parotid region

• features
  • largest of salivary gland ( लार ग्रन्थि में सबसे बड़ा )
  • situated below external acoustic meatus ( बाह्य कर्ण कुहर के नीचे )
  • between the ramus of mandible and sternocleidomastoid ( हनु के शाखा और पेशी के बीच )
  • skin over gland supplied by greater auricular nerve ( महा कर्ण तंत्रिका के द्वारा )
• structures within parotid gland ( ग्रन्थि के अंदर / अंतर्वस्तु )
  • arteries ( धमनी )
    • external carotid artery (बाह्य कर्णग्रीवा धमनी) enters gland through posteromedial ( पश्चमध्य ) surface
    • maxillary artery (हनु धमनी ) leaves the gland through its anteromedial surface ( अग्रमध्य )
    • superficial temporal artery (उपरिस्थ शंख धमनी ) gives transverse facial artery and emerges at the
      • anterior part of superior surface
  • veins ( शिरा )
    • retromandibular vein is formed within the gland ( पश्चहनु शिरा )
      • union of
        • superficial temporal and maxillary veins ( हनु शिरा और उपरिस्थ शंख शिरा )
    • in lower part of gland vein divides in to ( ग्रन्थि के निचले भाग में )
      • these emerge close the apex (lower pole ) ( उसके शिखर से निकास )
        • anterior division ( अग्र शाखा )
        • posterior division ( पश्च शाखा )
  • nerve ( तंत्रिका )
    • facial nerve is the nerve of second branchial arch ( आनन तंत्रिका )
      • leaves the skull by passing through stylomastoid foramen ( शरकर्णमूल छिद्र )
      • extracranial course ( बाह्यकपाल )
        • 1. crosses the lateral side of base of styloid process
          • then enters the posteromedial surface of parotid gland
      • branches at its exit from stylomastoid foramen
        • communicating branches with adjacent cranial and spinal nerves
        • posterior auricular nerve arises just below the stylomastoid foramen
          • ascends between mastoid process and external acoustic meatus
            • supplies
              • auricularis posterior
              • occipitalis
              • intrinisic muscles on back of auricle
        • digastric branch arises close to previous nerve
          • short and supplies posterior belly of digastric
        • stylohyoid branch arises with digastric branch
          • long and supplies stylohyoid muscle
      • terminal branches
        • temporal branches cross zygomatic arch and supply
          • auricularis anterior
          • auricularis superior
          • intrinsic muscles on the lateral side of ear
          • frontalis
          • orbicularis oculi
          • corrugator supercili
        • zygomatic branches
          • run across zygomatic bone
            • supply orbicularis oculi
        • buccal branches are two in number
        • marginal mandibular branch
          • runs below the angle of mandible
            • deep to platysma
          • crosses body of mandible supplies
            • muscles of lower lip and chin
        • cervical branch
          • emerges from apex of parotid gland
            • runs downwards and forwards in the neck to supply platysma
      • bells palsy
        • sudden paralysis of facial nerve at stylomastoid foramen
          • results in asymmetry of corner of mouth
          • inability to close eye
          • dissapearance of nasolabial fold
          • loss of wrinkling of skin of forehead on same side
• nerve supply
  • parasympathetic nerves are secretomotor
    • reach the gland through auriculotemporal nerve
    • preganglionic fibres begin in inferior salivatory nucleus
      • pass through glossopharyngeal nerve
        • tympanic branch
        • relay in otic ganglion
  • sympathetic nerves
    • postganglionic
      • vasomotor
        • derived from plexus around middle meningeal artery
      • travel along branches of maxillary,external carotid artery and their branches
  • sensory nerves
    • to the gland come from
      • auriculotemporal nerve
    • parotid fascia innervated by sensory fibres of great auricular nerve
• parotid duct or stensons duct
  • superiorly
    • accessory parotid gland
    • transverse facial vessels
    • upper buccal branch of facial nerve
  • inferiorly
    • lower buccal branch of facial nerve
    • anterior border of masseter
      • parotid duct turns medially and pierces
        • buccal pad of fat
        • buccopharyngeal fascia
        • buccinator
• contains
  • largest salivary gland
  • histology
    • it is a serous acini
• external features
  • surfaces ( स्तर या मुख )
    • superior (base of pyramid) ( ऊर्ध्व मुख )
      • forms the upper end of the gland ( ऊपरी भाग )
        • small and concave ( छोटा )
          • related to cartilaginous part of external acoustic meatus ( कर्ण कुहर )
          • posterior surface of temporomandibular joint ( जबड़े की संधि के पिछले भाग )
          • superficial temporal vessels ( उपरिस्थ शंख वाहिका )
          • auriculotemporal nerve
  • superficial ( उपरिस्थ मुख )
    • largest surface ( विशाल मुख )
    • covered by (ढका हुया है )
      • skin ( त्वचा )
      • superficial fascia ( उपरिस्थ प्रवरण )
        • containing anterior branches of great auricular nerve
        • preauricular or superficial parotid lymph nodes
        • posterior fibres of platysma
        • risorius
      • parotid fascia which is thick and adherent
  • anteromedial ( अग्रमध्य )
    • grooved by posterior border of ramus of mandible ( अधःहनु के पिछले शाखा
    • related to
      • masseter ( चर्वणी )
      • lateral surface of temporomandibular joint
      • posterior border of the ramus of mandible
      • medial pterygoid
      • emerging branches of facial nerve
  • posteromedial ( पश्च मध्य )
    • moulded to mastoid ( कर्णमूल )
    • moulded to styloid processs ( शर प्रवर्ध )
    • structures attached to them
    • related to
      • mastoid process ( कर्णमूल )
      • sternocleidomastoid
      • posterior belly of digastric
      • styloid process with structures attached to it
      • external carotid artery and facial nerve
        • enter the gland through this surface
      • internal carotid artery( अंतःकर्णग्रीवा धमनी ) lies deep to styloid process
  • relations
  • borders ( किनारे )
    • anterior ( अग्र )
      • separates superficial surface from anteromedial surface ( उपरिस्थ स्तर को अग्र मध्य स्तर से विभाजित करता हैं )
      • extends from anterior part of the superior surface to the apex ( ऊर्ध्व स्तर के अग्र भाग से शिखर तक )
      • following structures emerge at this border (
        • parotid duct ( कर्णपूर्व नाली )
        • terminal branches of facial nerve (
        • transverse facial vessels
    • posterior ( पश्च )
      • separates superficial surface from posteromedial surface ( उपरिस्थ स्तर को पश्चमध्य स्तर से अलग करता है )
      • overlaps sternocleidomastoid
    • medial / pharyngeal edge ( मध्य )
      • separates anteromedial surface from posteromedial surface
      • related to lateral wall of pharynx (
  • blood supply
  • parotid lymph nodes
• CLINICAL ANATOMY
  • parotid abscess ( कर्णपूर्व ग्रन्थि का फोड़ा )
    • caused by spread of infection from opening of parotid duct ( उसके नली के द्वारा फैलता हैं )
    • drained by making holes (hiltons method) ( छेद करके निकाला जाता है )
  • mixed parotid tumour is slow growing tumour ( अर्बुद )
  • parotid calculi may be formed in the parotid duct ( कर्णपूर्व पत्थर )