The parotid gland is a major salivary gland in many animals. In humans, the two parotid glands are present on either side of the mouth and in front of both ears. They are the largest of the salivary glands.

1. PAROTID GLANDPAROTID GLAND
Guided by-
Dr. Anil Govindrao Ghom
Dr. Ajit Mishra
Dr. Shweta Singh
Dr.Savita Ghom
Dr. Anurag Bakshi
Presented By-
Dr. Bratati Dey (Dept. Of OMR)

2. CONTENTSCONTENTS
 Introduction
 Anatomy of parotid gland
 Relations
 Structure with in parotid gland
 Parotid duct
 Blood supply
 Nerve supply
 Lymphatic drainage
 Development
 Parotid lymph node
 Examination of parotid gland
 Clinical anatomy
 References

3. IntroductionIntroduction
⁕ Parotid region contains the
largest salivary gland and
the ““QueenQueen ofof thethe Face”Face” ,
the facial nerve.
⁕ Para = Around, Otic = ear
⁕ It is the largest salivary
gland, situated below the
external acquastic meatus.

4. Capsule Of Parotid GlandCapsule Of Parotid Gland
⁕ The investing layer of deep
cervical fascia forms a
capsule for the gland.
⁕ The fascia split (between
angle of the mandible and
the mastoid process) to
enclose gland.

5. External featuresExternal features
⁕ The gland resembles a three sided pyramid,
apex of the pyramid direct downward
⁕ The gland has four surface and three border.

6. Horizontal section of parotid gland showingHorizontal section of parotid gland showing
its relation and the structure passingits relation and the structure passing

7. Relations of parotid glandRelations of parotid gland
The apex overlaps the posterior belly of
digastric & the adjoining part of carotid
triangle.
The cervical branch of facial nerve and the two
division of retromandibular vein emerge
through it.

8. Structure within parotid glandStructure within parotid gland
From medial to lateral side these are as follow
Arteries
ExternalExternal carotidcarotid
arteryartery
MaxillaryMaxillary
arteryartery
SuperficialSuperficial
temporaltemporal arteryartery
It enters the gland
through its
posteromedial surface
It leaves the gland
through its antero-
medial surface
It gives transverse
facial artery and
emerges at the anterior
part of the superior
surface.

10. Structure within parotid glandStructure within parotid gland
Veins – THETHE RETROMANDIBULARRETROMANDIBULAR VEINVEIN
is formed within the gland by the union of
superficialsuperficial temporaltemporal and maxillarymaxillary veinvein in the
lower part of the gland

11. Structure within parotid glandStructure within parotid gland
Nerve –
The FACIALFACIAL NERVENERVE
enters the gland through
the upper part of its
posteromedial surface and
divides into 5 terminal
branches.

12.  Facial nerve lies in relation to isthumus of the gland which
separate large superficial part from small deep part of the
gland.

13. PAROTID DUCTPAROTID DUCT
 Known as STENSEN’S DUCTSTENSEN’S DUCT, 5cm long, carries saliva from
gland to oral cavity.
 It emerges from middle of the anterior border of the gland.
 It runs forward and slightly downwards on the masseter.

14. Superiorly
Accessory parotid gland
Upper buccal branch of the facial nerve
The transverse facial vessels
Inferiorly
The buccal pad of fat
The buccopharyngeal fascia
The buccinator

15. BLOOD SUPPLYBLOOD SUPPLY
 TheThe parotidparotid glandgland isis suppliedsupplied byby thethe externalexternal
carotidcarotid arteryartery andand itsits branchesbranches thatthat arisesarises withinwithin
thethe glandgland..
 TheThe veinsveins draindrain intointo externalexternal jugularjugular veinvein andand
internalinternal jugularjugular veinvein..
 LymphaticLymphatic drainsdrains intointo parotidparotid groupgroup ofof lymphlymph
nodenode andand deepdeep cervicalcervical lymphlymph nodenode..

17. NERVE SUPPLYNERVE SUPPLY
Parasympathetic supply produce watery saliva
Pathway-preganglionic fibers begins in
inferior salivatory nucleus – 9th nerve –
tympanic branch – tympanic plexus –
lesserpetrosal nerve –otic ganglion – post
ganglionic fibers –auroculo temporal nerve –
parotid gland
Sympathetic supply produce mucous saliva

19. DEVELOPMENTDEVELOPMENT
 The parotid gland is ectoderm in origin.
 It developed from the buccal epithelium just lateral to
the angle of mouth
 The outer growth branches form the duct system and
acini.
 The mesoderm form the innerveting connective tissue
septa.

20. Examination Of Parotid GlandExamination Of Parotid Gland
SWELLINGSWELLING-
 Position of parotid gland. A swelling of parotid gland
obliterate the normal hollow just below the lobule of the ear
 Lymph node swelling are mistaken for parotid gland tumor
and vice versa.
 Note the extend, size, shape and consistency.
 Whether the swelling is fixed to the masseter muscle or not
is confirmed by clinching.

