the superficial k temporal artery) runs across the area parallel to the mandible. The mandibulostylohyoid ligament and approximately 1 cm above the parotid duct. (the angular tract) passes between the angle of the The anterior and posterior branches of the facial mandible and the stylohyoid ligament. Inferiorly, vein emerge from the inferior border. it usually extends down to the hyoid bone. These The deep (medial) surface of the parotid ligaments are all that separates the parotid gland gland lies on those structures forming the parotid anteriorly from the posterior pole of the superficial bed. Anteriorly, the gland lies over the masseter lobe of the submandibular gland.
Load more

Recommended publications
  • 03Murrsalivaryglandandductan
    11/6/2014 Andrew H. Murr, MD Professor and Chairman Roger Boles, MD Endowed Chair in Otolaryngology Education Department of Otolaryngology- Head and Neck Surgery Salivary Gland and Duct Anatomy UCSF Sialendoscopy/Salivary Duct Surgery Course November 6, 2014 University of California, San Francisco Salivary Gland and Duct Anatomy Function of Salivary Glands • Parotid Gland and Stensen’s Duct • Food digestion • Submandibular Gland and Wharton’s Duct – Lubrication • Sublingual Gland and Duct System – Clearance • Minor Salivary Glands • Tooth protection • Taste • Antimicrobial function 1 11/6/2014 Embryology Duct Ultrastructure Parotid Gland • Ectoderm origin – Surrounded by mesenchyme • 6-8 weeks of life • Originate at duct orifice – Parotid develops around and between facial nerve • Salivary tissue becomes encapsulated –*Parotid encapsulates last: only in parotid- lymphatic system is contained within parotid tissue prior to encapsulation Parotid Gland Parotid Gland • Largest and 1 st to • Tail develop • Accessory parotid • Serous acinar cells – 20% – Purely serous – seromucinous • Parotid fascia • Borders – Lateral Skin – Medial Parapharyngeal space – Superior Zygomatic arch – Posterior EAC – Inferior Styloid/carotid/jugular – Anterior Masseter 2 11/6/2014 Parotid Gland Parotid Gland Hollinshead • Arterial supply • Nerve Supply – External carotid – Parasympathetic • Maxillary • IX- preganglionic • Superficial temporal – LSP (ovale) to otic • Transverse facial ganglion • Postganglionic • Venous drainage – Auriculotemporal – Retromandibular – Sympathetic • Maxillary • Superior cervical ganglion • Superficial temporal – Via external carotid – External jugular plexus – Internal jugular Surgical Nerves Facial Nerve Hollinshead • Facial nerve • Greater Auricular 3 11/6/2014 LSD: Stenosis LSD Classification Marchal, F et al., Salivary stones and stenosis, A comprehensive classification. Rev Stomatol Chir Maxillofac 2008; 109: 233-236 Marchal, F et al., Salivary stones and stenosis, A comprehensive classification.
    [Show full text]
  • The Region of the Parotid Gland
    Thomas Jefferson University Jefferson Digital Commons Regional anatomy McClellan, George 1896 Vol. 1 Jefferson Medical Books and Notebooks November 2009 The Region of the Parotid Gland Follow this and additional works at: https://jdc.jefferson.edu/regional_anatomy Part of the History of Science, Technology, and Medicine Commons Let us know how access to this document benefits ouy Recommended Citation "The Region of the Parotid Gland" (2009). Regional anatomy McClellan, George 1896 Vol. 1. Paper 7. https://jdc.jefferson.edu/regional_anatomy/7 This Article is brought to you for free and open access by the Jefferson Digital Commons. The Jefferson Digital Commons is a service of Thomas Jefferson University's Center for Teaching and Learning (CTL). The Commons is a showcase for Jefferson books and journals, peer-reviewed scholarly publications, unique historical collections from the University archives, and teaching tools. The Jefferson Digital Commons allows researchers and interested readers anywhere in the world to learn about and keep up to date with Jefferson scholarship. This article has been accepted for inclusion in Regional anatomy McClellan, George 1896 Vol. 1 by an authorized administrator of the Jefferson Digital Commons. For more information, please contact: [email protected]. 130 THE REGION OF THE PAROTID GLAND. nerves. The motor infra-orbital nerves are comparatively of larger size, and consist of superficial and deep branches which pass forward over the masseter muscle to be distributed to the muscles beneath the lower margin of the orbit and about the mouth. The superficia l branches supply the superficial muscles of the face and form sensory connections with the nasal and infra-trochlear nerves along the nose.
