PAROTID GLAND, FACIAL NERVES AND

VASCULATURE
Parotid Gland
-largest
-functional
-anatomical dissection of the face expose the facial nerve
-dissected first completely before dissection of the
infratemporal region and muscles of mastication or carotid
triangle of the neck
-tough fascial capsule parotid sheath investing layer of
deep cervical fascia
-parotid bed irregular anteroinferior to the external
acoustic meatus wedged between mandibular ramus and
mastoid process
>Boundaries:
-apex of the gland- posterior to angle of mandible
-base related to zygomatic arch
-Parotid duct passes horizontal from the anterior edge of
gland turns medially anterior edge of gland turns medially
anterior border of masseter pierces buccinators oral cavity
small orifice opposite the 2nd maxillary molar tooth
-from superficial to deep parotid plexus of the facial nerve
and its branches, retromandibular vein and external carotid
artery
-parotid sheath within the gland are parotid lymph nodes
>Innervation:
-Auriculotemporal nerve branch of CN V3 passes superior
to it with the superficial temporal vessels
-Great Auricular nerve from cervical plexus (C2 and C3
spinal nerves) innervates parotid sheath and overlying skin
-Glossopharyngeal nerve (parasympathetic component)
pre-synaptic secretory fibers to the otic ganglion
-post-synaptic parasympathetic fibers from the ganglion to
the gland by auriculotemporal nerve
-stimulation of the parasympathetic fibers produce a thin,
watery saliva
-sympathetic fibers derived from the cervical ganglion through
the external carotid nerve plexus on the external carotid
artery
-vasomotor activity reduces secretion from the gland
-sensory fibers pass to the gland through the great auricular
and auriculotemporal nerves
>Clinical: Parotitis
-Parotitis is an inflammation of one or both of the parotid
salivary glands. There are many possible causes of parotitis,
ranging from a salivary stone (calculus) to viral or bacterial
infections. Symptoms of parotitis vary depending on the cause
of the inflammation, although a swollen parotid salivary gland
is usually present.

Facial Nerves
Overview:
-cutaneous nerves of the neck overlap those of the face
-cervical nerves from the cervical plexus extend posterior
aspect of the neck and scalp
-great auricle and muscles of parotid region of face
Trigeminal nerve (CN V)
-lateral surface of the pons of midbrain by 2 roots (motor &
sensory)

-sensory root unipolar neurons in sensory ganglion

bypassed by mutlipolar neuronal axons motor root
-sensory nerve for the face and motor nerve of mastication
>Trigeminal ganglion 3 branches
1. Ophthalmic nerve (CN V1)
2. Maxillary nerve (CN V2)
3. Mandibular nerve (CN V3) sensory according to their main
areas of termination
CN V1 & CN V2 purely sensory
CN V3 largely sensory but has motor fibers (axons) from the
root of CN V that mainly supply the muscles of mastication
Ophtalmic Nerve (CN V1)
-superior division
-smallest
-supplies area of skin (frontonasal prominence)
-enters orbit through the superior orbital fissure
- a) Frontal largest branch roof of orbit toward orbital
opening
- a.i) Supraorbital
-a.ii) Supratrochlear forehead and scalp
-b) Nasociliary nerve intermediate branch
-branches to eyeball and divides within the orbit into
posterior and
anterior ethmoidal, and infratrochlear nerves
-Posterior and Anterior ethmoidal leave orbit cranial and
nasal
cavities- terminal branch external nasal nerves nose
-Infratrochlear nerve terminal branch of nasociliary nerve
and its main
cutaneous branch
-c) Lacrimal nerve smallest branch
-primarily cutaneous
-some secretomotor fibers ganglion associated with the
maxillary nerve
for innervations of lacrimal gland
Maxillary Nerve (CN V2)
-intermediate division of CN V sensory
-leaves cranium through the foramen rotundum in the base of
the greater wing of the sphenoid
-enters pterygopalatine fossa branches to the
pterygopalatine ganglion orbit through inferior orbital fissure
-gives off zygomatic nerve and passes into infraorbital groove
as the infraorbital nerve
-Table 7.4 (page 851-852)
-cutaneous nerves derived from posterior rami of cervical
spinal nerves
-Zygomatic Nerve: lateral wall orbit
-a) Zygomaticofacial nerve
-b) Zygomaticotemporal nerve secretomotor fibers to the
lacrimal nerve
-c) Infraorbital nerve palatine branch to mucosa of the
maxillary sinus and
to the posterior teeth
-reaches skin of face infraorbital foramen on the
infraorbital surface of
Maxilla
-3 branches of the maxillary nerve skin maxillary
prominences
Mandibular Nerve (CN V3)
-inferior and largest division
-formed by the union of sensory fibers from sensory ganglion
and motor root of CN V in the foramen ovale in the greater
wing o the sphenoid
-3 sensory branches areas of skin embryonic mandibular
promincence
-motor fibers to the muscles of mastication

-only division of CN V carries motor fibers

-a) Auriculotemporal nerve passes deep to parotid gland
secretomotor fibers
-b) Buccaol nerve
-c) Mental nerve
>Clinical: Trigeminal Neuralgia
-place for pain depends on which branch is affected
-Ophthalmic branch: forehead, eyes, part of nose
-Maxillary branch: cheek, upper lip
-Mandibular branch: lower lip, teeth, chin

