mandible

• The mandibular foramen and canal lie

medial to the mandibular angle. They
contain the inferior alveolar nerve (V3) and
vessels.
• The lingula serves as attachment point for
the sphenomandibular ligament.
 Parotid
• Largest of all salivary glands
• Weight approx. 15gms
• Situated between the ramus of the
mandible and sternomastoid muscle
 Boundaries of parotid region
• Anteriorly by the sphenomandibular and
stylomandibular ligaments as well as the
fasciae of the medial pterygoid and
masseter muscles
• Superiorly by the zygomatic arch;
• Inferiorly by the posterior belly of the
digastric
 Boundaries of parotid region
• The deep cervical fascia envelops the
parotid gland and is weakest between the
styloid process and spine of the sphenoid:
Parotid region
 Parotid capsule
• Made up of Deep Cervical Fascia
• Fascia splits into 2
• 1). Superficial lamina – Thick and
adherent to the gland
• 2). Deep lamina – Thin and attached to
styloid process, mandible and the
tympanic plate
 STRUCTURE
• Three sided pyramid with apex directed
downward
• Four surfaces
• Three borders
 The PAROTID BED
• Posteriorly by the mastoid process with
the origins of the sternocleidomastoideus
and the posterior belly of the digastric
• Medially by the styloid process of the
temporal bone and the stylohyoid muscle.
Styloglossus and stylopharyngeus are
also medial to the parotid bed within the
lateral pharyngeal space;
 Surfaces
and relations
Parotid (back to forth)
Parotid (med to lat)
 APEX
• Overlies the
• posterior belly of digastric and the adjoing
part of carotid triangle
• The cervical branch of branch of facial
nerve
• The two divisions of retromandibular vein
 Superior surface
• Forms the upper end of the gland
• Small and concave
• Related to:
1).cartilagenous part of external acoustic meatus
2)Post. Surface of TM joint
3).superficial temporal vessels
4).auriculotemporal nerve
 Superficial surface
• Largest of the four surfaces
• Covered with
• Skin
• Superficial fascia containing branches of
gr.auricular nerve preauricular LN and
post fibres of risorius (platysma)
• Parotid fascia
• Few LN embedded in the gland
 Anteromedial surface
• Grooved by the post border of ramus of
mandible
• Related to:
• Masseter
• Lat surface of TM joint
• The medial pterygoid
• Emerging br of facial nerve
 Posteromedial surface
• Moulded by mastoid and styloid process
• Related to
• ECA
• ICA deep to styloid
 Anterior border
• Separates the sup surface from antmed
surface
• Str emerging
• Parotid duct
• Terminal br of facial Nr
• Transverse facial vessels
 Post border
• Separates superficial surface from
postmed
• Overlaps sternomastoid
 Medial border
• Separates antmed from postmed
• Related to wall of pharynx
layers of parotid region
 First plane

