University of Al-Ameed General Anatomy Dr.

Muntather Muhsen
Dentistry College

Parotid Region

، ‫اﻟﻤﻨﻄﻘﺔ اﻟﻨﻜﻔﻴﺔ ﻫﻲ اﻟﻤﻨﻄﻘﺔ اﻟﺘﻲ ﺗﻘﻊ ﻓﻲ اﻟﺠﺰء اﻟﺨﻠﻔﻲ اﻟﺠﺎﻧﺒﻲ ﻣﻦ ﻣﻨﻄﻘﺔ اﻟﻮﺟﻪ‬
:‫ﻳﺤﺪﻫﺎ‬
.‫ اﻟﻘﻮس اﻟﻮﺟﻨﻲ‬:‫• ﺑﺸﻜﻞ ﻣﺘﻔﻮق‬
‫ اﻷذن اﻟﺨﺎرﺟﻴﺔ واﻟﺤﺎﻓﺔ‬:‫ • ﺧﻠﻔﻲ‬.‫ اﻟﺰاوﻳﺔ واﻟﺤﺪود اﻟﺴﻔﻠﻴﺔ ﻟﻠﻔﻚ اﻟﺴﻔﻠﻲ‬:‫• أدﻧﻰ‬
.‫اﻷﻣﺎﻣﻴﺔ ﻟﻠﻘﺼﻴﺔ اﻟﺘﺮﻗﻮﻳﺔ اﻟﺨﺸﺎﺋﻴﺔ‬
.‫ راﻣﻮس اﻟﻔﻚ اﻟﺴﻔﻠﻲ‬:‫ • ﻓﻲ اﻟﻮﺳﻂ‬.‫ اﻟﺤﺎﻓﺔ اﻟﺨﻠﻔﻴﺔ ﻟﻠﻌﻀﻠﺔ اﻟﻤﺎﺿﻐﺔ‬:‫• ﻣﻦ اﻷﻣﺎم‬
‫ واﻟﻮرﻳﺪ‬، (CN VII) ‫ واﻟﻌﺼﺐ اﻟﻮﺟﻬﻲ‬، ‫ﺗﺸﻤﻞ اﻟﻤﻨﻄﻘﺔ اﻟﻨﻜﻔﻴﺔ اﻟﻐﺪة اﻟﻨﻜﻔﻴﺔ واﻟﻘﻨﺎة‬
.‫ واﻟﻌﻀﻠﺔ اﻟﻤﺎﺿﻐﺔ‬، ‫ واﻟﺸﺮﻳﺎن اﻟﺴﺒﺎﺗﻲ اﻟﺨﺎرﺟﻲ‬، ‫ﺧﻠﻒ اﻟﻔﻚ اﻟﺴﻔﻠﻲ‬

The parotid region is the region that located in the posterolateral part of the facial
region, bounded by the:
• Superiorly: Zygomatic arch.
• Inferiorly: Angle and inferior border of the mandible .
• Posteriorly: External ear and anterior border of the sternocleidomastoid.
• Anteriorly: posterior border of the masseter muscle.
• Medially: Ramus of the mandible.
The parotid region includes the parotid gland and duct, the facial nerve (CN VII), the
retromandibular vein, the external carotid artery, and the masseter muscle.

Lecture 4 1 Ali Sabah

 ‫( ﻣﻀﻤﻦ داﺧﻞ اﻟﻐﺪة‬CN VII) ‫ ﻋﻠﻰ اﻟﺮﻏﻢ ﻣﻦ أن اﻟﻌﺼﺐ اﻟﻮﺟﻬﻲ‬.‫ وﺗﺘﻜﻮن ﻓﻲ اﻟﻐﺎﻟﺐ ﻣﻦ ﺣﺐ اﻟﺸﺒﺎب اﻟﻤﺼﻠﻲ‬.‫اﻟﻐﺪة اﻟﻨﻜﻔﻴﺔ ﻫﻲ أﻛﺒﺮ ﺛﻼث ﻏﺪد ﻟﻌﺎﺑﻴﺔ ﻣﺰدوﺟﺔ‬
University
‫ﻓﺼﻮص ﺳﻄﺤﻴﺔ‬ of‫إﻟﻰ‬Al-Ameed
‫ ﻳﻘﺴﻢ اﻟﻌﺼﺐ اﻟﻮﺟﻬﻲ اﻟﻐﺪة‬.‫اﻟﻮﺟﻪ‬ General Anatomy
‫ﻣﻮاﺟﻬﺘﻬﺎ أﺛﻨﺎء ﺗﺸﺮﻳﺢ‬ Dr.‫ﻟﺘﻌﺼﺐ‬
‫ﻋﻀﻼت ﺗﻌﺒﻴﺮات اﻟﻮﺟﻪ ﻳﺘﻢ‬ Muntather
‫اﻟﻤﻤﺘﺪة ﻣﻦ اﻟﻐﺪة‬Muhsen
‫ إﻻ أن اﻟﻔﺮوع‬، ‫اﻟﻨﻜﻔﻴﺔ‬
Dentistry ‫ ﻣﺸﺘﻘﺔ ﻣﻦ اﻟﻄﺒﻘﺔ اﻟﻤﺴﺘﺜﻤﺮة ﻣﻦ اﻟﻠﻔﺎﻓﺔ‬، (‫ وﻫﻲ ﻏﻼف اﻟﻐﺪة اﻟﻨﻜﻔﻴﺔ )ﻛﺒﺴﻮﻟﺔ‬، ‫ ُﺗﺤﺎط اﻟﻐﺪة اﻟﻨﻜﻔﻴﺔ ﺑﻜﺒﺴﻮﻟﺔ ﻟﻔﺎﻓﻴﺔ ﺻﻠﺒﺔ ﻻ ﺗﺘﺰﻋﺰع‬.‫وﻋﻤﻴﻘﺔ‬
College
‫ اﻟﻐﺪة‬.‫اﻟﻌﻨﻘﻴﺔ اﻟﻌﻤﻴﻘﺔ‬
‫ ﺣﻴﺚ ﺗﻨﺤﺼﺮ ﺑﻴﻦ ﻓﺮع اﻟﻔﻚ اﻟﺴﻔﻠﻲ‬، ‫ ﻫﻲ أﻣﺎﻣﻴﺔ أدﻧﻰ ﻣﻦ اﻟﺼﻤﺎخ اﻟﺴﻤﻌﻲ اﻟﺨﺎرﺟﻲ‬، ‫ اﻟﺴﺮﻳﺮ اﻟﻨﻜﻔﻲ‬، ‫اﻟﻨﻜﻔﻴﺔ ﻟﻬﺎ ﺷﻜﻞ ﻏﻴﺮ ﻣﻨﺘﻈﻢ ﻷن اﻟﻤﻨﻄﻘﺔ اﻟﺘﻲ ﺗﺤﺘﻠﻬﺎ اﻟﻐﺪة‬
.‫ وﺗﺮﺗﺒﻂ ﻗﺎﻋﺪﺗﻬﺎ ﺑﺎﻟﻘﻮس اﻟﻮﺟﻨﻲ‬، ‫ ﺗﻘﻊ ﻗﻤﺔ اﻟﻐﺪة اﻟﻨﻜﻔﻴﺔ ﺧﻠﻒ زاوﻳﺔ اﻟﻔﻚ اﻟﺴﻔﻠﻲ‬.‫وﻋﻤﻠﻴﺔ اﻟﺨﺸﺎء‬

