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The parotid region is the area on the lateral aspect of the face, below the zygomatic arch, and anterior to the ear.
It contains the largest salivary gland — the parotid gland, along with its duct, facial nerve branches, external carotid artery, and retromandibular vein.
This region is of surgical importance due to the complex relations of nerves and vessels passing through the gland.
Three pairs of major salivary glands:
Parotid (largest, purely serous)
Submandibular (mixed, mostly serous)
Sublingual (mixed, mostly mucous)
Functions: secrete saliva → aids digestion, lubricates food, maintains oral hygiene.
Shape and Location:
Irregular, wedge-shaped gland lying between ramus of mandible and sternocleidomastoid (SCM).
Situated below and in front of the ear.
Extends from zygomatic arch above to the angle of mandible below.
Capsule:
True capsule: condensation of connective tissue of gland.
False capsule: derived from investing layer of deep cervical fascia.
The fascia forms parotid sheath, thickened at the upper border to form the stylomandibular ligament (separates it from submandibular gland).
Superficial (Lateral): Skin, superficial fascia, great auricular nerve.
Deep (Medial): Styloid process and associated muscles (styloglossus, stylopharyngeus), internal carotid artery, internal jugular vein.
Anterior: Ramus of mandible, masseter, medial pterygoid.
Posterior: Mastoid process, SCM, posterior belly of digastric.
Superior: External acoustic meatus, temporomandibular joint (TMJ).
Inferior: Posterior belly of digastric, carotid sheath.
Mnemonic: F–V–A
Facial nerve (divides into 5 terminal branches)
Retromandibular vein
External carotid artery (gives posterior auricular and divides into maxillary and superficial temporal arteries)
The gland is dissected after removal of skin and fascia from the lateral face.
Identify:
Parotid duct (Stensen’s duct) crossing masseter.
Facial nerve trunk emerging from stylomastoid foramen and dividing into temporo-facial and cervico-facial divisions.
Retromandibular vein and external carotid artery lying deep to it.
Parotid Abscess:
Due to infection (often from mumps or suppurative parotitis).
Severe pain due to unyielding fascia; swelling pushes ear upward and outward.
Parotid Tumors:
Usually pleomorphic adenoma (benign, slow-growing).
Surgery risky because of facial nerve branches passing through gland.
Frey’s Syndrome (Auriculotemporal Syndrome):
After parotidectomy, misdirected regeneration of auriculotemporal nerve causes sweating while eating (gustatory sweating).
Mumps:
Viral infection causing painful swelling of parotid; may lead to orchitis in males.
Facial Nerve Injury:
During surgery or trauma → Bell’s palsy (loss of facial expression on one side).
Skin – thin and movable over gland.
Superficial fascia – contains great auricular nerve (sensory to capsule) and superficial parotid lymph nodes.
Parotid fascia (false capsule) – tough fibrous layer derived from investing cervical fascia; limits glandular expansion → source of pain in swelling.
Lies against zygomatic arch and external acoustic meatus.
Roof is crossed by branches of temporal artery and auriculotemporal nerve.
Overlaps posterior belly of digastric and stylohyoid.
Prolongs downward as the facial process between mandible and sternocleidomastoid (SCM).
Related to masseter muscle.
Gives rise to parotid duct, which emerges from anterior border.
Facial nerve branches (temporal, zygomatic, buccal, marginal mandibular, cervical) radiate forward.
Lies over mastoid process and SCM.
Related to posterior belly of digastric, occipital artery, and great auricular nerve.
Deep within: styloid process with its attached muscles (styloglossus, stylopharyngeus, stylohyoid).
Contacts styloid apparatus (styloid process + muscles + ligament), internal jugular vein, and internal carotid artery.
Separated from pharyngeal wall by retrostyloid space containing glossopharyngeal, vagus, accessory nerves.
Mnemonic: “Nerve – Vein – Artery” (from superficial to deep)
Facial nerve – enters via stylomastoid foramen, divides within gland into temporofacial & cervicofacial trunks → five terminal branches.
Retromandibular vein – formed within gland by union of superficial temporal + maxillary veins.
External carotid artery – enters from below, gives posterior auricular branch and divides into maxillary & superficial temporal arteries.
~ 5 cm long, emerges from anterior border of gland.
Runs over masseter, parallel with zygomatic arch about 1 finger breadth below it.
At anterior border of masseter, turns medially, pierces:
Buccal fat pad
Buccopharyngeal fascia
Buccinator muscle
Mucous membrane of cheek
Opens opposite the upper second molar tooth as a small papilla.
Lies midway between zygomatic arch and angle of mandible.
Crossed by buccal branches of facial nerve.
Accompanied by transverse facial artery (above) and buccal fat pad (below).
Viral parotitis caused by paramyxovirus.
