Detailed anatomy of parotid gland and facial nerve.

1. PAROTID GLAND
FACIAL NERVE
Dr. Mehul Tandel

2. Salivary Glands

3. • Exocrine glands
• Glands with ducts
• Produce saliva and pour their
secretion in the oral cavity
• Major (paired)
• Parotid
• Submandibular
• Sublingual
• Minor
• In the tongue,
palatine tonsil,
palate, lips and
cheeks

5. Parotid Gland

6. Objectives
• INTRODUCTION
• PAROTID CAPSULE
• EXTERNAL FEATURES
• DEVELOPMENT
• RELATIONS
• STRUCTURES WITHIN THE PAROTID GLAND
• PAROTID DUCT
• NERVE SUPPLY
• LYMPHATIC DRAINAGE AND LYMPH NODES
• FUNCTIONS OF PAROTID GLAND
• CLINICAL ANATOMY

7. • Parotid region:
– The largest serous salivary gland = Parotid Gland
– The “queen of the face”, the facial nerve
• Parotid gland: Para= Around; Otic = Ear
• Parotid gland:
– Average Wt - 15gm / 25gm
– Irregular lobulated mass
Introduction

8. Also projects forwards on the surface of masseter.
Sternomastoid
Below
External
acoustic
meatusRamus of
mandible
Situation
Between

9. • Small detached part lies on the surface of the
masseter, between zygomatic arch and
parotid duct :–
• Accessory parotid gland or ‘Socia Parotidis’

10. • Occupies the deep hollow
behind the ramus of the
mandible.
• Wedge-shaped,
the base above &
the apex below
– behind the angle of the
mandible.

11. Parotid Capsule
1.False Capsule
2.True Capsule

12. Parotid Capsule
• False Capsule:
Formed by
investing layer
of the deep
cervical fascia

13. True Capsule:
Condensation of
fibrous stroma
Parotid Capsule

14. External Features
• Resembles a three sided pyramid.
The apex directed downwards.
• The gland has four surfaces:-
1) Superior (base of the pyramid)
2) Superficial
3) Anteromedial and
4) Posteromedial
The surfaces are separted by 3 borders:
a) Anterior b) Posterior and 3) Medial

15. Apex
Resembles a three sided pyramid
The apex directed downwards
Transverse section Lateral View – Left Parotid

16. Superficial
surface
Posterior
border
Medial border
Anterior
border
4 Surfaces
Superior Surface
(Base)
3 Borders
Lateral View – Left Parotid

17. 4 Surfaces 3 Borders
Transverse section Left Parotid – Sup View

18. Relations - Apex
• Overlaps the posterior
belly of the diagastric
The cervical branch of facial nerve
Two divisions of the
Retromandibular vein

19. Relations – Superior Surface / Base
External acoustic meatusTemporo mandibular joint

20. Relations – Superficial Surface
Parotid fascia
Posterior fibers of the
platysma and risorius
Superficial Parotid
Lymph Node

21. Grooved by posterior border of the ramus of the mandible
Relations – Antero-medial Surface
Styloid

22. Grooved by posterior border of the ramus of the mandible
Relations – Postero-medial Surface
Styloid

23. Separates Superficial surface from Antero-medial surface
Relations – Anterior Border

24. Relations – Posterior Border
Separates Superficial surface from Postero-medial surface

25. Relations – Medial Border
Separates Antero-medial surface from Postero-medial surface
Of Pharynx

26. Structures within the Parotid Gland
Superficial temporal Artery
Maxillary
Artery
Posterior
auricular artery
External carotid
Arteries
Deepest

27. Veins Intermediate

28. Facial nerve
Facial Nerve Superficial

29. Temporo-facial
Cervico-facial
Temporal
Zygomatic
Buccal
Marginal
Mandubular
Cervical

30. Radiate like Goose’s Foot
through Anterior Border Pes Anserinus

31. Parotid Duct
• Ductus parotideus;
Stensen’s duct
• Thick walled
• 5cm long and 5 mm
diameter
• Carries saliva to the
oral cavity.
• Course :

32. • Relations:
Superiorly:
Inferiorly:

33. • At the anterior border of the masseter, it turns medially
and pierces:
(a) Buccal pad of fat.
(b) Buccalpharyngeal fascia
(c) Buccinator
“Oblique course of the duct through the buccinator
prevent infaltion during blowing.”