PAROTID GLAND:

The parotid gland is the largest of three paired salivary glands. It composed mostly
of serous acini. Although the facial nerve (CN VII) is embedded within the parotid
gland, the branches extending from the gland to innervate the muscles of facial
expression are encountered during the dissection of the face. The facial nerve divides
the gland into superficial and deep lobes.
The parotid gland is enclosed within a tough, unyielding, fascial capsule, the parotid
sheath (capsule), derived from the investing layer of deep cervical fascia. The parotid
gland has an irregular shape because the area occupied by the gland, the parotid
bed, is anteroinferior to the external acoustic meatus, where it is wedged between
the ramus of the mandible and the mastoid process.
The apex of the parotid gland is posterior to the angle of the mandible, and its base
is related to the Zygomatic arch.

Lecture 4 2 Ali Sabah

 ً
، ‫ واﻟﻌﻀﻠﺔ اﻟﺪاﻛﻨﺔ‬، ‫ وﺗﺜﻘﺐ وﺳﺎدة اﻟﺨﺪ ﻣﻦ اﻟﺪﻫﻮن‬، ‫ ﺗﺪور اﻟﻘﻨﺎة ﺑﺸﻜﻞ إﻧﺴﻲ‬، ‫ ﻋﻨﺪ اﻟﺤﺪود اﻷﻣﺎﻣﻴﺔ ﻟﻠﻤﺎﺳﻴﺘﺮ‬.‫أﻓﻘﻴﺎ ﻣﻦ اﻟﺤﺎﻓﺔ اﻷﻣﺎﻣﻴﺔ ﻟﻠﻐﺪة‬ ‫ﺗﻤﺮ اﻟﻘﻨﺎة اﻟﻨﻜﻔﻴﺔ‬
University of Al-Ameed General Anatomy Dr. Muntather
.‫اﻟﺒﻠﻌﻮﻣﻴﺔ واﻟﻐﺸﺎء اﻟﻤﺨﺎﻃﻲ اﻟﺸﺪق وﺗﺪﺧﻞ إﻟﻰ ﺗﺠﻮﻳﻒ اﻟﻔﻢ ﻣﻦ ﺧﻼل ﻓﺘﺤﺔ ﺻﻐﻴﺮة ﻣﻘﺎﺑﻞ اﻟﻀﺮس اﻟﻔﻜﻲ اﻟﺜﺎﻧﻲ‬ Muhsen ‫واﻟﻠﻔﺎﻓﺔ‬
Dentistry
‫ ﺗﻜﻮن اﻟﻘﻨﺎة‬،College
‫ ﺣﻮل ﻧﻄﺎق اﻹﺻﺒﻊ أﺳﻔﻞ اﻟﻘﻮس اﻟﻮﺟﻨﻲ‬.‫ﻳﻌﻤﻞ اﻟﻤﻤﺮ اﻟﻤﺎﺋﻞ ﻟﻠﻘﻨﺎة ﻓﻲ اﻟﻌﻀﻠﺔ اﻟﻤﺴﺎﻋﺪة ﻛﺂﻟﻴﺔ ﺗﺸﺒﻪ اﻟﺼﻤﺎم وﻳﻤﻨﻊ ﺗﻀﺨﻢ اﻟﻘﻨﺎة أﺛﻨﺎء اﻟﻨﻔﺦ‬
‫ أوﻋﻴﺔ اﻟﻮﺟﻪ اﻟﻤﺴﺘﻌﺮﺿﺔ أﻋﻼه واﻟﻔﺮع اﻟﺸﺪﻗﻲ ﻣﻦ اﻟﻌﺼﺐ اﻟﻮﺟﻬﻲ أدﻧﺎه‬:‫ﻣﺼﺤﻮﺑﺔ ﺑـ‬
.‫ﻳﺘﻢ ﺗﻤﺜﻴﻞ اﻟﻘﻨﺎة ﺑﺎﻟﺜﻠﺚ اﻷوﺳﻂ ﻣﻦ اﻟﺨﻂ اﻟﻤﻤﺘﺪ ﻣﻦ اﻟﺰﻧﻤﺔ ﻟﻸذن إﻟﻰ ﻧﻘﻄﺔ ﻓﻲ ﻣﻨﺘﺼﻒ اﻟﻤﺴﺎﻓﺔ ﺑﻴﻦ اﻷﻧﻒ واﻟﺸﻔﺔ اﻟﻌﻠﻴﺎ‬

The parotid duct passes horizontally from the anterior edge of the gland . At the
anterior border of the masseter, the duct turns medially, pierces Buccal pad of fat,
the buccinator muscle, Buccopharyngeal fascia and Buccal mucosa and enters the
oral cavity through a small orifice opposite the 2nd maxillary molar tooth .