    [Show full text]
  • Computed Tomography of the Buccomasseteric Region: 1
    605 Computed Tomography of the Buccomasseteric Region: 1. Anatomy Ira F. Braun 1 The differential diagnosis to consider in a patient presenting with a buccomasseteric James C. Hoffman, Jr. 1 region mass is rather lengthy. Precise preoperative localization of the mass and a determination of its extent and, it is hoped, histology will provide a most useful guide to the head and neck surgeon operating in this anatomically complex region. Part 1 of this article describes the computed tomographic anatomy of this region, while part 2 discusses pathologic changes. The clinical value of computed tomography as an imaging method for this region is emphasized. The differential diagnosis to consider in a patient with a mass in the buccomas­ seteric region, which may either be developmental, inflammatory, or neoplastic, comprises a rather lengthy list. The anatomic complexity of this region, defined arbitrarily by the soft tissue and bony structures including and surrounding the masseter muscle, excluding the parotid gland, makes the accurate anatomic diagnosis of masses in this region imperative if severe functional and cosmetic defects or even death are to be avoided during treatment. An initial crucial clinical pathoanatomic distinction is to classify the mass as extra- or intraparotid. Batsakis [1] recommends that every mass localized to the cheek region be considered a parotid tumor until proven otherwise. Precise clinical localization, however, is often exceedingly difficult. Obviously, further diagnosis and subsequent therapy is greatly facilitated once this differentiation is made. Computed tomography (CT), with its superior spatial and contrast resolution, has been shown to be an effective imaging method for the evaluation of disorders of the head and neck.
    [Show full text]
  • Gross Anatomy of the Head and Neck Date: 26Th April 2020
    MATRIC NO.: 17/MHS01/302 ASSIGNMENT TITTLE: NOSE AND ORAL CAVITY COURSE TITTLE: GROSS ANATOMY OF THE HEAD AND NECK DATE: 26TH APRIL 2020 QUESTION 1 Discuss the anatomy of the tongue, and comment on its applied anatomy ANSWER TONGUE: The tongue is a mobile muscular organ covered with mucous membrane. It can assume a variety of shapes and positions. It is partly in the oral cavity and partly in the oropharynx. The tongue’s main functions are articulation (forming words during speaking) and squeezing food into the oropharynx as part of deglutition (swallowing). The tongue is also involved with mastication, taste, and oral cleansing. It has importance in the digestive system and is the primary organ of taste in the gustatory system. The human tongue is divided into two parts; an oral part at the front and a pharyngeal part at the back. The left and right sides of the tongue are separated by a fibrous tissue called the lingual septum that results in a groove, the median sulcus on the tongue’s surface. PARTS OF THE TONGUE The tongue has a root, body, and apex. The root of the tongue is the attached posterior portion, extending between the mandible, hyoid, and the nearly vertical posterior surface of the tongue. The body of the tongue is the anterior, approximately two thirds of the tongue between root and apex. The apex (tip) of the tongue is the anterior end of the body, which rests against the incisor teeth. The body and apex of the tongue are extremely mobile. A midline groove divides the anterior part of the tongue into right and left parts.
    [Show full text]
  • Atlas of the Facial Nerve and Related Structures
    Rhoton Yoshioka Atlas of the Facial Nerve Unique Atlas Opens Window and Related Structures Into Facial Nerve Anatomy… Atlas of the Facial Nerve and Related Structures and Related Nerve Facial of the Atlas “His meticulous methods of anatomical dissection and microsurgical techniques helped transform the primitive specialty of neurosurgery into the magnificent surgical discipline that it is today.”— Nobutaka Yoshioka American Association of Neurological Surgeons. Albert L. Rhoton, Jr. Nobutaka Yoshioka, MD, PhD and Albert L. Rhoton, Jr., MD have created an anatomical atlas of astounding precision. An unparalleled teaching tool, this atlas opens a unique window into the anatomical intricacies of complex facial nerves and related structures. An internationally renowned author, educator, brain anatomist, and neurosurgeon, Dr. Rhoton is regarded by colleagues as one of the fathers of modern microscopic neurosurgery. Dr. Yoshioka, an esteemed craniofacial reconstructive surgeon in Japan, mastered this precise dissection technique while undertaking a fellowship at Dr. Rhoton’s microanatomy lab, writing in the preface that within such precision images lies potential for surgical innovation. Special Features • Exquisite color photographs, prepared from carefully dissected latex injected cadavers, reveal anatomy layer by layer with remarkable detail and clarity • An added highlight, 3-D versions of these extraordinary images, are available online in the Thieme MediaCenter • Major sections include intracranial region and skull, upper facial and midfacial region, and lower facial and posterolateral neck region Organized by region, each layered dissection elucidates specific nerves and structures with pinpoint accuracy, providing the clinician with in-depth anatomical insights. Precise clinical explanations accompany each photograph. In tandem, the images and text provide an excellent foundation for understanding the nerves and structures impacted by neurosurgical-related pathologies as well as other conditions and injuries.