34. Opens into the vestibule of
the mouth
Opposite the crown of the
upper 2nd molar tooth.

35. Nerve Supply
• Parasympathetic (Secretomotor):
– Auriculo temporal nerve
– Produces watery secretion
• Symapathetic:
– Vasomotor, Mucous rich sticky secretion
– Derived from plexus around the external carotid
artery
• Sensory:
– Great auricular and auriculotemporal Nerve

36. Inferior
Salivatory
Nucleus
Glossophargeal
nerve
(9th cranial nerve)
Tympanic
Branch
Tympanic
Plexus
Pre-ganglionic fibers arise
From
Lesser
Petrosal
Nerve
Otic
Ganglion
Post-ganglionic
Fibres
Auriculoemp-
oral Nerve
The Parotid Gland
To supply
Parasympathetic (Secretomotor) Pathway
Relay

37. Glossophargeal
nerve
Inferior Salivatory Nucleus
Tympanic Branch
Tympanic Plexus
Lesser Petrosal Nerve
Otic Ganglion
Auriculoemporal
Nerve
The Parotid
Gland
ParaSympathetic
Medulla
Oblangata
Pons

38. Superior Cervical
Ganglion
T1 & T2
Plexus around
External Carotid
Artery
The Parotid
Gland
Sympathetic

39. Lympatic Drainage
Parotid nodes —> Upper deep cervical nodes.

40. Clinical Anatomy
• Diseases of parotid gland
A) Congenital:
Aplasia or atresia:-
– Any one or group of salivary glands may be
absent, unilaterally or bilaterally.
– Salivary loss leads to increased dental caries,
burning sensation, oral infections,
taste aberrations

41. B) Acquired:
– Infective
Mumps
Bacterial Parotitis
– Parotid Abcess
– Mixed Parotid Tumor
– Neurological
Frey's syndrome
– Sialolithiasis

42. • Mumps:
• Viral disease
• Caused by the mumps virus
Paramyxovirus.
• Painful swelling of the parotid gland.
• Do not suppurate
• Orchitis – Inflammation of testis
• Pancreatitis

43. • Bacterial Parotitis:
• It can be acute, chronic and
recurrent.
• Infecfion spread from mouth
– Poor oral hygiene,
– Particularly among elderly
postoperative patient
• Suppurate = Form Abcess

44. • Parotid Abcess:
• Infection spread from mouth
• Suppuration of parotid lymph
node
• Drain By Hilton’s Method:
• Small Horizontal incision
• To avoid injury of facial nerve
branches

45. • Frey’s Syndrome:
 Also known as gustatory sweating or
Auriculo-temporal nerve syndrome.
 Commonly occurs after parotid surgery or trauma.
 Injury of Auriculo-temporal & Great auricular nerev
 During healing: Secreto-motor fibers of auriculo-
temporal nerve join with great auricular nerve & reach
sweat glands of facial skin.

47.  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

48. • Mixed Parotid Tumor:
• Slow growing
• Benign
• Painless
• Does not involve facial nerve

49. • Sialolithiasis:
• Salivary calculi, or salivary
stones),
• Calcified mass forms within
a salivary gland,
• Usually in the duct of the
submandibular gland
• Less commonly the parotid
gland.

50. The Cranial Cavity
Base
Anterior Cranial
Fossa
Middle Cranial
Fossa
Posterior Cranial
Fossa

51. The middle cranial fossa
Internal Acoustic Meatus
Groove for
Greater petrosal
nerve
Groove for
Lesser petrosal
nerve
Petrous Part Of
Temporal Bone
Foramen Lacerum

52. Internal
acoustic Meatus
Greater petrosal
nerve
Lesser petrosal
nerve

53. Facial Nerve

54. Objectives
• Introduction
• Functional Components
• Nuclei
• Course & Relations
• Branches & Distributions
• Ganglia Associated With Facial Nerve
• Clinical Anatomy

55. Introduction
• Seventh cranial nerve
• 2nd “busiest” cranial nerve
of the human body
• Nerve of the second
branchial arch
• Mixed

56. Functional Components of Cranial Nerves
• Total – 7, 4 – General Sensations & 3 – Special sensations
• General Components:
 GSA – General Somatic Afferent
• Touch, temperature, and pain from non-visceral structures
 GSE – General Somatic Efferent
• Motor to skeletal muscle
 GVA – General Visceral Afferent
• Touch (distention), temperature, and pain from the viscera
 GVE – General Visceral Efferent
• Motor to viscera, smooth muscle, and glands

57. Functional Components of Cranial Nerves
• Special Components:
 SSA – Special Somatic Afferent
• Vision, hearing, and balance
 SSE – Doesn’t exist
 SVA – Special Visceral Afferent
– Taste and olfaction
 SVE – Special Visceral Efferent / Branchial Efferent
• Motor to muscles derived from the branchial
arches

58. Functional components of Facial Nerve
Special visceral Efferent / Branchial Efferent
Facial Muscles, Posterior Belly Of Digastric, Stylohyoid & Stapedius

59. General Visceral Efferent / Parasympathetic / Secretomotor
Glands of the
Nose,
Palate and
Pharynx
General Visceral Affetent

60. Special Visceral Afferent
Taste Sensations from Anterior 2/3rd of Tongue, Palate

61. General Somatic Afferent
Through communication with Vagus Nerve

63. Nuclei
• 4 nuclei situated in the lower pons.
1. Motor nucleus or brachiomotor : lies deep in lower pons.
2. Superior salivatory nucleus or parasympathetic.
3. Lacrimatory nucleus – parasympathetic.
4. Nucleus of tractus solitarius – Gustatory and also receives
afferent fibres from the glands.