The oblique passage of the duct in the buccinator muscle acts as a valve -like
mechanism & prevents inflation of the duct during blowing . About a fingerbreadth
below the zygomatic arch the duct accompanied by the: transverse facial vessels
above and buccal branch of facial nerve below

The duct is represented by the middle 1/3 of a line extending from the tragus of the
auricle to a point midway between the ala of nose & upper lip.

Lecture 4 3 Ali Sabah

 University of Al-Ameed General Anatomy Dr. Muntather Muhsen
Dentistry College

Structures Present Within the Parotid Gland

1. Facial nerve and its branches: Facial nerve emerges from the stylomastoid foramen and
enters the gland by piercing upper part of its posteromedial surface .It then divides into
two trunks:
‫اﻟﻬﻴﺎﻛﻞ اﻟﻤﻮﺟﻮدة داﺧﻞ اﻟﻐﺪة اﻟﻨﻜﻔﻴﺔ‬
‫ ﻳﺨﺮج‬:‫ اﻟﻌﺼﺐ اﻟﻮﺟﻬﻲ وﻓﺮوﻋﻪ‬.1
A. Temporo-Facial trunk: This gives rise to: ‫اﻟﻌﺼﺐ اﻟﻮﺟﻬﻲ ﻣﻦ اﻟﺜﻘﺐ اﻹﺑﺮي‬
‫اﻟﺨﺸﺎﺋﻲ وﻳﺪﺧﻞ إﻟﻰ اﻟﻐﺪة ﻋﻦ ﻃﺮﻳﻖ‬
• Temporal nerve ‫ ﺛﻢ‬، ‫ﺛﻘﺐ اﻟﺠﺰء اﻟﻌﻠﻮي ﻣﻦ ﺳﻄﺤﻪ اﻟﺨﻠﻔﻲ‬
:‫ﻳﻨﻘﺴﻢ إﻟﻰ ﺟﺰﺋﻴﻦ‬
• Zygomatic nerve :‫ ﻳﺆدي إﻟﻰ‬:‫ ﺟﺬع اﻟﻮﺟﻪ اﻟﺼﺪﻏﻲ‬.‫أ‬
‫• اﻟﻌﺼﺐ اﻟﺼﺪﻏﻲ‬
B. Cervico-facial trunk: This further divides into three branches: ‫• اﻟﻌﺼﺐ اﻟﻮﺟﻨﻲ‬
‫ ﻳﻨﻘﺴﻢ ﻫﺬا‬:‫ ﺟﺬع ﻋﻨﻖ اﻟﺮﺣﻢ واﻟﻮﺟﻪ‬.‫ب‬
• Buccal :‫إﻟﻰ ﺛﻼﺛﺔ ﻓﺮوع‬
‫• اﻟﺸﺪق‬
• Marginal mandibular ‫• اﻟﻔﻚ اﻟﺴﻔﻠﻲ اﻟﻬﺎﻣﺸﻲ‬
‫• ﻋﻨﻘﻲ‬
• Cervical
The five terminal branches leave through the anterior border of the gland in a radiating
manner that resembles the foot of a goose. Hence, this pattern is known as pes anserinus

2. Retromandibular vern: It is formed within the substance of parotid gland by union of

superficial temporal and maxillary veins, and lies below the facial nerve .
3. External carotid artery: It occupies the deep part of gland.
4. Deep parotid lymph nodes.
‫ﺗﻐﺎدر اﻟﻔﺮوع اﻟﺨﻤﺴﺔ اﻟﻄﺮﻓﻴﺔ ﻋﺒﺮ اﻟﺤﺪود اﻷﻣﺎﻣﻴﺔ ﻟﻠﻐﺪة‬
‫ ﻳُ ﻌﺮف ﻫﺬا اﻟﻨﻤﻂ‬، ‫ وﻣﻦ ﺛﻢ‬.‫ﺑﻄﺮﻳﻘﺔ ﻣﺸﻌﺔ ﺗﺸﺒﻪ ﺳﻔﺢ اﻹوزة‬
pes anserinus ‫ﺑﺎﺳﻢ‬
‫ ﺗﺘﻜﻮن داﺧﻞ ﻣﺎدة اﻟﻐﺪة اﻟﻨﻜﻔﻴﺔ‬:‫ اﻟﻮردة ﺧﻠﻒ اﻟﻔﻚ اﻟﺴﻔﻠﻲ‬.2
‫ وﺗﻘﻊ‬، ‫ﻋﻦ ﻃﺮﻳﻖ اﺗﺤﺎد اﻷوردة اﻟﺴﻄﺤﻴﺔ اﻟﺼﺪﻏﻴﺔ واﻟﻔﻜﻴﺔ‬
.‫ﺗﺤﺖ اﻟﻌﺼﺐ اﻟﻮﺟﻬﻲ‬
.‫ وﻳﺤﺘﻞ اﻟﺠﺰء اﻟﻌﻤﻴﻖ ﻣﻦ اﻟﻐﺪة‬:‫ اﻟﺸﺮﻳﺎن اﻟﺴﺒﺎﺗﻲ اﻟﺨﺎرﺟﻲ‬.3
.‫ اﻟﻐﺪد اﻟﻠﻴﻤﻔﺎوﻳﺔ اﻟﻨﻜﻔﻴﺔ اﻟﻌﻤﻴﻘﺔ‬.4

Lecture 4 4 Ali Sabah

University of Al-Ameed General Anatomy Dr. Muntather Muhsen
Dentistry College

INNERVATION OF PAROTID GLAND AND RELATED STRUCTURES:

Although the CN VII is embedded within the gland the CN VII does not provide
innervation to the gland. The auriculotemporal nerve, a branch of CN V3, is closely related
to the parotid gland and passes superior to it with the superficial temporal vessels. The
auriculotemporal nerve and the great auricular nerve, a branch of the cervical plexus
composed of fibers from C2 and C3 spinal nerves, innervates the parotid sheath as well as
the overlying skin .
The parasympathetic component of the glossopharyngeal nerve (CN IX) supplies
presynpatic secretory fibers to the otic ganglion. The postsynaptic parasympathetic fibers
are conveyed from the ganglion to the gland by the auriculotemporal nerve
(Parasympathetic secretomotor supply arises from the glossopharyngeal nerve. The nerves
reach the gland via the tympanic branch, the lesser petrosal nerve, the otic ganglion, and
the auriculotemporal nerve).
Stimulation of the parasympathetic fibers produces a thin, watery saliva. Sympathetic
fibers are derived from the cervical ganglia through the external carotid nerve plexus on
the external carotid artery. The vasomotor activity of these fibers may reduce secretion
from the gland . Sensory nerve fibers pass to the gland through the great auricular and
auriculotemporal nerves.

