ANATOMY

PAROTID GLAND

The parotid gland is located in the space between the ramus of the mandible and the external auditory
canal and mastoid tip. The anterior portion of the gland overlies the masseter muscle,and the posterior
portion overlies the sternocleidomastoid muscle.The deep, medial portion of the gland is adjacent to the
parapharyngeal space.The styloid process is adjacent and deep to the gland. The carotid artery and
internal jugular vein are medial to the styloid process. The parotid gland is covered by the parotid fascia.
This layer is an extension of the superficial layer of the deep cervical fascia that splits to envelop the
gland.On its inferomedial surface,the condensation of the fascial envelope suspended between the
styloid process and the mandible is termed the stylomandibular ligament. This ligament separates the
inferior portion of the parotid gland from the posterior portion of the submandibular gland. The parotid
duct (Stensen’s duct) exits the superficial part of the gland anteriorly and passes across the masseter
muscle at a location halfway between the zygoma and the oral commissure. As the duct reaches the
anterior portion of the masseter muscle, it turns medially to pierce the buccinator muscle and enters the
buccal mucosa of the oral cavity opposite the second upper molar tooth.Lymph nodes may be found
within the capsule of the parotid gland.These lymph nodes drain the scalp, forehead, eye, cheek, and
oral commissure. Surgeons often speak of superficial and deep lobes of the parotid gland and suggest
that the facial nerve lies in a true cleavage plane between these two lobes.Most anatomists conclude
that there is no true anatomic division between the superficial and deep lobes.These terms simply refer
to the presence of tissue both lateral and medial to the facial nerve. The position of the facial nerve is
the dominant consideration in surgery of the parotid gland. As the nerve exits the stylomastoid foramen,
it enters the posterior and medial portion of the gland, usually as a single trunk. Its primary bifurcation
occurs at the pes anserinus with subsequent secondary division into five facial and cervical branches.The
nerve lies within the substance of the gland and is not simply covered by folds of the gland. Numerous
variations in the branching pattern of the facial nerve occur,and the surgeon must be observant during
approach and dissection of the nerve.1 Parotid gland secretions are stimulated by parasympathetic
fibers originating in the inferior salivatory nucleus of the brainstem.These fibers join the
glossopharyngeal nerve and then the lesser petrosal nerve before joining the otic ganglion just outside
the foramen ovale.The auriculotemporal nerve picks up these parasympathetic fibers and distributes
them to the parotid gland.

SUBMANDIBULAR GLAND

The submandibular gland is located within the submandibular triangle of the neck. Like the parotid
gland,it is covered with a fascial capsule,which originates from the superficial layer of the deep cervical
fascia. At the posterior border of the gland, the stylomandibular ligament separates the submandibular
gland from the parotid gland. The anterior border of the submandibular gland is folded over the
posterior border of the mylohyoid muscle, creating portions of the gland both superficial and deep to
the mylohyoid muscle. The submandibular gland duct (Wharton’s duct) arises from the medial aspect of
the gland and proceeds submucosally in the floor of the mouth medial to the sublingual gland to reach
its papilla at the side of the frenulum of the tongue. The vascular supply to the submandibular gland is
from the facial artery, which enters the gland just superior to the posterior belly of the digastric muscle.
Small branches from the facial artery enter the gland directly. The lingual nerve is located just medial
and superior to the gland within the sublingual space. The hypoglossal nerve courses between the
medial portion of the submandibular gland and the hyoglossus muscle deep to the digastric muscle. The
marginal mandibular branch of the facial nerve often overlies the lateral aspect of the submandibular
gland. It is positioned in a plane deep to the platysma muscle but superficial to the submandibular gland
fascia. Protection of these nerves during surgery of the submandibular gland will be discussed in more
detail. Parasympathetic stimulation of the submandibular gland causes formation and release of saliva.
The responsible parasympathetic fibers originate in the superior salivatory nucleus in the
brainstem.These fibers travel with the seventh cranial nerve and enter the chorda tympani nerve as it
branches from the facial nerve within the mastoid. After traversing the middle ear and entering the
infratemporal fossa, the chorda tympani joins the lingual nerve just below the foramen ovale. The
parasympathetic fibers run with the lingual nerve to the submandibular ganglion, which is suspended
from the lingual nerve just superior to the gland.

SUBLINGUAL GLANDS

The sublingual glands are located submucosally in the floor of the mouth. They are paired structures and
nearly meet in the anterior part of the floor of the mouth.Typically,there is no single duct draining the
submandibular glands.Rather,there are 10 to 12 smaller ducts that pass directly into the mucosa of the
floor of the mouth. The sublingual glands are innervated by parasympathetic fibers of the chorda
tympani nerve.