The Venous Plane

The second plane

NERVOUS PLANE
The deepest part

PAROTID BED
 NERVE SUPPLY
• The parotid gland is innervated by the
lesser petrosal branch (secretomotor) of
the IXth (glossopharyngeal) nerve
• Preganglionic parasympathetic fibers from
the tympanic plexus in the middle ear
 Nerve supply of parotid
Lesser petrosal nerve
• enter the middle cranial fossa by a hiatus on the anterior
aspect of the petrous bone,
• run through the periosteal dura
• and exit the middle cranial fossa through the foramen ovale
with V3.
• The preganglionic fibers synapse in the otic ganglion on the
medial aspect of V3.
• The postganglionic fibers join with the auriculotemporal nerve
to run to the parotid gland.
• The auriculotemporal nerve thus carries secretomotor
fibers of IXth and sensory fibers of V3 for pain in the gland.
 Nerve supply
• The sympathetic innervation is from the
superior cervical ganglion via the arteries
and it controls the fluid content of the
saliva.
 APPLIED ANATOMY
• Infections may spread from the parotid fascia
into the lateral pharyngeal space which
communicates with the retropharyngeal
space) between the pharynx and
prevertebral musculature.
• Infections may track inferiorly through the
neck and into the thorax, along the course of
the carotid sheath, between visceral and
prevertebral fasciae.
• Parotid swellings are painful because of
the thick unyielding fascia overlying it
• Mumps
• Facial nerve defines the layer of dissection
for superficial parotidectomy operations
 Parotid Gland
• . Located on side of face, anterior to mastoid tip
and external auditory canal, inferior to zygomatic
arch, and superior to the lower border of the
angle of the mandible. Anteriorly, it overlaps the
masseter muscle.
• Stenson's duct enters oral cavity through buccal
mucosa opposite upper second molar.
• Parasympathetic secretory afferents to the
parotid leave the inferior salivary nucleus with the
glossopharyngeal nerve and travel via
Jacobson's plexus in the middle ear to synapse
in the otic ganglion. Post-synaptic fibers are
distributed to the parotid by the auriculotemporal
nerve.
• Facial nerve passes through this gland.
Facial nerve
Cranial nerve VII
• Nerve of 2nd branchial arch
• Mixed nerve
• Motor component supplies the facial
muscles of expression and elevation of
hyoid (muscles of 2nd arch)
• Secretomotor to salivary gland (except
parotid) lacrimal gland and nasal palatal
and pharyngeal gland
• Sensory for taste sensations from the
anterior 2/3 of the tongue
 Nuclei of facial nerve
• Motor nucleus – lies in deep reticular formation
of lower pons, supplies the upper part of the
face bilaterally
• Superior salivary nucleus – lies in the lower
part of the pons
• Lacrimatory nucleus – lies in lower pons
• Nucleus of tractus solitarius – it lies in medulla
 Course and relation
• Arises in two routes at brain stem, motor
and sensory (nerves intermedius),
attached to lower border of pons medial to
8th nerve ----------
• Along with 8th nerve it moves laterally and
forward to reach internal acoustic meatus
• In the meatus it is accompanied by labrynthine
vessels and here the 2 roots combine into one
nerve
• In th facial canal the pathway is divided into
3parts
• 1st part : laterally above vestibule
• 2nd part : along the medial wall of middle ear
• 3rd part : vertically down behind promontory
• At the junction of 1st and 2nd part lies
geniculate ganglion
• The nerve leaves the skull by
styloidmastoid foramen
• Extracranial course – crosses the lateral
side of the base of styloidit enters the
parotid and the terminates in terminal
branches
Branches of Facial nerve

In facial canal, at stylomastoid

foramen and terminal branches
 In facial canal:

1. Greater petrosal nerve (parasym): arises

from genicualte ganglion --- pterygopalatine
ganglion (for. Lacerum) --- lacrimal gland
and mucous gland
2. Nerve to stapedius – 2nd part
3. Chorda tympani – 3rd part, secretomotor
fibre joins lingual before supplying
submandibular or sublingual gland via
submand ganglion
 Chorda tympani
•
The special sensory component of the
facial nerve transmits taste through the
chorda tympani which leaves the lingual
nerve and enters the skull through the
petrotympanic fissure. The chorda
tympani then joins the geniculate ganglion
on the medial wall of the tympanic cavity.
 At stylomastoid foramen
1. Posterior auricular Nr
2. Digastric Nr
3. Stylohyoid
 Terminal branches
1. Temporal
2. Zygomatic
3. Buccal
4. Mandibular
5. Cervical
INFRATEMPORAL REGION
 INFRATEMPORAL REGION

• The infratemporal fossa is a small space

between the ramus of the mandible and
the lateral pterygoid plate of the sphenoid.
• On a skull, it is big enough for maybe 1
1/2 fingers but it has many things in it.
• inferior to the temporal fossa and
zygomatic arch
• and deep to the ramus of the mandible.
• It stretches from the parotid fascia
posterior to the mandibular ramus to the
tuberosity of the maxilla.
The anterior wall of infratemporal
fossa

• Body and tuberosity of the maxilla, deep to zygoma

and zygomatic process of the maxilla.
• The pterygomaxillary fissure may be seen in the
medial aspect of this anterior wall, opening into the
more medial pterygopalatine fossa.
• The inferior orbital fissure may also be
seen.
• Inferior to the pterygomaxillary fissure is
the hamulus serving as attachment point
for the pterygomandibular raphé. It
serves as the common site of origin for the
buccinator and the superior constrictor
muscle and runs from the hamulus to the
upper 1/5 of the mylohyoid line
 The roof of the infratemporal
fossa
• the greater wing of the sphenoid anteriorly
• and the squamous portion of the temporal
bone posteriorly.