Lecture 4 5 Ali Sabah

 ‫ﺗﺮﺟﻤﺔ ﺻﻔﺤﺔ ‪5‬‬

‫اﺣﺘﺒﺎس اﻟﻐﺪد اﻟﺒﻜﺘﻴﺮﻳﺔ واﻟﻬﻴﺎﻛﻞ ذات اﻟﺼﻠﺔ‪:‬‬

‫ﻋﻠﻰ اﻟﺮﻏﻢ ﻣﻦ أن ‪ CN VII‬ﻣﻀﻤﻦ داﺧﻞ اﻟﻐﺪة ‪ ،‬إﻻ أن ‪CN‬‬
‫‪ VII‬ﻻ ﻳﻮﻓﺮ ﺗﻌﺼﻴ ًﺒﺎ ﻟﻠﻐﺪة‪ .‬ﻳﺮﺗﺒﻂ اﻟﻌﺼﺐ اﻷذﻧﻲ اﻟﺼﺪﻏﻲ ‪،‬‬
‫ً‬
‫وﺛﻴﻘﺎ ﺑﺎﻟﻐﺪة اﻟﻨﻜﻔﻴﺔ وﻳﻤﺮ‬ ‫ارﺗﺒﺎﻃﺎ‬
‫ً‬ ‫وﻫﻮ ﻓﺮع ﻣﻦ ‪، CN V3‬‬
‫ﻣﺘﻔﻮﻗﺎ ﻋﻠﻴﻬﺎ ﻣﻊ اﻷوﻋﻴﺔ اﻟﺼﺪﻏﻴﺔ اﻟﺴﻄﺤﻴﺔ‪ .‬اﻟﻌﺼﺐ اﻷذﻧﻲ‬ ‫ً‬
‫اﻟﺼﺪﻏﻲ واﻟﻌﺼﺐ اﻷذﻧﻲ اﻟﻜﺒﻴﺮ ‪ ،‬وﻫﻮ ﻓﺮع ﻣﻦ اﻟﻀﻔﻴﺮة‬
‫اﻟﻌﻨﻘﻴﺔ اﻟﻤﻜﻮﻧﺔ ﻣﻦ أﻟﻴﺎف ﻣﻦ ‪ C2‬و ‪ C3‬اﻟﻌﻤﻮد اﻟﻔﻘﺮي ‪،‬‬
‫ﻳﻌﺼﺐ اﻟﻐﻤﺪ اﻟﻨﻜﻔﻲ وﻛﺬﻟﻚ اﻟﺠﻠﺪ اﻟﻤﺤﻴﻂ‪ .‬ﻳﻮﻓﺮ اﻟﻤﻜﻮن‬
‫ً‬
‫أﻟﻴﺎﻓﺎ إﻓﺮازﻳﺔ‬ ‫اﻟﺴﻤﺒﺘﺎوي ﻟﻠﻌﺼﺐ اﻟﺒﻠﻌﻮﻣﻲ اﻟﻠﺴﺎﻧﻲ )‪(CN IX‬‬
‫ﻗﺒﻞ اﻟﻮﻻدة ﻟﻠﻌﻘﺪة اﻷذﻧﻴﺔ‪ .‬ﻳﺘﻢ ﻧﻘﻞ اﻷﻟﻴﺎف اﻟﺴﻤﺒﺘﺎوي ﺑﻌﺪ‬
‫اﻟﻤﺸﺒﻜﻲ ﻣﻦ اﻟﻌﻘﺪة إﻟﻰ اﻟﻐﺪة ﻋﻦ ﻃﺮﻳﻖ اﻟﻌﺼﺐ اﻷذﻧﻲ‬
‫اﻟﺼﺪﻏﻲ )ﻳﻨﺸﺄ اﻟﻌﺮض اﻹﻓﺮازي اﻟﺴﻤﺒﺘﺎوي ﻣﻦ اﻟﻌﺼﺐ‬
‫اﻟﻠﺴﺎﻧﻲ اﻟﺒﻠﻌﻮﻣﻲ‪ .‬ﺗﺼﻞ اﻷﻋﺼﺎب إﻟﻰ اﻟﻐﺪة ﻋﺒﺮ اﻟﻔﺮع‬
‫اﻟﻄﺒﻠﻲ ‪ ،‬واﻟﻌﺼﺐ اﻟﺼﺨﺮي اﻷﺻﻐﺮ ‪ ،‬واﻟﻌﻘﺪة اﻷذﻧﻴﺔ ‪،‬‬
‫واﻟﻌﺼﺐ اﻟﺼﺪﻏﻲ( ‪ .‬ﻳﻨﺘﺞ ﻋﻦ ﺗﺤﻔﻴﺰ اﻷﻟﻴﺎف اﻟﺴﻤﺒﺘﺎوي‬
‫ﻣﺎﺋﻴﺎ‪ُ .‬ﺗﺸﺘﻖ اﻷﻟﻴﺎف اﻟﺴﻤﺒﺜﺎوﻳﺔ ﻣﻦ اﻟﻌﻘﺪ اﻟﻌﻨﻘﻴﺔ‬ ‫ً‬
‫رﻗﻴﻘﺎ ً‬ ‫ﻟﻌﺎ ًﺑﺎ‬
‫ﻣﻦ ﺧﻼل ﺿﻔﻴﺮة اﻟﻌﺼﺐ اﻟﺴﺒﺎﺗﻲ اﻟﺨﺎرﺟﻲ ﻋﻠﻰ اﻟﺸﺮﻳﺎن‬
‫اﻟﺴﺒﺎﺗﻲ اﻟﺨﺎرﺟﻲ‪ .‬ﻗﺪ ﻳﻘﻠﻞ اﻟﻨﺸﺎط اﻟﺤﺮﻛﻲ ﻟﻬﺬه اﻷﻟﻴﺎف ﻣﻦ‬
‫إﻓﺮاز اﻟﻐﺪة‪ .‬ﺗﻤﺮ اﻷﻟﻴﺎف اﻟﻌﺼﺒﻴﺔ اﻟﺤﺴﻴﺔ إﻟﻰ اﻟﻐﺪة ﻋﺒﺮ‬
‫اﻷﻋﺼﺎب اﻷذﻧﻴﺔ اﻟﻜﺒﻴﺮة واﻷﻋﺼﺎب اﻷذﻧﻴﺔ اﻟﺼﺪﻏﻴﺔ‪.‬‬
 :‫ﻋﻤﻠﻴﺎت اﻟﻐﺪة اﻟﻨﻜﻔﻴﺔ‬
University of Al-Ameed General Anatomy Dr.
:‫ وﺗﺸﻤﻞ‬، ‫ﻓﻲ اﺗﺠﺎﻫﺎت ﻣﺨﺘﻠﻔﺔ‬ Muntather
"‫"ﻋﻤﻠﻴﺎت‬ Muhsen
‫ ﺗﺮﺳﻞ‬، ‫ﻣﻔﺼﺼﺔ ﻏﻴﺮ ﻣﻨﺘﻈﻤﺔ‬ ‫اﻟﻐﺪة ﻋﺒﺎرة ﻋﻦ ﻛﺘﻠﺔ‬
Dentistry College ‫ أﻣﺎم اﻟﺼﻤﺎخ اﻟﺴﻤﻌﻲ اﻟﺨﺎرﺟﻲ‬، ‫ اﻟﻨﺘﻮء اﻟﺤﻘﺎﻧﻲ اﻟﺬي ﻳﻤﺘﺪ ﺻﻌﻮدً ا ﺧﻠﻒ اﻟﻤﻔﺼﻞ اﻟﺼﺪﻏﻲ‬.1
