Temporal region and parotid gland 1) Parotid gland a) Related bones i) Superficial, Posterior and deep to ramus of mandible

ii) Anterior mastoid process iii) Lateral to styloid process iv) Extend up to the Inferior portion of the zygomatic arch v) External auditory meatus b) 2 ends (upper and lower) i) Located by Upper portion (1) Artery Superficial temporal, Vein Superfical temporal, Nerve auriculotemporal ii) Located by lower portion (1) Artery External carotid, vein 2 divisions of retromandibular, Nerve Cervical branch of facial nerve (CNVII) c) 2 borders (ant. & post.) i) Located by Anterior border (1) Accessory part of parotid gland (2) Parotid duct (3) Branches of the Facial Nerve (temporal, zygomatic, buccal, marginal, mandibular d) 3 surfaces (Lat. (superficial), Anteromedial, Posteriomedial) i) Located near Lateral (superficial) surface) (1) Skin, Fascia, parotid lymph nodes (2) Branch of great auricular nerve ii) Located near Anteromedial surface (1) Muscle Masseter and medial pterygoid, Bone ramus of mandible iii) Located near Posteriomedial surface (1) Muscles Sternomastoid and Post. Belly of digastric, Bones mastoid and styloid processes, arteries (2) Facial nerve and external carotid artery pierce the gland here e) Structures within the gland i) Artery External carotid, Vein retromandibular, Nerve - Facial f) Accessory part small and partially detached, above parotid duct g) Parotid Duct Pathway Forward over masseter pierces Buccinator opens in the vestibule of the mouth opposite upper 2 molar tooth. Relations of parotid duct i) Accessory part of gland, buccal branch of facial nerve, buccal pad of fat Fascia i) Forms capsule around gland ii) Upward extension of deep cervical fascia of the neck iii) Deep medial part extends from syloid process to angle of the mandible (1) This portion in thickened to form stylomandibular ligament Nerve supply i) Sensory auriculotemporal ii) Secretory motor (parasympathetics) (1) The preganglionic fibers from the tympanic branch of the glossopharyngeal nerve (CNIX) enter the tympanic cavity and merges with the tympanic plexus of nerves. (2) In the tympanic plexus it becomes the lesser petrosal nerve which will relay in the Otic ganglion (a) Otic ganglion is associated with mandibular nerve and is inferior to the foramen ovale (3) From the otic ganglion the postganglionic fibers travel with the auriculotemporal nerve to innervate the gland i) h) i)
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Clincical i) Stones within the parotid duct (1) Complaint of intense pain while salivating (2) Treatments (a) If stone is in anterior portion of the duct incision of the buccal mucosa allows stone removal (b) If stone is in posterior (main) part of the duct you must excise the gland ii) Adenoma tumor of the gland (1) May involve one or more of the branches of the facial nerve within the gland (2) Surgery may injury facial nerve so careful assessment of case must occur iii) Parotiditis (1) Complaint sever pain when chewing and swelling of the cheek, pain is localized over the auricle, temporal region, temporalmandibular joint (TMJ), and external auditory meatus (a) The pain occurs over this region due to the auriculotemporal nerve being sensory to both the gland and skin over the temporal fossa and auricle (2) Cause mumps virus which is a common cause of inflammation of the gland as well as the duct (a) Inflamation in adults may cause serious complications such as orchitis/oophoritis (inflamed testis or ovaries) or pancreatitis (3) Diagnostic redness of papilla on which the parotid duct opens in the vestibule of the mouth, this differentiates mumps from a tooth ache iv) Sialogram of the duct (1) Injection of radio-opaque material into the duct through the mucous membrane of the cheek followed by radiography to see dilated or displaced duct due to any pathology Temporal Region a) Muscles of Mastication i) Temporalis (1) Origin floor of the temporal fossa and deep temporal fascia (2) Insertion coronoid process and Anterior margin of ramus of mandible (3) Main actions elevation and retraction of mandible (4) Nerve supply (a) Deep temporal nerves from Mandibular nerve (anterior division) (b) Zygomaticotemporal nerves from maxillary nerve (5) Arteries (a) Deep temporal from maxillary artery (b) Middle temporal from superficial temporal artery ii) Masseter (1) Origin (a) Deep head medial aspect of zygomatic arch (b) Superficial head maxillary process of zygomatic bone (lower border of zygomatic arch) (2) Insertion lateral surface of ramus of mandible (3) Main actions elevation of mandible (4) Innervation Masseter nerve from the mandibular nerve (anterior division) iii) Medial pterygoid (1) Origin (a) Deep head medial surface of lateral plate of pterygoid plate (b) Superficial head maxillary tuberosity (2) Insertion medial surface of mandible near angle (3) Main actions Elevation and side to side movements of the mandible (4) Innervation Main trunk of the mandibular nerve (also called nerve to the medial pterygoid) iv) Lateral pterygoid (1) Origin (a) Upper head infratemporal surface of greater wing of sphenoid

