Parotid Region
The parotid region is bounded anteriorly by the ramus of the mandible with the masseter muscle laterally and the medial pterygoid muscle medially; posteriorly, by the mastoid, sternocleidomastoid muscle, and posterior belly of the digastric muscle; medial
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Parotid Region
Core Messages
• The essence of parotid surgery consists of removing the gland without harming the facial nerve and its branches. The first surgical stage always consists of identifying the common trunk of the facial nerve. • The identification of the facial nerve and the isolation of its branches may be carried out using the operating microscope, with a magnifying prismatic loop (enlargement between 2× and 4×) or even with the naked eye, depending on what the surgeon is accustomed to.
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Anatomic Layout
The parotid region is bounded anteriorly by the ramus of the mandible with the masseter muscle laterally and the medial pterygoid muscle medially; posteriorly, by the mastoid, sternocleidomastoid muscle, and posterior belly of the digastric muscle; medially by the jugular carotid tract, the styloid process with the stylienus muscles (Riolan’s bundle), and the pharyngeal wall (superior constrictor muscle of the pharynx); superiorly, by the external auditory canal and the extreme posterior of the zygomatic arch; and inferiorly by the imaginary horizontal line between the angle of the mandible and the anterior margin of the sternocleidomastoid muscle. The superficial and deep parotid fasciae invest the gland and are formed by the division of the superficial cervical fascia into two. The parotid lymph nodes are concentrated in two sites, one superficial, immediately below the fascia, and one deep, intraparotid site, adjacent to the external carotid artery (Fig. 4.1). Significant Anatomical Structures: superficial cervical fascia, great auricular nerve, external jugular vein, retromandibular vein, facial nerve branch serving the platysma, buccal branches of facial nerve, Stensen’s duct, transverse artery of the face, zygomatic branches of facial nerve, temporal branches of facial nerve, superficial temporal artery, auriculotemporal nerve, posterior auricular artery, facial M. Lucioni, Practical Guide to Neck Dissection, DOI 10.1007/978-3-642-33977-6_4, © Springer-Verlag Berlin Heidelberg 2013
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Parotid Region
Fig. 4.1 Parotid region: cross section. m Mandible, t palatine tonsil, v vertebral body, 1 sternocleidomastoid muscle, 2 posterior belly of digastric muscle, 3 external jugular vein, 4 facial nerve, 5 masseter muscle, 6 Stensen’s duct, 7 lymph node, 8 external carotid artery, 9 retromandibular vein (or posterior facial vein), 10 internal pterygoid muscle, 11 styloid process, 12 stylopharyngeus muscle, 13 styloglossus muscle, 14 stylohyoid muscle, 15 internal jugular vein, 16 internal carotid artery, 17 glossopharyngeal nerve, 18 spinal accessory nerve, 19 vagus nerve, 20 cervical sympathetic chain, 21 hypoglossal nerve, 22 prevertebral muscles, 23 superior constrictor muscle of the pharynx
nerve, stylomastoid artery, Riolan’s bundle, internal jugular vein, external carotid artery, glossopharyngeal nerve, Hering’s nerve, goose’s foot, temporofacial trunk, cervicofacial trunk, Ponce–Tortella’s loop, superior constrictor muscle of the pharynx, ascending palatine artery, ascending phary
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