Parotid Gland - Applied Anatomy and Surgical Considerations

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PAROTID GLANDAPPLIED

ANATOMY AND SURGICAL

CONSIDERATIONS

DR FAHAD QIAM

FCPS II RESIDENT (ORAL AND MAXILLOFACIALSURGERY)

SURGICAL E WARD

KHYBER TEACHING HOSPITAL


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CONTENTS

What is the parotid gland

Anatomy of the parotid gland

Applied anatomy of the parotid gland

Overview of parotid gland disorders

Surgical exposure of the parotid gland & case

presentation

Complications of parotid gland surgery

Self assessment exercise


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PAROTID??


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Starts to develop

at 35thday in

utero

Largest of all

salivary glands

Secretes serous

saliva andsalivary amylase

Contributes 25%

of total saliva

production


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RELATIONS


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IMPORTANT RELATIONSHIPS

External carotid artery and its branches

Retromandibular vein and its tributaries

Facial nerve


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EXTERNAL CAROTID ARTERY AND ITS

BRANCHES


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RETROMANDIBULAR VEINS AND ITS

TRIBUTARIES


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FACIAL NERVE

Arises at the pons

Exits via internal acoustic meatus

Goes into facial canal of temporal bone

Exits skull at stylomastoid foramen

Large motor and smallsensory root

Geniculate ganglionGreater petrosal nerve, nerve tostapedius and chorda tympani

Motor supply to the muscles of facial expression


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NERVE TESTING


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DA JALIL

KEBABS!!


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FACIAL NERVE


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NERVE SUPPLY

Auriculotemporal nerve provides sensory supply

Auriculotemporal nerve Otic Ganglion Glossopharyngeal nerve


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WHO????


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APPLIEDANATOMY

Bi-lobed structure

Facial nerve passesaround the isthmus

connecting the two lobes

Contains lymph nodesthat are both intra-

glandular and extra-

glandular


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ANATOMICAL VARIATIONS


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FACIALNERVEGIVESTWOBRANCHESINTHE

GLAND, TEMPOROFACIALANDCERVICOFACIAL


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CASENO.1 A 56 year old man

reported to theDepartment of Oral andMaxillofacial Surgery witha painless swelling in theright pre-auricular region

for the past 3 years. Theswelling was firm,indurated, well localizied,measuring 4x5cm ingreatest diameter. Therewere no associatedsymptoms. No dentalcause for the swelling wasfound. OPG wasunremarkable. Facialnerve was intact.


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HOW TO DIAGNOSE?


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SURGICAL EXPOSURE OF THE

PAROTID GLAND


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HEADPOSITIONINGANDDRAPING


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THEINCISION


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FACIALNERVEMARKERS

Tragal pointer (nerve is inferior and 1cm deep to thislandmark)

Tympanic ring

Anterior aspect of mastoid bone

Tympanomastoid suture line (leads directly tostylomastoid foramen)

Posterior belly of digastric muscle (Facial nerve at samedepth, just above muscle)

Styloid process (facial nerve in angle between styloid anddigastric, and crosses styloid more anteriorly)


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CASENO.2 A 6 year old male

reported with a 2 monthhistory of a tenderswelling in the left pre-auricular region. It was

associated withoccasional pusdischarge and bleedingduring spitting.

Bilateral submandibularlymph nodes werepalpable


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NEED FOR DEEP PAROTIDECTOMY?

Rare as deep lobe is only affected in 20% of parotid

tumors

Undergoes atrophy after superficial parotidectomy

More cumbersome as it usually requires a ramus

osteotomy for full exposure

Requires ligation of external carotid artery,

retromandibular vein, superficial temporal veins

and division of facial nerve trunk


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COMPLICATIONS


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FREYS SYNDROME


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BELLS PALSY


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FOLLOWUP


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SIALOCELE


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PARASTHESIA OF THE EAR LOBE


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KEYPOINTS No or short muscle relaxant

Excellent lighting

Correctly applied traction and

counter traction

Adequate exposure (SMAS)

Clear definition of regionalanatomy

Always take a cuff of normalparotid tissue

Use of EMG based facial nerve

testing

Use of bipolar current

Raw gland surface should not besutured to the skin

Pressure dressing

Use of close suction drain

Sacrifice versus preservation

Patient counselling


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ANYQUESTIONS?

Parotid Gland - Applied Anatomy and Surgical Considerations

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