Temporal fossa, parotid region

& salivary glands

By Dr. Baseem N. Abdulhadi

FIBMS, CABMS (ENT)

Temporal fossa:

It contains the temporalis muscle, the deep temporal nerves and vessels, the auriculotemporal nerve, and the superficial temporal vessels.

■ Has the following boundaries:1. Anterior: zygomatic process of the frontal bone and the frontal process of the zygomatic bone.2. Posterior: temporal line.3. Superior: temporal line.4. Lateral: zygomatic arch.5. Inferior: infratemporal crest.6. Floor: parts of the frontal, parietal, temporal, and greater wing of the sphenoidbone.

The parotid region is the posterolateral part of the facial region

bounded by the:

• Zygomatic arch superiorly.

• External ear and anterior border of the sternocleidomastoid

posteriorly.

• Ramus of the mandible medially.

• Anterior border of the masseter muscle anteriorly.

• Angle and inferior border of the mandible inferiorly.

The parotid region includes the parotid gland and duct, the

parotid plexus of the facial nerve (CN VII), the retromandibular

vein, the external carotid artery, and the masseter muscle.

The parotid gland

Relationships of the parotid gland

Parotid gland: cross section

Innervation of the parotid gland

Clinical correlates:

1) Parotid duct injury.

2) Parotid tumors and parotid surgery (parotidectomy).

3) Parotid infection [mumps & parotitis].

4) Sialography of the parotid duct.

5) Frey’s syndrome.

Submandibular and sublingual glands:

Clinical correlates: 1. Submandibular gland calculus formation.2. Submandibular gland excision. 3. Sublingual gland cyst formation. 4. Submandibular duct sialogram.

Quiz time !!

Question A

A 45-year-old woman is undergoing surgical resection

of the salivary gland for probable cancer. After surgery,

she notes that she cannot move her tongue well.

Which of the following salivary glands is most likely

involved in the surgery?

A. Parotid

B. Sublingual

C. Submandibular

D. Maxillary

Question A

A 45-year-old woman is undergoing surgical resection of the

salivary gland for probable cancer. After surgery, she notes that

she cannot move her tongue well. Which of the following

salivary glands is most likely involved in the surgery?

A. Parotid

B. Sublingual

C. Submandibular

D. Maxillary

The hypoglossal nerve courses deep to the submandibular gland, and injury to this nerve weakens or paralyzes muscles of the tongue.

Question BA 46 year old man visits the speech therapist complaining of dryness of the mouth. The therapist performs a swallowing study and, on examination, finds that the man has a lack of salivary secretion from the submandibular gland. This indicates a lesion of which of the following nervous structures?

(A) Lingual nerve at its origin(B) Chorda tympani in the middle ear cavity(C) Superior cervical ganglion(D) Lesser petrosal nerve(E) Auriculotemporal nerve

Question BA 46 year old man visits the speech therapist complaining of dryness of the mouth. The therapist performs a swallowing study and, on examination, finds that the man has a lack of salivary secretion from the submandibular gland. This indicates a lesion of which of the following nervous structures?

(A) Lingual nerve at its origin(B) Chorda tympani in the middle ear cavity(C) Superior cervical ganglion(D) Lesser petrosal nerve(E) Auriculotemporal nerve

Question CDuring surgery for a malignant parotid tumor in a 69-year-old woman, the main trunk of the facial nerve is lacerated. Which of the following muscles is paralyzed?

(A) Masseter muscle

(B) Stylopharyngeus muscle

(C) Anterior belly of the digastric muscle

(D) Buccinator muscle

(E) Tensor tympani

Question CDuring surgery for a malignant parotid tumor in a 69-year-old woman, the main trunk of the facial nerve is lacerated. Which of the following muscles is paralyzed?

(A) Masseter muscle

(B) Stylopharyngeus muscle

(C) Anterior belly of the digastric muscle

(D) Buccinator muscle

(E) Tensor tympani

Question DA 22-year-old male is involved in a knife fight after a soccer game. He is brought to the emergency department. An 8-cm laceration that involves the right cheek, from his right ear to near the corner of his mouth, is noted. Which of the following structures is most likely injured?

A. Parotid duct

B. Submandibular duct

C. Superficial temporal artery

D. Lingual artery

E. Mandibular branch

of the facial nerve

Question DA 22-year-old male is involved in a knife fight after a soccer game. He is brought to the emergency department. An 8-cm laceration that involves the right cheek, from his right ear to near the corner of his mouth, is noted. Which of the following structures is most likely injured?

A. Parotid duct

B. Submandibular duct

C. Superficial temporal artery

D. Lingual artery

E. Mandibular branch

of the facial nerve

The buccal branch of the facial nerve and the parotid duct travel in the area of the cheek and can be located by a line drawn from the tragus of the ear (or the external auditory meatus) to the corner of the mouth.

Thank you