.‫ ﺗﻤﺘﺪ ﻋﻤﻠﻴﺔ اﻟﻮﺟﻪ إﻟﻰ اﻷﻣﺎم ﻋﻠﻰ اﻟﻌﻀﻠﺔ اﻟﻤﺎﺿﻐﺔ‬.2
.‫ ﺟﺰء ﺻﻐﻴﺮ ﻣﻦ ﻋﻤﻠﻴﺔ اﻟﻮﺟﻪ ﻳﻘﻊ ﻋﻠﻰ ﻃﻮل اﻟﻘﻨﺎة اﻟﻨﻜﻔﻴﺔ‬، (‫ ﻋﻤﻠﻴﺔ اﻹﻛﺴﺴﻮار )ﺟﺰء‬.3
.‫اﻹﻧﺴﻴ ﺔ وﻓﺮع اﻟﻔﻚ اﻟﺴﻔﻠﻲ‬
ّ ‫ وﺗﻘﻊ ﺑﻴﻦ اﻟﻌﻀﻠﺔ اﻟﺠﻨﺎﺣﻴﺔ‬، ‫ ﻋﻤﻠﻴﺔ ﺟﻨﺎﺣﻴﺔ ﺗﻤﺘﺪ إﻟﻰ اﻷﻣﺎم ﻣﻦ اﻟﺠﺰء اﻷﻋﻤﻖ‬.4
.‫ ﻋﻤﻠﻴﺔ اﻟﺸﺮﻳﺎن اﻟﺴﺒﺎﺗﻲ اﻟﺘﻲ ﺗﻘﻊ ﺧﻠﻒ اﻟﺸﺮﻳﺎن اﻟﺴﺒﺎﺗﻲ اﻟﺨﺎرﺟﻲ‬.5
Processes of Parotid Gland:
The gland is an irregular lobulated mass, sends “processes" in various directions.
These include :
1. Glenoid process that extends upward behind the temporomandibular joint, in
front of external auditory meatus
2. Facial process that
extends anteriorly onto
the masseter muscle.
3. Accessory process (part),
small part of facial process
lying along the parotid
duct.
4. Pterygoid process that
extends forward from the
deeper part, lies between
the medial pterygoid
muscle & the ramus of
mandible.
5. Carotid process that lies
posterior to the external
carotid artery. ‫ﻳﻔﺼﻞ اﻟﻐﺪة اﻟﻨﻜﻔﻴﺔ ﻋﻦ اﻟﻐﺪة‬ .‫ﻳُ ﻄﻠﻖ ﻋﻠﻰ ﺟﺰء ﻣﻦ اﻟﻠﻔﺎﻓﺔ اﻟﻤﻤﺘﺪة ﻣﻦ ﻋﻤﻠﻴﺔ اﻹﺑﺮة إﻟﻰ زاوﻳﺔ اﻟﻔﻚ اﻟﺴﻔﻠﻲ اﻟﺮﺑﺎط اﻹرﺑﻲ اﻟﻔﻜﻲ‬
.‫ﺗﺤﺖ اﻟﻔﻚ اﻟﺴﻔﻠﻲ‬
.‫ اﻟﺸﺮﻳﺎن اﻟﺴﺒﺎﺗﻲ اﻟﺨﺎرﺟﻲ وﻓﺮوﻋﻪ اﻟﻄﺮﻓﻴﺔ‬:‫إﻣﺪاد اﻟﺸﺮاﻳﻴﻦ‬
‫ ﻓﻲ اﻟﻐﺪة اﻟﻨﻜﻔﻴﺔ ﺛﻢ إﻟﻰ اﻟﻐﺪد اﻟﻠﻴﻤﻔﺎوﻳﺔ اﻟﻌﻨﻘﻴﺔ اﻟﻌﻤﻴﻘﺔ‬:‫ اﻟﺘﺼﺮﻳﻒ اﻟﻠﻴﻤﻔﺎوي‬.‫ ﻓﻲ اﻟﻮرﻳﺪ اﻟﺮﺟﻌﻲ‬:‫اﻟﺘﺼﺮﻳﻒ اﻟﻮرﻳﺪي‬

A portion of fascia extending from the styloid process to the angle of mandible is
called stylomandibular ligament. It separates the parotid gland from the
submandibular gland.