Pain aggravated on chewing due to tough fascia.
In males may cause orchitis and infertility.
Bacterial infection producing pus under the un-yielding capsule → severe pain.
Swelling pushes ear up and out.
Drain through small incision parallel to duct to avoid facial nerve injury.
After parotidectomy or trauma, parasympathetic fibers of auriculotemporal nerve join sweat glands → sweating and flushing on chewing.
Pleomorphic adenoma = most common benign tumor.
Surgical removal requires facial-nerve preservation.
During surgery or fracture of mandible angle → loss of facial expression on same side.
Type: Purely serous gland (tubulo-alveolar).
Secretory units: Acini lined by pyramidal cells with round nuclei and basophilic cytoplasm.
Duct system: Intercalated → striated → interlobular ducts.
Stroma: Connective tissue septae divide gland into lobules; contain vessels and ducts.
Develops from ectodermal buds of the oral epithelium near the angles of the stomodeum around 6ᵗʰ week of intra-uterine life.
Solid cords grow into mesenchyme, branch, and canalize to form ducts and acini.
Epithelial component → secretory tissue and ducts; mesenchyme → capsule and stroma.
Becomes functional by the end of foetal life but secretion begins after birth.
Largest salivary gland: Parotid gland — purely serous in secretion.
Structures within the gland (superficial → deep):
Facial nerve
Retromandibular vein
External carotid artery
Fascia:
The false capsule (parotid sheath) is derived from the investing layer of deep cervical fascia.
Its rigidity explains the intense pain in mumps and abscess.
Stylomandibular ligament:
Thickened part of parotid fascia.
Separates parotid gland from submandibular gland.
Parotid duct (Stenson’s duct):
5 cm long, opens opposite upper 2nd molar.
Pierces buccinator, not its muscle fibers — passes through a gap.
Facial nerve within parotid:
Divides into temporofacial and cervicofacial trunks, giving five branches:
Temporal – Zygomatic – Buccal – Marginal mandibular – Cervical (mnemonic: To Zanzibar By Motor Car).
Parotid gland relations (surface marking):
Extends from zygomatic arch to angle of mandible.
Covers posterior border of ramus of mandible.
Parasympathetic supply:
From glossopharyngeal nerve (IX) → tympanic branch → lesser petrosal → otic ganglion → auriculotemporal nerve → gland.
Stimulation → copious watery secretion.
Sympathetic fibers:
From superior cervical ganglion via external carotid plexus → vasoconstriction.
Lymphatic drainage:
To parotid lymph nodes, then deep cervical nodes.
Because the gland is enclosed within a dense, inelastic fascia (parotid sheath).
Inflammation causes rapid increase in pressure, compressing sensory fibers of the great auricular nerve.
Injury to facial nerve or its branches within the gland.
Leads to paralysis of muscles of facial expression (Bell’s palsy type).
Frey’s syndrome (gustatory sweating):
Aberrant regeneration of parasympathetic fibers (auriculotemporal nerve) to sweat glands instead of glandular tissue.
Stimulation during eating causes sweating and flushing over parotid area.
Infection of parotid duct → parotid abscess or sialadenitis.
Duct opens opposite 2nd molar; pus may drain here.
Because swelling occurs beneath the unyielding fascia, pushing the pinna superolaterally.
To avoid iatrogenic facial paralysis; the nerve lies superficial in the gland and radiates fan-wise forward.
Can be injured in facial lacerations (esp. over masseter).
Blockage by calculi → painful swelling before meals (salivary colic).
The gland lies posterior to the ramus of mandible and deep part contacts masseter and medial pterygoid muscles; inflammation irritates these → spasm.
Great auricular nerve (C2, C3) — branch of cervical plexus.
Sensory fibers of the auriculotemporal nerve also supply the external acoustic meatus → referred otalgia.
Superior: Zygomatic arch.
Inferior: Angle and posterior border of mandible.
Anterior: Masseter muscle.
Posterior: Sternocleidomastoid and mastoid process.
From superficial to deep:
Facial nerve – divides into branches within gland.
Retromandibular vein.
External carotid artery – gives terminal branches (superficial temporal & maxillary arteries).
Length: ~5 cm.
Emerges from anterior border of parotid gland.
Runs over masseter, one finger breadth below zygomatic arch.
Turns medially, pierces buccinator muscle, and opens into the mouth opposite the upper second molar tooth.
Glandular tissue: Auriculotemporal nerve (branch of mandibular nerve).
Fascia and overlying skin: Great auricular nerve (C2, C3).
Preganglionic fibers: Inferior salivatory nucleus → Glossopharyngeal nerve → Tympanic branch → Lesser petrosal nerve → Otic ganglion.
Postganglionic fibers: Auriculotemporal nerve → Parotid gland.