64. Nuclei
Motor Nucleus /
Brachiomotor
Superior Salivatory
Nucleus
Lacrimatory
Nucleus
Nucleus Of
Tractus Solitarius
Facial Nerve
Pons
MO
MB

66. • The part of motor nucleus supplying upper
part of face---controlled by corticonuclear
fibres of both sides
• The part of motor nucleus supplying lower
part of face---controlled by corticonuclear
fibres of opposite side (only)
CENTRAL CONNECTIONS

67. CENTRAL CONNECTIONS

68. Course and Relations
Motor root
Small Sensory
Root
Nervous Intermedius
Pons
MO
MB

69. Vestibulo-cochlear
Nerve
Internal Acoustic
Meatus
Nervous Intermedius
Pons
Course and Relations - Intracranial

70. In the Internal Acoustic Meatus
Divided In 3 Parts within the canal
Course and Relations - Intracranial

71. Course and Relations - Intracranial
1st Part
Genu
2nd Part
3rd Part
Stylo-Mastoid Foramen

72. Course and Relations - Extracranial

73. A. Within the facial canal:
1. Greater petrosal nerve
2. The nerve to the stapedius
3. Chorda tympani
B. At its exit from the stylomastoid foramen:
1. The posterior auricular
2. Digastric
3. Stylohyoid
Branches and Distribution

74. C. Terminal branches within the parotid gland:
1. Temporal
2. Zygomatic
3. Buccal
4. Marginal mandibular
5. Cervical
D. Communicating branches:
With adjacent cranial and spinal nerves.

75. Within the facial canal:
Greater Superficial
Petrosal Nerve
Nerve to
Stapedius
Chorda
Tympani

76. Greater Superficial
Petrosal Nerve
Deep petrosal
Nerve
Nerve to
Pterygoid Canal
Pterygo-palatine
Ganglion

77. Pterygo-palatine
Ganglion
Lacrimal Gland
Nose, Palate &
Pharynx

78. Nerve to
Stapedius
Stapedius Muscle

79. Damps down excessive
vibration of Stapes
Stapedius Muscle
Hyperacusis

80. Chorda Tympani
Nerve
Stylo-mastoid
Foramen
Tympanic
Membrane
Petro-Tympanic
Fissure

81. Chorda Tympani
Nerve
Lingual Nerve
Submandibular
Ganglion
Submandibular &
Sublingual Gland
Taste Sensation from
Anterior 2/3rd of Tongue

82. Posterior
Auricular Nerve
Auricular Branch
Occipitais

83. Digastric –
Posterior Belly
Stylohyoid

84. Terminal Branches:
Temporo-facial
Cervico-facial
Temporal
Zygomatic
Buccal
Marginal
Mandubular
Cervical

86. 1. Loss of Lacrimation
2. Loss of Stapedial Reflex
3. Loss of taste from Ant 2/3rd
of tongue
4. Lack of Salivation
5. Facial Palsy
Internal Acoustic Meatus
At Genu
All except loss of Lacrimation
Below Genu
All except loss of Lacrimation &
Loss of Stapedial Reflex Below Stylomastoid
Foramen
Only facial Palsy

87. Applied
• In infranuclear lesions of facial nerve (Bell’s palsy)-
whole Ipsilateral face is paralyzed
• Affected side is motionless
• Loss of wrinkles on forehead
• Eye cannot be closed
• In smiling the mouth is drawn to normal side
• During mastication food accumulates in vestibule of mouth
• In Supranuclear lesions of facial nerve
• Lower part of opposite face is paralyzed
• Upper part is escaped due to
• Bilateral representation of upper part in cerebral cortex

88. Bell’s Palsy

90. Communicating Branches
• Facial nerve branches exchange fibers with
sensory cutaneous branches of the trigeminal
nerve.
• For effective co-ordination

91. Ganglia
1. Geniculate ganglion
1. Sensory ganglion.
2. Taste fibres
2. Submandibular ganglion:
1. Parasympathetic ganglion
2. Secretomotor fibre to the submandibular and
sublingual glands.
3. Pterygopalatine ganglion:
1. Parasympathetic ganglion.
2. Secretomotor fibres for the lacrimal gland