CHAPTER THE PAROTID, TEMPORAL AND INFRATEMPORAL REGIONS
Full text. Full text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (K), or click on a page. The parotid gland is a major salivary gland in many animals. In humans, the two parotid glands Superficial or lateral relations: The gland is situated deep to the skin, Branches of facial nerve and parotid duct emerge through this surface. The identification of the facial nerve in the parotid gland and its relation with either retromandibular vein or superficial temporal vein during parotidectomy or.
Variant position of the facial nerve in parotid gland
Treatment is by addressing the underlying systemic condition. Sarcoidosis Sarcoidosis is a chronic systemic disease characterised by the production of non-caseating granulomas of unknown aetiology. It can affect any organ of the body, depressing cellular immunity and enhancing humoral immunity. Salivary gland involvement primarily involves the parotid gland, causing enlargement and swelling.
Histopathology shows clustering of lymphocytic infiltrates and epimyoepithelial islands. Tuberculosis The most common head and neck manifestation of tuberculosis mycobacterial disease is infection of cervical lymph nodes. The infection is thought to originate in the tonsils or gingiva, ascending to the parotid gland. Two clinical forms; acute and chronic lesions.
Acute lesions have diffuse glandular edema, easily confused with acute sialdentitis or abscess.
The chronic lesions occur as slow growing masses mimicking tumors. History and Examination[ edit ] A patient with parotid swelling may complain of swelling, pain, xerostomiabad taste and sometimes sialorrhoea.Parotid Gland – Relations Internal Structures and Surgical Anatomy – Sanjoy Sanyal
Episodic swelling of major salivary glands accompanied by pain and related to salivary stimuli suggests duct obstruction. Also need to assess the facial nerve.
The facial nerve passes through the parotid so may be affected if there is a change in the parotid gland. Facial nerve paralysis in a previously untreated patient usually indicates that a tumour is malignant. Keywords facial nerve, parotid gland, retromandibular vein, total parotidectomy Introduction The retromandibular vein is formed by union of the maxillary and superficial temporal veins in the parotid gland [ 1 ].
The facial nerve enters the posteromedial surface of the parotid gland and crosses superficial to external carotid artery and retromandibular vein and divided into the cervicofacial and temporofacial divisions in the parotid gland [ 2 ]. During surgery for removal of tumors from the parotid gland, facial nerve can be injured because of its variant position between the maxillary and superficial temporal veins as found in this case.
Purpose of this paper is to reduce unexpected bleeding from superficial temporal vein during surgery and postoperative morbidity related to facial nerve paralysis.
Case Report We described a variant position of the facial nerve in parotid gland of the left side during routine educational dissection of a year-old male cadaver in the Department of Anatomy, GSL Medical College. The main trunk of the facial nerve was located between the formative tributaries of the retromandibular vein, i.
These two divisions then crossed maxillary vein superficially instead of the retromandibular vein. The retromandibular vein was formed by union of maxillary and superficial temporal veins below the apex of parotid gland Figure 1. Facial nerve is located between maxillary vein and superficial temporal vein in intermediate plane. Discussion The risk of damage to the facial nerve during surgical procedures of the parotid gland revealed the importance of knowledge of detailed anatomy of this region [ 3 ].
Chapter 48: The parotid, temporal and infratemporal regions
We found main trunk of the facial nerve and its divisions were forked between the maxillary and superficial temporal veins, so this variation could be used as a reference in surgery. Retromandibular vein was a sensitive marker for identifying the location of parotid gland neoplasm with respect to the facial nerve on cross-sectional imaging [ 7 ]. The identification of the facial nerve in the parotid gland and its relation with either retromandibular vein or superficial temporal vein during parotidectomy or repair of facial trauma is a paradigmatic procedure [ 8 ].
The superficial temporal and retromandibular veins have been reported to be used as guide to expose facial nerve branches in the parotid gland in cases of open reduction of mandibular condyle fractures and also for superficial parotidectomy [ 9 ].
These veins were usually grafted into the carotid during endarterectomy and for surgery involving microvascular anastomosis especially in oral reconstruction procedures [ 10 ].
So knowledge of such variation is very important for surgeon during surgery to prevent unexpected bleeding from superficial temporal vein while dealing with the facial nerve. Conclusion Knowledge of this type of variant position of the facial nerve is important for the physicians as the facial nerve might be compressed by increased venous return from superficial temporal and maxillary veins as the nerve was forked between these two veins, and for the surgeons in order to avoid any intraoperative trial and error procedures which might lead to unexpected bleeding from the superficial temporal vein and facial nerve damage.
Acknowledgements Our sincere thanks to all the people who helped and supported during the writing of this manuscript. We would thank our institution for allowing us to dissect cadaver and faculty members without whom this manuscript would have been a distant reality.
Mandibular landmarks as an aid in minimizing injury to the marginal mandibular branch: A metric and geometric anatomical study. Intraparotid anatomy of the facial nerve and retromandibular vein.