belcnil lhe oral fieEUiB Sr.&{nardtuhrgarulbn
A- ParOtid Gland: connecr the following
. 2 cm below & behind the angle of
It corresponds to the middle Y" of a horizontal line drawn from the tragus
of the.ear to a point on the upper lip midway between the ala of the
nose and the angle of the mouth.
Points of Suroical Importance:
1-Parotid abscess should be drained by Hilton technique (to avoid injury of
2- Frey's syndrome (gustatory syndrome):
- lt follows surgery in the parotid region or tempromandibular joint.
- After injury of auriculotemporal N. post-ganglionic parasympathetic fibers from
otic ganglion become united to sympathetic fibers from superior cervical
ganglion, which supply the vessels & sweat glands of the skin.
- G/P: flushing & sweating of the skln (even with salivation).
Site: in the digastric triangle, partly below & partly deep to the mandible.
PaftSl superficial part, deep part (in relation to mylohyoid muscle) and submandibular
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. Posteriorly: to the angle of mandible.
. Superiorly.'to mylohyoid line of mandible.
. lnferiorlv: it overlaps the 2 bellies of digastric muscle.
o lnfero-lateral surface: related to skin, superficial fascia (containing
platysrna, cervical branch of facial nerve, anterior facial vein and LNs) &
Lateral su*ace: related to the submandibular fossa of the mandible,
facial artery, my4lohyoid nerve & vessels.
Medial surface: related to 2 muscles (mylohyoid & hyoglossus) & 2
nerves (lingual & hypoglossal).
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2- Sympathetic: plexus around the facial artery.
&. lt receives secretomor fibers from the submandibular ganglion.
. Passes through chorda tympani from facial nerve.
LymphatiC Drainaoe: to submandibular & upper deep cervical LNs.
1f,[f, I is a small part lying deep to mylohyoid & superficial to hyogtossus &
!F between lingual nerve above & hypoglossal nerve below.
3) Submandibular (Wafton's) Duct:
5 cm long. lt has the following course & relations:
o !t arises from the deep part & passes fonruards between mylohyoid
& hyoglossus, having triple relation with the lingual n. (1" lateral to
the n., then below it & finally medialto it).
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Facial artery should be double ligated during operation for submandibular salivary gland
. From the floor of the pharynx at the Foramen(aecum
fOramen Caegum whiCh deSCendS in the Posldonof
neck to form both lobes & isthmus.
. From the 4th branchial arch which gives
the superior parathyroid and para-follicular
o The thyroid is one of the largest endocrine
glands weighing approximately 20 gm &
o lt is situated in the neck opposite to the Sth,
6th, & 7th cervical vertebrae.
o Normal thyroid is made up of 2 lobes joined
by thin band of tissues; the isthmus.
Line of descent of thyroid gland
an(track of dryroglossal fistula
Usual position of fryroglossal cyst
Nemal position of &yroid gland
o The apex of the lobe lies on the thyroid cartilage below the oblique line while its base
o lti:,ffi l?i,ll:'ffi:i: ltri3'i'JPl o" trachear*nn= {F
1. True capsule from the stroma of the gland.
2. False capsule from the pretracheal fascia.
. Skin, SC tissue, platysma muscle.
o lnvesting layer of deep cervical fascia.
. Sternomastoid muscle (nerve supply: spinal part of Xl cranial nerve).
. Strap muscles (sternothyroid, sternohyoid & omohyoid muscles) ) supplied
by ansa cervicalis from below ) cut the muscles as high as possible.
Trachea, esophagus with recurrent laryngeal nerve in between.
Cricoid and thyroid cartilages, cricothyroid muscle and inferior constrictor
of the pharynx. (i.e. pharynx & larynx).
Carotid sheath (the carotid artery, the internal jugular vein & the vagus) &
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o The 1't branch of the external carotid artery.
o lt is related to the external laryngeal nerve (when injured, it leads to loss of high
pitched voice & voice fatigue).
2) lnferior Thyroid artery (inverted L-shaped course):
From the thyro-cervical trunk which is a branch of 1"t part of subclavian artery. Its
terminal branches near the gland are in close relation to recurrent laryngeal nerve
(in between, above or below terminal branches).
From the arch of aorta or innominate artery (present in 1 - 3o/o of people ) severe
bleeding during thyroidectomy).
4) Accessory Tracheal & Esophageal arteries:
ln ligament of Berry's; which is a thickened part of the pretracheal fascia that joins
1. Superior Thyroid y,' to internal jugular vein (or
2. Middle Thyroid vein: crosses common carotid
to join internal jugular vein (middle thyroid vein is
the shortest vein; hence it should be the first vein
3. lnferior Thyroid veins (10-12 veins): pass
from the isth-mus over the iront of the tr-achda to
join the left innominate vein.
o Peripheral purt:. To the upper & lower
o Medial ports of both lobes )
1) Pre-laryngeal LNs over cricothyroid membrane (gland of Poirier).
3) Deep cervical LNs ) para-tracheal LNs (mediastinal).
Structure of the Thyroid Gland
o lt is formed of follicles lined with cuboidal epithelium (which is the
parenchyma) & vascular CT stroma.
Oriqin: The nerve arises from the vagus.
on'the Rt. side turns around the 1" part of Rt. subclavian artery & on
e turns around the arch of the aorta.
o The nerve runs in groove between the trachea & esophagus in close to the
te rm i n a I b ra n ch e s of t h e ! n.f.e.f i
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o lt enters the larynx at the inferior horn of thyroid cartilage.
It SUpplieS: All intrinsic ms of the larynx except cricothvroid muscle (external
laryngeal) & the mucous membrane below the vocal cords.
o The nerve might be non recurrent in small percent of cases (2o/o) & in this
situation it might be injured with ligation of the middle thyroid vein.
o Ligation of inferior thyroid artery should be performed away from the gland to
NB: Fibers of the adductors are in the middle of the recunent laryngeal n. while the
fibers of abductors are in the periphery.
O riO i n : ft arises from the superior laryngeal n. of the vagus.
COU rSe: lt passes in close relation to .g.Up.efjp.t.thyf.q.id..af.tS.fy. It supplies:
I n i U ry : causes loss of high pitched voice..
Superior thyroid artery should be ligated as near as possible to the gland to
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