21. Examination Of Parotid GlandExamination Of Parotid Gland
SKINSKIN OVEROVER PAROTIDPAROTID GLANDGLAND:
In case of parotid abscess, edematous skin
Fluctuation is very late features of parotid abscess
Warm & tender skin
Looked for scar & fistula
In case of malignancy, check infiltration of the
tumor

22. Examination Of Parotid GlandExamination Of Parotid Gland
DUCTDUCT –– ((stensen’sstensen’s duct)duct)
Buccal surface of cheek
opposite to upper 2nd molar
In case of parotid abscess
purulent discharge comes
out
In malignancy blood will
come out
Terminal part of duct
palpated bidigitally

23. Examination Of Parotid GlandExamination Of Parotid Gland
EXAMINATION OF FACIAL NERVE-
Facial nerve is not involved in benign tumor but
involved in malignant growth.
LYMPH NODE –
Preauricular, parotid, submandibular group of
lymph node
MOVEMENT OF JAW –
Restricted in malignant growth

24. CLINICALANATOMYCLINICALANATOMY
 parotid swelling are very painful due to the
underlying nature of the parotid fascia.
 mumps is an infectious disease of parotid
gland caused by paramyxo virus. Viral parotitis
or mumps characteristically does not
suppurative.

25. Developmental abnormalitiesDevelopmental abnormalities
AplasiaAplasia oror agenesisagenesis ofof salivarysalivary glandgland –
 Complete absence of salivary gland is rare but may occur
together with other developmental defect.
 Specially malformation of first & second brancheal arch
 Agenesis reported along with congenital conditions like
Treacher collin syndrome, hemifacial microstomia
 Also observed in Ectodermal dysplasia

26. AccessoryAccessory salivarysalivary
DuctsDucts –
common, do not require
tretment
Location- superior and
anterior to the normal
location of stensen’s
duct.

27. Diverticula-
A diverticula is a pouch or sack protruding from
the wall of the duct
Diverticula in the duct of major salivary gland
often lead to pooling of saliva & recurrent
sialadenitis.
Diagnosis made by sialography.

28. Darier’s Disease-
Salivary duct abnormality have been reported in
darrier’s disease
Also known as dyskeratosis follicularis
Diagnosed by sialography

29. SialolithiasisSialolithiasis
Also known as salivary calculi or salivary
stone
Etiopathogenesis- NeurohumoralNeurohumoral MechanismMechanism
Prevalance-
Submandibular 83%
Parotid 10%
Sublingual 7%

30. SialolithiasisSialolithiasis
Types
Ductal
sialoliths
Glandular
sialoliths

31. SialolithiasisSialolithiasis
ClinicalClinical featuresfeatures--
Pain, swelling acute suppurative process, pus, ulceration,
absence of salivation
Swab test
RadiographicRadiographic featuresfeatures--
For parotidparotid glandgland periapical view in the buccal vestibule,
reduce exposure to avoid burnout sialolith

32. SialographySialography
Sialography is indicated when sialolith are
radiolucent.
The film usually shows contrast medium
present behind the stone.
In some cases ‘cherry‘cherry blossomblossom’ or ‘fruitfruit ladenladen
branchlessbranchless treetree’ appearance seen.

33. • Contrast media for sialography
TYPESTYPES
Iodine based
Ionic
aqueous
solution
Non ionic
aquous
solution
Oil based
Iodized oil
(lipiodol)

34. FREYFREY SYNDROMESYNDROME-
Also known as AuriculoAuriculo TemporalTemporal SyndromeSyndrome
Parotidectyomy is the removal of parotid gland.
After this operation there may be regeneration of
secretomotor fibers in the auriculotempral nerve
which join the grater auricular nerve
This causes stimulation of the sweet gland →
hyperamia → Redness & sweating in the area of
skin

35. PleomorphicPleomorphic AdenomaAdenoma
• The term was suggested by willis characterizing unusual histological
pattern.
• Also known as- ‘iceberg tumor’, ‘endothelioma’.
• Most common benign salivary gland tumor.
• Clinical features –small, painless, round to oval lobulated, dumbbells
shaped appearance, sometimes erosion of the underlying bone.
• Management- surgical excision

36. WarthinWarthin TumorTumor
[Papillary[Papillary CystadenomaCystadenoma LymphomatosumLymphomatosum]]
 Benign neoplasm
 Occurs almost exclusively in the parotid gland
 2nd most common benign tumor
 Clinical features- slow growing, painless, nodular mass, firm
on palpation, 6th -7th decade of life
 Risk factor- smokers