Overview:
-muscles of facial expression and motor root of the trigeminal
nerve/mandibular nerve to the muscles of mastication
(masseter, temporal, medial and lateral pterygoids)
Facial Nerve (CN VII)
-both motor root and sensory/ parasympathetic root
>Motor Root
-muscles of facial expression, superficial muscles of the neck
(platysma), auricular muscles, scalp muscles and muscles of
mesoderm in embryonic 2nd pharyngeal arch
-emerges from the cranium through the stylomastoid foramen
between the mastoid and styloid process
-Posterior auricular nerve supply the auricularis posterior
and occipital belly of the occipitofrontalis muscle
-main trunk of CN VII within parotid gland
-forms the parotid plexus
>Five terminal branches:
-a) Temporal branch superior border of gland
-supplies auricularis superior and anterior frontal belly of
occipitofrontalis
and anterior frontal belly of occipitofrontalis and most
important,
superior part of orbicularis oculi
-b) Zygomatic branch passes 2 or 3 branches superior and
mainly inferior to
supply the inferior part of orbicularis oculi and other
frontal muscles
inferior to the eye to supply the inferior part of orbicularis
oculi and other
frontal muscles inferior to orbit
-c) Buccal branch passes external to buccinator to supply
this muscle and
and muscle of the upper lip (upper parts of oris and the
fibers of levator
labii superioris)
-d) Marginal Mandibular branch supplies the risorius and
muscles of lower
lip and chin
-emerges from the inferior border of the gland and crosses
the inferior
border of mandible deep to platysma face
-20% passes inferior to the angle of the mandible
-e) Cervical branch passes inferiorly from the inferior border
of gland and
Runs posterior to the mandible to supply the platysma
>Clinical: Facial Nerve Palsy
-unilateral facial paralysis of sudden onset, due to lesion of
the facial nerve and resulting in characteristic distortion of the
face

Scalp and Facial Vessels

Overview:
-richly supplied with arteries and veins
-most are branches from external carotid artery
-most facial veins drained by veins that accompany arteries of
the face
-venous return superficial but anastomose with deep veins
dural sinus
And venous plexus deep drainage
-Table 7.5 (p. 856)
1.)Facial Artery major arterial supply to face
-from ECA inferior border of mandible anterior to
masseter
>Branches:
a) Superior labial artery
b) Inferior labial artery
c) Lateral nasal artery
d) Angular artery terminal part
2.) Superficial Temporal artery
-smaller terminal branch of ECA maxillary artery frontal
and parietal branches
3.) Transverse facial artery
-arises from the SFA within gland
-divides into branches that supply gland and duct, masseter
and skin of
the face
-anastomose with branch of facial artery
4.) Supraorbital and Supratrochlear arteries
-branches of ophthalmic artery
5.) Supraorbital artery
-continues and supplies anterior scalp
6.) Mental artery
-only superficial branch derived from the maxillary artery
Arteries of the Scalp
-rich blood supply
-within layer two (subcuataneous connective tissue layer
between the
skin and epicranial aponeurosis
-arterial anastomose freely
-walls firmly attached to the dense connective tissue limiting
their ability to constrict when cut
-from ECA through the occipital, posterior auricular and
superficial temporal arteries and from internal carotid arteries
through the supratrochlear and supraorbital arteries
-little blood to neurocranium (from middle meningeal artery)
External Veins of the Face
-Table 7.6 (p.857)
Overview
-abundant anastomosis
-alternate routes superficial pathways (facial and
retromandibular / external jugular veins) and deep drainage
(anastomosis with the cavernous sinus, pterygoid venous
plexus, and the internal jugular veins)
>Facial veins
-valveless primary superficial drainage
-tributaries deep facial vein drains into the pterygoid
venous plexus of the infratemporal fossa
-joined by anterior (communicationg) branch fo the
retromandibular vein
-drains directly or indirectly into the IJV
-communicates with the superior ophthalmic vein drains into
cavernous sinus

Retromandibular vein union between the superficial

temporal and maxillary veins
-anterior branch that unites with facial vein and posterior
branch that joins the posterior auricular vein inferior to parotid
gland to form the external jugular vein- subclavian vein
>Veins of the Scalp
-supraorbital and supratrochlear veins (venous drainage of
superficial parts of scalp)
-superficial temporal veins and posterior auricular veins
drains scalp and anterior and posterior to the auricles
Posterior auricular veins receives mastoid emissary veins
from the sigmoid sinus (dural venous sinus)
Occipital veins drain occipital region of scalp
Venous drainage of deep parts of scalp in the temporal region
deep temporal sinus - (tributaries of pterygoid venous
plexus)
>Lymphatics
Overview:
-no lymph nodes in the scalp except parotid/buccal region
-no lymph nodes in face
-lymph nodes from scalp, face and neck drain into the
superficial ring (pericervical collar) of lymph nodes
submental, parotid, submandibular, mastoid and occipital
-superficial lymphatic vessels accompany veins
-deep lymphatics accompany arteries
-all lymphatic vessels head and neck drain directly or
indirectly into the deep cervical lymph nodes always the IJV
on the neck
-jugular lymphatic trunk joins thoracic duct on the left side
and the IJV or brachiocephalic on the right side
Summary:
1.)Lymph lateral part face and scalp (eyelids) superficial
parotid lymph nodes
2.)Lymph from deep parotid nodes drain cervical lymph
nodes
3.)Lymph from upper lip nd lateral parts of lower lip drain to
submandibular lymph nodes
4.)Lymph from chin and central part lower lip submental
lymph nodes