From superior cervical ganglion via external carotid plexus → controls vasoconstriction.
Veins: Retromandibular vein.
Lymphatics: Parotid lymph nodes → Deep cervical lymph nodes.
Because the gland is enclosed in a dense, unyielding parotid fascia.
Inflammation increases internal pressure → compresses great auricular nerve.
Gustatory sweating over the parotid region after parotidectomy.
Occurs due to misdirected regeneration of parasympathetic fibers to sweat glands.
Anterior: Ramus of mandible and masseter.
Posterior: Mastoid process, sternocleidomastoid.
Medial: Styloid process and its muscles.
Superior: Zygomatic arch.
Inferior: Posterior belly of digastric.
1. The largest salivary gland is —
A. Submandibular gland
B. Sublingual gland
C. Parotid gland
D. Buccal gland
✅ Answer: C. Parotid gland
2. The parotid duct opens into the mouth opposite —
A. First molar tooth
B. Second molar tooth
C. Premolar tooth
D. Canine tooth
✅ Answer: B. Second molar tooth
3. The nerve supplying the parotid gland (secretomotor) is —
A. Facial nerve
B. Trigeminal nerve
C. Glossopharyngeal nerve
D. Vagus nerve
✅ Answer: C. Glossopharyngeal nerve
4. The parotid fascia is derived from —
A. Pretracheal fascia
B. Prevertebral fascia
C. Investing layer of deep cervical fascia
D. Buccopharyngeal fascia
✅ Answer: C. Investing layer of deep cervical fascia
5. The facial nerve leaves the skull through —
A. Stylomastoid foramen
B. Jugular foramen
C. Foramen ovale
D. Foramen spinosum
✅ Answer: A. Stylomastoid foramen
6. Frey’s syndrome results from injury to —
A. Glossopharyngeal nerve
B. Auriculotemporal nerve
C. Buccal branch of facial nerve
D. Mandibular nerve
✅ Answer: B. Auriculotemporal nerve
7. The secretion of the parotid gland is —
A. Serous
B. Mucous
C. Seromucous
D. Mixed
✅ Answer: A. Serous
8. The parotid gland is crossed superficially by —
A. Facial vein
B. Retromandibular vein
C. Transverse facial artery
D. Posterior auricular artery
✅ Answer: C. Transverse facial artery
9. The stylomandibular ligament is derived from —
A. Buccopharyngeal fascia
B. Investing layer of deep cervical fascia
C. Carotid sheath
D. Parotid fascia
✅ Answer: D. Parotid fascia
10. The facial nerve divides the parotid gland into —
A. Superficial and deep lobes
B. Upper and lower lobes
C. Medial and lateral lobes
D. Anterior and posterior lobes
✅ Answer: A. Superficial and deep lobes
Lies below and in front of the ear.
Extends from zygomatic arch (above) to angle of mandible (below).
Fills the parotid bed, between ramus of mandible and mastoid process.
True capsule: Condensation of connective tissue of gland.
False capsule (parotid fascia): Derived from investing layer of deep cervical fascia.
Because the parotid fascia is thick and unyielding — inflammation increases pressure within, compressing sensory fibers of great auricular nerve.
Facial nerve (VII cranial nerve).
Facial nerve
Retromandibular vein
External carotid artery
Enters through stylomastoid foramen → passes forward through gland → divides into temporofacial and cervicofacial trunks → gives five terminal branches.
Mnemonic: To Zanzibar By Motor Car
→ Temporal, Zygomatic, Buccal, Marginal Mandibular, Cervical.
Auriculotemporal nerve (branch of mandibular nerve), carrying postganglionic fibers from otic ganglion (parasympathetic pathway of glossopharyngeal nerve).
From external carotid artery and its terminal branches — superficial temporal and maxillary arteries.
By retromandibular vein formed within the gland.
Superficial and deep parotid lymph nodes → deep cervical lymph nodes.
Purely serous, compound tubuloalveolar gland.
From ectodermal buds of oral epithelium near the angles of the stomodeum during 6ᵗʰ week of development.
Runs over masseter, then pierces buccinator → opens opposite upper second molar tooth.
Mumps – viral parotitis.
Frey’s syndrome – gustatory sweating post-surgery.
Parotid abscess – painful swelling under fascia.
Pleomorphic adenoma – benign tumor.
Facial nerve palsy – due to surgery or infection.
Great auricular nerve (C2, C3).
Because parasympathetic fibers destined for salivation regenerate abnormally to sweat glands → sweating during eating.
Purely serous, watery secretion containing amylase.
Retrostyloid space, containing internal carotid artery, internal jugular vein, and cranial nerves IX, X, XI, XII.
Auriculotemporal nerve, branch of mandibular nerve (V3).
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