37. Mikulicz’sMikulicz’s diseasedisease
 Synonyms- Benign lympho-epithelial lesions.
 First described by MikuliczMikulicz in 1888
 It is an Autoimmune disorder.
 Unilateral / bilateral enlargement of parotid gland
 Prodromal symptoms- fever, URTI, oral infection, tooth
extraction.
 Mild local discomfort, diffuse, poorly outline enlargement of
salivary gland
 Management- surgical excision

38. Basal cell adenomaBasal cell adenoma
 Age/sex- Female > male, older age group
 Occurs primarily in major salivary gland, particularly in the
parotid gland
 Symptoms- painless, slow growing.
 Diagnosis- difficult to make clinical diagnosis,
 Biopsy shown fairly well defined connective tissue capsule the
cells are isomorphic and baseloid with round nuclei.
 T/t- surgical excision, recurrence rate is rare

39. MucoepidermoidMucoepidermoid CarcinomaCarcinoma
 It is a malignant tumor of salivary gland.
 Malignant tumors comprise 15–32% of parotid tumors, 41–
45% of submandibular tumors and 70–90% of sublingual
tumors.
 It occurs in 2nd-7th decade

40. Clinical Staging of salivary glandClinical Staging of salivary gland
tumortumor
By spiro
Staging of salivary gland neoplasm
 T₁:0-3cm solitary and freely mobile & CRVII intact
 T₂:3.1-6cm, solitary & freely mobile skin or fixed CRVII intact
 T₃:6cm or multiple nodules or ulceration or deep fixation or
CRVII dysfunction
 Patient with T₁ & T₂ =stage I & stage II respectively
 Metastasis of lymphnodes with T₃ lesion = stage III

41. By American joint committee
 Ptimary tumor-
 Tx: can’t be assessed by rules
 T₀: no evidence of primary tumor
 T₁: 0-2cm
 T₂: 2-4cm, without significant local extension
 T₃: 4-6cm, without significant local extension
 T₄ₐ: >6cm without local extension
 T₄b: any size with significant local extension

42.  Nodal involvement-
 Nₓ: can’t be assessed
 N₀: no regional lymph node metastasis
 N₁: clinical / histologically positive regional lymph nodes
 Distant metastasis-
 Mₓ: distant metastasis can’t be assessed
 M₀: no distant metastasis
 M₁: Distant metastasis

43. Stage grouping is performed as followStage grouping is performed as follow
Stage I Stage II Stage III Stage IV
T₁N₀M₀ or
T₂N₀M₀
T₃N₀M₀ T₁ or T₂N₀M₀
or
T₄ₐ or T₄bN₀M₀
T₃N₁M₀ or
T₄ₐ or T₄bN₁M₀
or
Any T any N
M₁

44. Diagnostic test of the salivary glandDiagnostic test of the salivary gland
Sialography
Scintigraphy
USG
CT ScanArteriography
MRI
Flow rate study

45. ScintigraphyScintigraphy
o Also known as salivary gland
scanning.
o It is used for studying glandular
parenchyma.
o The salivary gland tissue take
up compound of iodine bromine
& technetium
oo IndicationIndication-
o Salivary gland function
o Allow bilateral comparison
o Image of all four gland at the
same time.

46. UltrasonographyUltrasonography
 It involves transmission of energy into salivary tissue,
receiving of the energy after it has been reflected by
the tissue & recording it so that it can be presented by
the interpretation.
 Useful for radiolucent stone.
 Different echo signals are obtained from different
tumors.

47. UltrasonographyUltrasonography

48. CT SCANCT SCAN
It demonstrated small differences in soft
tissues
X-ray examination & distinction between
gland & adjacent soft tissue is improved.
IndicationIndication
 Both Intrinsic and Extrinsic swelling

50. ArteriographyArteriography
It will define the vasculature of the tumor but
also delineate the vascular supply.

51. MagneticMagnetic Resonance ImagingResonance Imaging
 Useful in discrete swelling of salivary gland and
provide excellent soft tissue details.
 It readily enables differentiation between the normal
and abnormal.

52. REFERENCESREFERENCES
 B D Chaurasia’s HUMAN ANATOMY volume 3, Krishna Garg Fifth
edition 141-146
 Burket’s ORAL MEDICINE, Michael Glick 12th edition 232-236
 Textbook of ORAL MEDICINE Anil Govindrao Ghom, Third edition
42-43
 Nicolas Landis, Pleomorphic Adenoma of the Parotid Gland The
American Journal of Medicine, Vol 129, No 1, January 2016
 Fondazione IRCCS et al, Major and minor salivary gland tumors
Critical Reviews in Oncology/Hematology 74 (2010) 134–148
 Ravikiran ongole, Praveen B N, Text book of oral medicine oral
diagnosis and oral radiology 332-368

53. Thank
you