Arterial supply: External carotid artery & its terminal branches.

Venous drainage: Into the retro-mandibular vein.

Lymph Drainage: Into the parotid & then into the deep cervical lymph nodes.

Lecture 4 6 Ali Sabah

 ‫ وﻫﻲ ﻋﺒﺎرة ﻋﻦ وﺳﺎدة دﻫﻨﻴﺔ ﻋﻤﻴﻘﺔ ﺗﻘﻊ ﻋﻠﻰ ﺟﺎﻧﺒﻲ اﻟﻮﺟﻪ ﺑﻴﻦ ﻋﻀﻠﺔ اﻟﺒﻮﻛﻴﻨﺎﺗﻮر واﻟﻌﺪﻳﺪ‬.‫دﻫﻮن اﻟﺨﺪ ﻫﻲ واﺣﺪة ﻣﻦ ﻋﺪة ﻛﺘﻞ دﻫﻨﻴﺔ ﻣﻐﻠﻔﺔ ﻓﻲ اﻟﺨﺪ‬
‫اﻟﺤﺸﻮة اﻟﺪﻫﻨﻴﺔ اﻟﺸﺪﻗﻴﺔ‬
University ‫ ﻳﺒﺪأ ﺗﻜﻮﻳﻦ‬.‫ اﻟﻔﺮاغ‬.(‫واﻟﻮﺟﻪ اﻟﻮﺟﻨﻲ اﻟﺼﻐﺮى‬
of Al-Ameed General‫واﻟﻮﺟﻨﻴﺔ اﻟﻜﺒﻴﺮة‬
Anatomy‫ﻣﻦ اﻟﻌﻀﻼت اﻟﺴﻄﺤﻴﺔ اﻷﺧﺮى )ﺑﻤﺎ ﻓﻲ ذﻟﻚ اﻟﻌﻀﻠﺔ اﻟﻌﻀﻠﻴﺔ‬
Dr. Muntather Muhsen
‫ ﻳﺘﻨﺎﻗﺺ ﺑﺮوزﻫﺎ ﻓﻲ ﻣﻨﻄﻘﺔ وﺳﻂ اﻟﻮﺟﻪ ﻣﻊ اﻟﺘﻐﻴﺮات ﻓﻲ ﻧﺴﺐ اﻟﻮﺟﻪ اﻟﻨﺎﺗﺠﺔ ﻋﻦ‬.‫ وﻳﺰداد ﺣﺠﻢ اﻟﻀﻤﺎدة ﺣﺘﻰ اﻟﻮﻻدة‬، ‫ أﺷﻬﺮ ﻓﻲ اﻟﺮﺣﻢ‬3 ‫ﻓﻲ ﻋﻤﺮ‬
Dentistry College
‫ وزﻣﺎﻧﻲ‬، ‫ ﺟﻨﺎﺣﻲ‬، ‫ ﺟﻨﺎﺣﻲ‬، ‫ ﺷﺪﻗﻲ‬:‫ ﺗﺸﻴﺮ اﻷوﺻﺎف اﻟﺘﺸﺮﻳﺤﻴﺔ اﻟﺘﻘﻠﻴﺪﻳﺔ إﻟﻰ أن اﻟﻮﺳﺎدة اﻟﺪﻫﻨﻴﺔ اﻟﺸﺪﻗﻴﺔ ﻟﻬﺎ ﺟﺴﻢ ﻣﺮﻛﺰي وأرﺑﻊ ﻋﻤﻠﻴﺎت‬.‫اﻟﺸﻴﺨﻮﺧﺔ‬

The Buccal Pad of Fat:

The buccal fat is one of several encapsulated fat masses in the cheek . It is a deep fat pad
located on either side of the face between the buccinator muscle and several more
superficial muscles (including the masseter, the zygomaticus major, and the zygomaticus
minor).The inferior portion of the buccal fat pad is contained within the buccal space.
The buccal fat pad formation begins at 3 months in utero, and the pad increases in size
until birth. Its prominence in the midfacial region decreases with the changes in facial
proportions brought by aging. Traditional anatomic descriptions state that the buccal fat
pad has a central body and four processes: buccal, pterygoid, pterygopalatine and temporal
The blood supply to the buccal fat pad originates from:

