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Anatomy

Head and Neck

Question 28 of 180

Which of the following structures does NOT pass through the parotid gland:

Answer:

The facial nerve, retromandibular vein and external carotid artery are important structures that pass into the substance of the parotid gland. The posterior auricular artery arises from the external carotid artery within the parotid gland. The mandibular division of the trigeminal nerve does not pass through the parotid gland.

The parotid glands are the largest of the paired salivary glands and are enclosed within the split investing layer of the deep cervical fascia. The parotid glands produce watery saliva and salivary amylase required for food bolus formation and oral digestion.

Anatomical Location

The parotid glands are anterior to and inferior to the lower half of the ear. They extend down to the lower border of the mandible and up to the zygomatic arch. Posteriorly they cover the anterior part of the sternocleidomastoid and continue anteriorly to halfway across the masseter muscle.

parotid gland

Relations of the Parotid Gland. (Image by Henry Vandyke Carter [Public domain], via Wikimedia Commons)

Parotid Duct

The parotid duct leaves the anterior edge of the parotid gland midway between the zygomatic arch and the corner of the mouth. It traverses the masseter muscle and after crossing the medial border of the masseter, turns deeply into the buccal fat pad and pierces the buccinator muscle. It opens into the oral cavity near the second upper molar tooth.

Relations

Several major structures enter and pass through or just deep to the parotid gland including:

  • The facial nerve (and its five terminal branches arising within the parotid gland)
  • The external carotid artery (and its branches arising within the parotid gland - the posterior auricular artery and its terminal branches the maxillary and superficial temporal artery)
  • The retromandibular vein (formed within the parotid gland from the union of the superficial temporal and maxillary vein).

Innervation

Sensory innervation of the parotid gland is provided by the auriculotemporal nerve (branch of the mandibular nerve).

The auriculotemporal nerve also carries secretomotor parasympathetic fibres to the parotid gland; these postganglionic parasympathetic fibres have their origin in the otic ganglion (just inferior to the foramen ovale) which receives preganglionic parasympathetic fibres from the glossopharyngeal nerve.

Sympathetic innervation originates from the superior cervical ganglion.

Clinical Implications

Parotitis refers to inflammation of the parotid gland, usually as a result of an infection. The parotid gland is enclosed in a tough fibrous capsule which limits swelling of the gland, resulting in pain which may be referred to the external ear.

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  • Biochemistry
  • Blood Gases
  • Haematology
Biochemistry Normal Value
Sodium 135 – 145 mmol/l
Potassium 3.0 – 4.5 mmol/l
Urea 2.5 – 7.5 mmol/l
Glucose 3.5 – 5.0 mmol/l
Creatinine 35 – 135 μmol/l
Alanine Aminotransferase (ALT) 5 – 35 U/l
Gamma-glutamyl Transferase (GGT) < 65 U/l
Alkaline Phosphatase (ALP) 30 – 135 U/l
Aspartate Aminotransferase (AST) < 40 U/l
Total Protein 60 – 80 g/l
Albumin 35 – 50 g/l
Globulin 2.4 – 3.5 g/dl
Amylase < 70 U/l
Total Bilirubin 3 – 17 μmol/l
Calcium 2.1 – 2.5 mmol/l
Chloride 95 – 105 mmol/l
Phosphate 0.8 – 1.4 mmol/l
Haematology Normal Value
Haemoglobin 11.5 – 16.6 g/dl
White Blood Cells 4.0 – 11.0 x 109/l
Platelets 150 – 450 x 109/l
MCV 80 – 96 fl
MCHC 32 – 36 g/dl
Neutrophils 2.0 – 7.5 x 109/l
Lymphocytes 1.5 – 4.0 x 109/l
Monocytes 0.3 – 1.0 x 109/l
Eosinophils 0.1 – 0.5 x 109/l
Basophils < 0.2 x 109/l
Reticulocytes < 2%
Haematocrit 0.35 – 0.49
Red Cell Distribution Width 11 – 15%
Blood Gases Normal Value
pH 7.35 – 7.45
pO2 11 – 14 kPa
pCO2 4.5 – 6.0 kPa
Base Excess -2 – +2 mmol/l
Bicarbonate 24 – 30 mmol/l
Lactate < 2 mmol/l

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