The Parotid & Temporal Region

edited by :

C.W.T
Suliman Qaralleh

Parotid Region
Extends between: the ramous of the mandible anteriorly & the mastoid process posteriorly

Contains: Parotid Gland & Str. Inside it

Structures Within Parotid Gland

1. Superficial: Facial n. & its terminal branches

2. Middle: Retromandibular V. & the terminal part of superficial temporal and maxillary veins

3. Deep: ECA & its terminations ( the beginning part of maxillary a. and superficial temporal a.)

4. Parotid L.N.: distributed within & on the gland drain into DCLN ( Deep Cervical Lymph Nodes )

Parotid Gland
Largest S. G.
Wedge-shaped gland: Base:inferior-posteriorly to the zygomatic arch Apex: inferiorly to the neck of the mandible Covered by C.T. sheath (parotid capsule) derived from investing layer of deep cervical fascia * P. gland is Divided by Facial n. into superficial & deep parts

Processes of The Parotid Gland

Extensions of parotid tissue into certain regions

Glenoid Process: upward to into the posterior part of the mandibular fossa
Pterygoid process: forward deeply between the ramous of the mandible and the medial pterygoid muscle

Facial process forward superficially over the masseter muscle

Accessory part of parotid gland:

a small part of facial process that separates from the main gland

Relations To Parotid Gland

Superficial (lat.): Parotid fascia Great auricular n. Skin Superior: EAM TMJ

Deep Relations (Medial)

Antero-medial: Masseter m. post. Part of Ramus TMJ Postero-medial: Carotid sheath Styloid process Mastoid process SCM & Pos. belly of digastric

*Medial structures to parotid gland are termed: The Parotid Bed

Parotid Duct (Stensen's duct)

- Pass ant. & horizontal over the masseter m. & below to the zygomatic arch - At ant. Border of masseter: pierces buccinator m. to enter the oral cavity

- Opens into oral cavity opposite to the upper second molar

Accessory Parotid Duct drains into its own small duct which opens into main duct (Stinsons duct)

The external carotid artery (ECA) will provide blood supply to the parotid tissue, the vein is the retromandibular vein so it will provide the drainage to it , the sensation over the parotid gland come from the great auricular nerve and it takes from the glossopharyngeal nerve (IX) for secretion which is the lesser petrosal nerve Read Your Text For additional Blood Supply, Innervation & Lymph Drainage of Parotid Gland

Clinical: Mumps
A viral infection to parotid gland causing swelling & pain

Pain is due to swelling within tight parotid fascia (p. capsule)

Pain is worse during chewing because the gland is compressed

between the ramous of the mandible and the mastoid process When the mouth is opened

Parotid duct may also become obstructed with stones (calculi) & cause a painful swelling

Parotidectomy
Surgical removal of the parotid gland

Most common cause: cancer * 80% of salivary gland tumors occur in Parotid g.
Risks of surgery:

1. Facial n. (VII)
2. ECA 3. Retromandibular vein

*Important step in Parotidectomy: Identification, isolation, and preservation of those structures

The Temporal Region

The region that situated on the side of the head Boundaries: Sup.& post.: sup. Temporal line Ant.: frontal process of zygomatic bone Inf.: zygomatic arch *continues inf. & deep to zyg. Arch with infratemporal region

Contents of Temporal Region

1. Temporalis m. largest muscle of mastication Originates from the whole floor of the temporal region insertion into the coronoid process of the mandible and the anterior border of the ramous innervated by two nerves we name them the temporal nerves coming from the anterior division of the mandibular nerve action elevation (the anterior part of it) and retraction (the posterior part of it) 2. Temporal fascia: deep fascia covering the muscle and its attached as continuation of the epicranial aponeurosis laterally 3. Deep temporal a. origin from the maxillary a. & nerves ( the same as arteries )

4. Superficial Temporal a. & v.: pass posterior to the TMJ

5. Auriculotemporal nerve: from the posterior division of mandibular nerve pass posterior to superficial temporal vessels

it gives sensation over the temporal region

Clinical Case
A 44-year-old female with swelling over the parotid gland on the right side visited you in the clinic. She stated that she first noticed the swelling 3 months previously, and since that time it had rapidly increase in size. Recently, she noticed that her right side of her face felt weak and she could no longer whistle for her cat. On examination, a hard swelling deeply attached to the parotid gland was identified. On testing the facial muscles, it was found that the muscles on right side were weaker than those on left side. Before starting any further management, answer the following questions?

Q1. What is (are) the cutaneous innervation of the skin over the parotid region? Q2. What muscles control her whistling? Q3. What is the connection between the right side facial weakness & the parotid swelling? Q4. What is the diagnosis? Q5. What is the treatment? Q6. What is (are) the structure(s) that may be endangered of such kind of treatment?