1. The buccal and deep temporal branches of the maxillary artery

2. the transverse facial branch of the superficial temporal artery
3. branches of the facial artery. This rich vascularity allows a reliable long axial flap and
explains the rapid surface reepithelialization.
The buccal and zygomatic branches of the facial nerve and the parotid duct lie lateral to the
fat pad and should not be injured during flap mobilization. The buccal process is located
deep to the superficial musculoaponeurotic system at the anterior border of the masseter
muscle. In children, this lobe may overlie the masseter muscle, producing the characteristic
cherubic fullness.
‫ ﻓﺮوع‬.3 ‫ ﻓﺮع اﻟﻮﺟﻪ اﻟﻤﺴﺘﻌﺮض ﻟﻠﺸﺮﻳﺎن اﻟﺼﺪﻏﻲ اﻟﺴﻄﺤﻲ‬.2 ‫ اﻟﻔﺮوع اﻟﺸﺪﻗﻴﺔ واﻟﻌﻤﻴﻘﺔ ﻟﻠﺸﺮﻳﺎن اﻟﻔﻜﻲ‬.1 :‫ﻳﻨﺸﺄ ﺗﺪﻓﻖ اﻟﺪم إﻟﻰ اﻟﻮﺳﺎدة اﻟﺪﻫﻨﻴﺔ اﻟﺸﺪﻗﻴﺔ ﻣﻦ‬
‫ ﺗﻘﻊ اﻟﻔﺮوع اﻟﺸﺪﻗﻴﺔ واﻟﻮﺟﻨﻴﺔ ﻟﻠﻌﺼﺐ‬.‫ ﺗﺴﻤﺢ ﻫﺬه اﻷوﻋﻴﺔ اﻟﺪﻣﻮﻳﺔ اﻟﻐﻨﻴﺔ ﺑﺴﺪﻳﻠﺔ ﻣﺤﻮرﻳﺔ ﻃﻮﻳﻠﺔ ﻣﻮﺛﻮﻗﺔ وﺗﺸﺮح ﺳﺮﻋﺔ إﻋﺎدة اﻟﺘﻬﻴﺌﺔ اﻟﺴﻄﺤﻴﺔ‬.‫ﺷﺮﻳﺎن اﻟﻮﺟﻪ‬
‫ ﺗﻘﻊ ﻋﻤﻠﻴﺔ اﻟﺸﺪق ﻓﻲ ﻋﻤﻖ اﻟﺠﻬﺎز اﻟﻌﻀﻠﻲ اﻟﺼﺎﺑﻮﻧﻲ اﻟﺴﻄﺤﻲ‬.‫اﻟﻮﺟﻬﻲ واﻟﻘﻨﺎة اﻟﻨﻜﻔﻴﺔ ﺟﻨ ًﺒ ﺎ إﻟﻰ ﺟﻨﺐ ﻣﻊ اﻟﻮﺳﺎدة اﻟﺪﻫﻨﻴﺔ وﻳﺠﺐ ﻋﺪم إﺻﺎﺑﺔ أﺛﻨﺎء ﺗﺤﺮﻳﻚ اﻟﺴﺪﻳﻠﺔ‬
.‫ ﻣﻤﺎ ﻳﻨﺘﺞ ﻋﻨﻪ اﻻﻣﺘﻼء اﻟﻜﺮوﺑﻲ اﻟﻤﻤﻴﺰ‬، ‫ ﻗﺪ ﻳﻜﻮن ﻫﺬا اﻟﻔﺺ ﻓﻮق اﻟﻌﻀﻠﺔ اﻟﻤﺎﺿﻐﺔ‬، ‫ ﻓﻲ اﻷﻃﻔﺎل‬.‫ﻋﻨﺪ اﻟﺤﺪود اﻷﻣﺎﻣﻴﺔ ﻟﻠﻌﻀﻠﺔ اﻟﻤﺎﺿﻐﺔ‬
Lecture 4 7 Ali Sabah
 ‫اﻻﻋﺘﺒﺎرات اﻟﺴﺮﻳﺮﻳﺔ‬
University of Al-Ameed
‫ﺣﺒﻴﺒﺎت اﻟﻌﺮق ﻋﻠﻰ اﻟﺠﻠﺪ‬ ‫ ﺗﻈﻬﺮ‬، ‫ ﻋﻨﺪﻣﺎ ﻳﺄﻛﻞ اﻟﻤﺮﻳﺾ‬.‫اﻟﻨﻜﻔﻴﺔ‬General ‫ واﻟﺘﻲ ﺗﺘﻄﻮر أﺣﻴﺎ ًﻧﺎ ﺑﻌﺪ اﺧﺘﺮاق‬Dr.
‫ﺟﺮوح اﻟﻐﺪة‬Anatomy ‫ﻟﻼﻫﺘﻤﺎم‬Muntather
‫ﻣﻦ اﻟﻤﻀﺎﻋﻔﺎت اﻟﻤﺜﻴﺮة‬Muhsen
‫ﺗﻌﺪ ﻣﺘﻼزﻣﺔ ﻓﺮاي‬
Dentistry College
‫اﻟﺤﺮﻛﻴﺔ اﻹﻓﺮازﻳﺔ‬ ‫ ﺗﻨﻤﻮ اﻷﻟﻴﺎف‬، ‫ أﺛﻨﺎء ﻋﻤﻠﻴﺔ اﻟﺸﻔﺎء‬.‫ ﺗﺤﺪث ﻫﺬه اﻟﺤﺎﻟﺔ ﺑﺴﺒﺐ ﺗﻠﻒ اﻷﻋﺼﺎب اﻷذﻧﻴﺔ اﻟﺼﺪﻏﻴﺔ واﻷﻋﺼﺎب اﻷذﻧﻴﺔ اﻟﻜﺒﻴﺮة‬.‫اﻟﺬي ﻳﻐﻄﻲ اﻟﻨﻜﻔﻴﺔ‬
‫ وﺑﻬﺬه‬.‫ ﺗﺼﻞ ﻫﺬه اﻷﻟﻴﺎف إﻟﻰ اﻟﻐﺪد اﻟﻌﺮﻗﻴﺔ ﻓﻲ ﺟﻠﺪ اﻟﻮﺟﻪ‬، ‫ ﻓﻲ اﻟﻨﻬﺎﻳﺔ‬.‫اﻟﺴﻤﺒﺘﺎوي ﻓﻲ اﻟﻌﺼﺐ اﻷذﻧﻲ اﻟﺼﺪﻏﻲ وﺗﻨﻀﻢ إﻟﻰ اﻟﻨﻬﺎﻳﺔ اﻟﺒﻌﻴﺪة ﻟﻠﻌﺼﺐ اﻷذﻧﻲ اﻟﻌﻈﻴﻢ‬
.‫ ﻓﺈن اﻟﻤﻨﺒﻪ اﻟﻤﺨﺼﺺ ﻹﻧﺘﺎج اﻟﻠﻌﺎب ﻳﻨﺘﺞ ﻋﻨﻪ إﻓﺮاز اﻟﻌﺮق ﺑﺪﻻً ﻣﻦ ذﻟﻚ‬، ‫اﻟﻮﺳﻴﻠﺔ‬

Clinical Consideration

Frey's Syndrome
Frey's syndrome is an interesting complication that sometimes develops after penetrating
wounds of the parotid gland .
When the patient eats, beads of perspiration appear on the skin covering the parotid. This
condition is caused by damage to the auriculotemporal and great auricular nerves . During
the process of healing, the parasympathetic secretomotor fibers in the auriculotemporal
nerve grow out and join the distal end of the great auricular nerve. Eventually, these fibers
reach the sweat glands in the facial skin. By this means, a stimulus intended for saliva
production produces sweat secretion instead .