    [Show full text]
  • SŁOWNIK ANATOMICZNY (ANGIELSKO–Łacinsłownik Anatomiczny (Angielsko-Łacińsko-Polski)´ SKO–POLSKI)
    ANATOMY WORDS (ENGLISH–LATIN–POLISH) SŁOWNIK ANATOMICZNY (ANGIELSKO–ŁACINSłownik anatomiczny (angielsko-łacińsko-polski)´ SKO–POLSKI) English – Je˛zyk angielski Latin – Łacina Polish – Je˛zyk polski Arteries – Te˛tnice accessory obturator artery arteria obturatoria accessoria tętnica zasłonowa dodatkowa acetabular branch ramus acetabularis gałąź panewkowa anterior basal segmental artery arteria segmentalis basalis anterior pulmonis tętnica segmentowa podstawna przednia (dextri et sinistri) płuca (prawego i lewego) anterior cecal artery arteria caecalis anterior tętnica kątnicza przednia anterior cerebral artery arteria cerebri anterior tętnica przednia mózgu anterior choroidal artery arteria choroidea anterior tętnica naczyniówkowa przednia anterior ciliary arteries arteriae ciliares anteriores tętnice rzęskowe przednie anterior circumflex humeral artery arteria circumflexa humeri anterior tętnica okalająca ramię przednia anterior communicating artery arteria communicans anterior tętnica łącząca przednia anterior conjunctival artery arteria conjunctivalis anterior tętnica spojówkowa przednia anterior ethmoidal artery arteria ethmoidalis anterior tętnica sitowa przednia anterior inferior cerebellar artery arteria anterior inferior cerebelli tętnica dolna przednia móżdżku anterior interosseous artery arteria interossea anterior tętnica międzykostna przednia anterior labial branches of deep external rami labiales anteriores arteriae pudendae gałęzie wargowe przednie tętnicy sromowej pudendal artery externae profundae zewnętrznej głębokiej
    [Show full text]
  • Temporal Branch of the Facial Nerve and Its Relationship to Fascial Layers
    ORIGINAL ARTICLE Temporal Branch of the Facial Nerve and Its Relationship to Fascial Layers Seda T. Babakurban, MD; Ozcan Cakmak, MD; Simel Kendir, MD; Alaittin Elhan, PhD, MD; Vito C. Quatela, MD Objectives: To eliminate the inconsistency in the no- 3 (14.3%), and 4 (14.3%) twigs in the specimens. The menclature, to anatomically and definitively describe the temporoparietal fascia had no attachment to the zygo- topographic relationship of the temporal branch of the matic arch and continued caudally as the superficial mus- facial nerve to the fascial layers and the fat pads, and to culoaponeurotic system. Adhesions were between the tem- create an effective algorithm to define the safest ap- poroparietal fascia and the superficial layer of the deep proaches and planes for surgical procedures in this area. temporal fascia around the zygomatic arch. In most speci- mens, the superficial layer of the deep temporal fascia con- Methods: The study was performed using 18 hemifa- tinued as the parotideomasseterica fascia, and a deep layer cial cadaveric specimens. In 12 hemifacial specimens, the abutted the posterosuperior edge of the zygomatic arch. facial halves were coronally sectioned and dissected. In 6 hemifacial specimens, planar dissection was per- Conclusion: An easy and safe surgical approach in this formed layer by layer. area is to elevate the superficial layer deep to the inter- mediate fat pad directly on the deep layer of the deep tem- Results: The temporal branch of the facial nerve that tra- poral fascia descending to the periosteum along the zy- versed inside the deep layers of the temporoparietal fas- gomatic arch.