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(b) Lower head lateral surface of lateral plate of pterygoid plate (2) Insertion - Pterygoid fovea capsule of the temporalmandibular joint and articular disc near neck of mandible (3) Main actions - Protrude and side to side movement of the mandible (4) Innervation anterior division of mandibular nerve (also called nerve to lateral pterygoid) Temporal Mandibular Joint (TMJ) a) Synovial condylar subtype b) Articular surfaces Uniquely covered in fibrocartilage, normally synovial joints are hyaline i) Articular tubercle (eminence) ii) Mandibular fossa (above) iii) Head of mandible (below) c) Capsule attachments lined with synovial membrane i) Above to articular tubercle ii) Below - Around the Neck of the mandible iii) Laterally and medially along the margins of the articular fossa iv) Below - Circumference of the mandibular fossa d) Articular disc divides joint into upper and lower compartments i) Upper surface is concavo-convex and its lower surface is concave (1) Upper surface allows the head of the mandible to move forward on articular tubercle (protrusion) and backwards into the mandibular fossa (retraction) (a) Muscles that cause Protrusion lateral pterygoid assisted by medial pterygoid (b) Muscles that cause Retraction posterior fibers of temporalis, deep part of maseter, geniohyoid and diagastric (2) Lower surface allows the hinge-like movement (elevation and depression) (a) Muscles that cause Elevation temporalis, masseter and medial pterygoid (b) Muscles that cause Depression gravity, diagastric, geniohyoid, and mylohyoid muscles e) Ligaments i) Lateral temporomandibular ligament (strongest) from zygomatic arch to lateral part of Mandible ii) Pterygomandibular ligament form pterygoid hamuls to end of mylohyoid line iii) Sphenomandibular ligament from spine of sphenoid to lingual and medial part of ramus iv) Sylomandibular ligament from styloid process of temporal bone to the posterior angle of the mandible f) Relations i) Parotid gland (1) Deep to the joint (2) Between the joint and external auditory meatus to reach styloid process ii) Structures deep to the neck of the mandible (1) Auriculotemporal nerve (2) Maxillary vessels g) Side to side movements are accomplished by the two pterygoid muscles h) Blood supply for TMJ is from the maxillary artery i) Nerve supply for TMJ is both the auriculotemporal nerve and nerve to the masseter j) Clinical points i) Dislocation of TMJ (1) Anterior dislocation of mandibular head (a) Excessive contraction of Lateral pterygoid during yawning or taking a large bite (2) Posterior dislocation of mandibular head (a) Uncommon due to presence of postglenoid tubercle and strong intrinsic lateral ligament ii) Arthritis of TMJ (1) May cause clicking due to delayed anterior movement of disc during mandibular depression and elevation k) Bones associated with the TMJ joint i) Temporal, maxilla, sphenoid, zygomatic, mandible The mandible bone

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Muscles attached to external surface (1) Insertion for both the platysma and masseter (2) Origin for the buccinators Structures related to the external surface of the mandible (1) Temporomandibular ligament (2) Stylomandibular ligament (3) Insertion for the masseter (4) Facial artery and vein (5) Mental nerve Structures related to the internal surface of the mandible (1) Pterygomandibular ligament (2) Sphenomandibular ligament (3) Insertion for the temporalis, lateral pterygoid, medial pterygoid (4) Origin for the superior constrictor of the pharynx, mylohyoid, genioglossus, geniohyoid (5) Submandibular gland Nerves and vessels related to the internal surface of the mandible (1) Nerves (a) Linguinal, Inferior alveolar, auriculotemporal, nerve to the mylohyoid (2) Arteries (a) Maxillary, facial and inferior alveolar (3) Submandibular gland (4) Submandibular lymph nodes Ligaments (1) Stylomandibular ligament to the angle of the mandible (2) Sphenomandibular ligament to lingual and medial side of ramus of mandible (3) Pterygomandibular ligament to mylohyoid line (4) Lateral temporomandibular ligament to lateral part of neck