Parotid Salivary Gland and Lesions of the Facial Nerve

The parotid salivary gland consists essentially of superficial and deep parts, and the
important facial nerve lies in the interval between these parts. A benign parotid neoplasm
rarely, if ever ,causes facial palsy. A malignant tumor of the parotid is usually highly
invasive and quickly involves the facial nerve, causing unilateral facial paralysis .

Parotid Gland Infections

The parotid gland may become acutely inflamed as a result of retrograde bacterial infection
from the mouth via the parotid duct.The gland may also become infected via the
bloodstream, as in mumps . In both cases, the gland is swollen; it is painful because the
fascial capsule derived from the investing layer of deep cervical fascia is strong and limits
the swelling of the gland. The swollen glenoid process , which extends medially behind the
temporomandibular joint, is responsible for the pain experienced in acute parotitis when
eating .
‫ وﻳﻘﻊ‬، ‫أﺳﺎﺳﺎ ﻣﻦ أﺟﺰاء ﺳﻄﺤﻴﺔ وﻋﻤﻴﻘﺔ‬ ً ‫اﻟﻐﺪة اﻟﻠﻌﺎﺑﻴﺔ اﻟﻨﻜﻔﻴﺔ وآﻓﺎت اﻟﻌﺼﺐ اﻟﻮﺟﻬﻲ ﺗﺘﻜﻮن اﻟﻐﺪة اﻟﻠﻌﺎﺑﻴﺔ اﻟﻨﻜﻔﻴﺔ‬
‫ ﻧﺎد ًرا ﻣﺎ ﻳﺘﺴﺒﺐ اﻟﻮرم اﻟﻨﻜﻔﻲ اﻟﺤﻤﻴﺪ ﻓﻲ ﺣﺪوث ﺷﻠﻞ ﻓﻲ‬.‫اﻟﻌﺼﺐ اﻟﻮﺟﻬﻲ اﻟﻤﻬﻢ ﻓﻲ اﻟﻔﺘﺮة اﻟﻔﺎﺻﻠﺔ ﺑﻴﻦ ﻫﺬه اﻷﺟﺰاء‬
‫ ﻣﻤﺎ ﻳﺘﺴﺒﺐ‬، ‫ ﻋﺎدة ﻣﺎ ﻳﻜﻮن اﻟﻮرم اﻟﺨﺒﻴﺚ ﻓﻲ اﻟﻐﺪة اﻟﻨﻜﻔﻴﺔ ﺷﺪﻳﺪ اﻟﺘﻮﻏﻞ وﻳﺴﺒﺐ ﺳﺮﻳﻌً ﺎ ﻓﻲ اﻟﻌﺼﺐ اﻟﻮﺟﻬﻲ‬.‫اﻟﻮﺟﻪ‬
.‫ﻓﻲ ﺷﻠﻞ اﻟﻮﺟﻪ ﻣﻦ ﺟﺎﻧﺐ واﺣﺪ‬
‫ ﻛﻤﺎ ﻗﺪ‬، ‫ ﻗﺪ ﺗﻠﺘﻬﺐ اﻟﻐﺪة اﻟﻨﻜﻔﻴﺔ ﺑﺸﺪة ﻧﺘﻴﺠﺔ ﻋﺪوى ﺑﻜﺘﻴﺮﻳﺔ رﺟﻌﻴﺔ ﻣﻦ اﻟﻔﻢ ﻋﺒﺮ اﻟﻘﻨﺎة اﻟﻨﻜﻔﻴﺔ‬:‫اﻟﺘﻬﺎﺑﺎت اﻟﻐﺪة اﻟﻨﻜﻔﻴﺔ‬
‫ إﻧﻪ ﻣﺆﻟﻢ‬.‫ ﺗﻜﻮن اﻟﻐﺪة ﻣﻨﺘﻔﺨﺔ‬، ‫ ﻓﻲ ﻛﻠﺘﺎ اﻟﺤﺎﻟﺘﻴﻦ‬.‫ ﻛﻤﺎ ﻫﻮ اﻟﺤﺎل ﻓﻲ اﻟﻨﻜﺎف‬، ‫ﺗﺼﺎب اﻟﻐﺪة ﺑﺎﻟﻌﺪوى ﻋﺒﺮ ﻣﺠﺮى اﻟﺪم‬
‫ اﻟﻌﻤﻠﻴﺔ‬.‫ﻷن اﻟﻜﺒﺴﻮﻟﺔ اﻟﻠﻔﺎﻓﻴﺔ اﻟﻤﺸﺘﻘﺔ ﻣﻦ اﻟﻄﺒﻘﺔ اﻟﻤﺴﺘﺜﻤﺮة ﻣﻦ اﻟﻠﻔﺎﻓﺔ اﻟﻌﻨﻘﻴﺔ اﻟﻌﻤﻴﻘﺔ ﻗﻮﻳﺔ وﺗﺤﺪ ﻣﻦ ﺗﻮرم اﻟﻐﺪة‬
‫ ﻣﺴﺆوﻟﺔ ﻋﻦ اﻷﻟﻢ اﻟﺬي ﻳﻌﺎﻧﻲ ﻣﻨﻪ اﻟﺘﻬﺎب‬، ‫ واﻟﺘﻲ ﺗﻤﺘﺪ ﻓﻲ اﻟﻮﺳﻂ ﺧﻠﻒ اﻟﻤﻔﺼﻞ اﻟﺼﺪﻏﻲ اﻟﻔﻜﻲ‬، ‫اﻟﺤﻘﺎﻧﻴﺔ اﻟﻤﺘﻮرﻣﺔ‬
The End .‫اﻟﻐﺪة اﻟﻨﻜﻔﻴﺔ اﻟﺤﺎد ﻋﻨﺪ ﺗﻨﺎول اﻟﻄﻌﺎم‬

Lecture 4 8 Ali Sabah