    [Show full text]
  • Tongue Anatomy 25/03/13 11:05
    Tongue Anatomy 25/03/13 11:05 Medscape Reference Reference News Reference Education MEDLINE Tongue Anatomy Author: Eelam Aalia Adil, MD, MBA; Chief Editor: Arlen D Meyers, MD, MBA more... Updated: Jun 29, 2011 Overview The tongue is basically a mass of muscle that is almost completely covered by a mucous membrane. It occupies most of the oral cavity and oropharynx. It is known for its role in taste, but it also assists with mastication (chewing), deglutition (swallowing), articulation (speech), and oral cleaning. Five cranial nerves contribute to the complex innervation of this multifunctional organ. The embryologic origins of the tongue first appear at 4 weeks' gestation.[1] The body of the tongue forms from derivatives of the first branchial arch. This gives rise to 2 lateral lingual swellings and 1 median swelling (known as the tuberculum impar). The lateral lingual swellings slowly grow over the tuberculum impar and merge, forming the anterior two thirds of the tongue. Parts of the second, third, and fourth branchial arches give rise to the base of the tongue. Occipital somites give rise to myoblasts, which form the intrinsic tongue musculature. Gross Anatomy From anterior to posterior, the tongue has 3 surfaces: tip, body, and base. The tip is the highly mobile, pointed anterior portion of the tongue. Posterior to the tip lies the body of the tongue, which has dorsal (superior) and ventral (inferior) surfaces (see the image and the video below). Tongue, dorsal view. View of ventral (top) and dorsal (bottom) surfaces of tongue. On dorsal surface, taste buds (vallate papillae) are visible along junction of anterior two thirds and posterior one third of the tongue.
    [Show full text]
  • Understanding the Perioral Anatomy
    2.0 ANCC CE Contact Hours Understanding the Perioral Anatomy Tracey A. Hotta , RN, BScN, CPSN, CANS gently infl ate and cause lip eversion. Injection into Rejuvenation of the perioral region can be very challenging the lateral upper lip border should be done to avoid because of the many factors that affect the appearance the fade-away lip. The client may also require injec- of this area, such as repeated muscle movement caus- tions into the vermillion border to further highlight ing radial lip lines, loss of the maxillary and mandibular or defi ne the lip. The injections may be performed bony support, and decrease and descent of the adipose by linear threading (needle or cannula) or serial tissue causing the formation of “jowls.” Environmental puncture, depending on the preferred technique of issues must also be addressed, such as smoking, sun the provider. damage, and poor dental health. When assessing a client Group 2—Atrophic lips ( Figure 2 ): These clients have for perioral rejuvenation, it is critical that the provider un- atrophic lips, which may be due to aging or genetics, derstands the perioral anatomy so that high-risk areas may and are seeking augmentation to make them look be identifi ed and precautions are taken to prevent serious more youthful. After an assessment and counseling adverse events from occurring. as to the limitations that may be achieved, a treat- ment plan is established. The treatment would begin he lips function to provide the ability to eat, speak, with injection into the wet–dry junction to achieve and express emotion and, as a sensory organ, to desired volume; additional injections may be per- T symbolize sensuality and sexuality.
    [Show full text]
  • Mouth the Mouth Extends from the Lips to the Palatoglossal Arches
    Dr.Ban I.S. head & neck anatomy 2nd y Mouth The mouth extends from the lips to the palatoglossal arches. The palatoglossal arches (anterior pillars) are ridges of mucous membrane raised up by the palatoglossus muscles. The roof is the hard palate and the floor is the mylohyoid muscle. Rising from the floor of the mouth, the tongue occupies much of the oral cavity. The red margin of the lips, is devoid of hair, highly sensitive and has a rich capillary blood supply. The mucous membrane of the anterior part of hard palate is strongly united with the periosteum. From a little incisive papilla overlying the incisive foramen a narrow low ridge, the median palatine raphe, runs anteroposteriorly. Palatine rugae are short horizontal folds of mucous membrane, located on each sides of the anterior parts of median palatine raphe. Over the horizontal plate of the palatine bone mucous membrane and periosteum are separated by a mass of mucous glands tissue. Nerve supply: 1 Dr.Ban I.S. head & neck anatomy 2nd y Much of the mucous membrane of the cheeks and lips is supplied by the buccal branch of the mandibular nerve, mental branch of the inferior alveolar and the infraorbital branch of the maxillary nerve; the last two also supply the red margin of the lower and upper lips respectively. The upper gums are supplied by the superior alveolar, greater palatine and nasopalatine nerves (maxillary), while the lower receive their innervation from the inferior alveolar, buccal , mental and lingual nerves (mandibular). The buccal nerve does not usually innervate the upper gums.
    [Show full text]
  • PAROTIDECTOMY Johan Fagan
    OPEN ACCESS ATLAS OF OTOLARYNGOLOGY, HEAD & NECK OPERATIVE SURGERY PAROTIDECTOMY Johan Fagan The facial nerve is central to parotid Structures that traverse, or are found surgery for both surgeon and patient. within the parotid gland Knowledge of the surgical anatomy and the landmarks to find the facial nerve are • Facial nerve and branches (Figure 1) the key to preserving facial nerve function. • External carotid artery: It gives off the Surgical Anatomy transverse facial artery inside the gland before dividing into the internal maxil- Parotid gland lary and the superficial temporal arteries (Figure 2). The parotid glands are situated anteriorly and inferiorly to the ear. They overlie the vertical mandibular rami and masseter muscles, behind which they extend into the retromandibular sulci. The glands extend superiorly from the zygomatic arches and inferiorly to below the angles of the mandible where they overlie the posterior bellies of the digastric and the sternoclei- domastoid muscles. The parotid duct exits the gland anteriorly, crosses the masseter muscle, curves medially around its anterior margin, pierces the buccinator muscle, and Figure 1: Main branches of facial nerve enters the mouth opposite the 2nd upper molar tooth. Superficial Muscular Aponeurotic System and Parotid Fascia The Superficial Muscular Aponeurotic System (SMAS) is a fibrous network that invests the facial muscles and connects them with the dermis. It is continuous with the platysma inferiorly; superiorly it at- taches to the zygomatic arch. In the lower face, the facial nerve courses deep to the SMAS and the platysma. The parotid Figure 2: Branches of the external carotid glands are contained within two layers of artery parotid fascia, which extend from the zygoma above and continue as cervical • Veins: The maxillary and superficial fascia below.
    [Show full text]
  • Palate, Tonsil, Pharyngeal Wall & Mouth and Tongue
    Mouth and Tongue 口腔 與 舌頭 解剖學科 馮琮涵 副教授 分機 3250 E-mail: [email protected] Outline: • Skeletal framework of oral cavity • The floor (muscles) of oral cavity • The structure and muscles of tongue • The blood vessels and nerves of tongue • Position, openings and nerve innervation of salivary glands • The structure of soft and hard palates Skeletal framework of oral cavity • Maxilla • Palatine bone • Sphenoid bone • Temporal bone • Mandible • Hyoid bone Oral Region Oral cavity – oral vestibule and oral cavity proper The lips – covered by skin, orbicularis muscle & mucous membrane four parts: cutaneous zone, vermilion border, transitional zone and mucosal zone blood supply: sup. & inf. labial arteries – branches of facial artery sensory nerves: infraorbital nerve (CN V2) and mental nerve (CN V3) lymph: submandibular and submental lymph nodes The cheeks – the same structure as the lips buccal fatpad, buccinator muscle, buccal glands parotid duct – opening opposite the crown of the 2nd maxillary molar tooth The gingivae (gums) – fibrous tissue covered with mucous membrane alveolar mucosa (loose gingiva) & gingiva proper (attached gingiva) The floor of oral cavity • Mylohyoid muscle Nerve: nerve to mylohyoid (branch of inferior alveolar nerve) from mandibular nerve (CN V3) • Geniohyoid muscle Nerve: hypoglossal nerve (nerve fiber from cervical nerve; C1) The Tongue (highly mobile muscular organ) Gross features of the tongue Sulcus terminalis – foramen cecum Oral part (anterior 2/3) Pharyngeal part (posterior 1/3) Lingual frenulum, Sublingual caruncle
    [Show full text]