Padalecki 5

Question 1

Anterior and Posterior Boundaries of the Parotid Region

Answer 1

A. Anterior - anterior border of the mandibular ramus

B. Posterior - mastoid process of temporal bone

Question 2

Superior and Inferior Boundaries of the Parotid Region

Answer 2

C. Superior - zygomatic arch

D. Inferior - posterior belly of the digastric muscle

Question 3

Medial and Lateral Boundaries of the Parotid Region

Answer 3

E. Medial - to the styloid process and beyond

F. Lateral - superficial layer of parotid fascia

Question 4

Location of the Parotid Gland

Answer 4

1. Inferior and anterior to the auricle
2. Lateral and posterior to masseter muscle
3. Lateral, posterior, and medial to the mandibular ramus

Question 5

Shape of the Parotid Gland

Answer 5

1. Roughly triangular

2. Apex points inferiorly

Question 6

Parotid gland is sometime described as _______.

Answer 6

Bilobate

Question 7

a. Constricted between _____ and _____.
b. Deep “lobe” expands into the ________.
c. Lobes demarcated by courses of ______; there is fatty tissue between the lobes to allow for movement

Answer 7

a. mandible and styloid process
b. lateral pharyngeal space
c. facial nerve branches

Question 8

Embedded within the parotid from superficial to deep:

Answer 8

1. parotid plexus and branches
2. retromandibular vein
3. external carotid artery

Question 9

The parotid space location is ________.

Answer 9

encompasses parotid gland

Question 10

a. Extension of investing cervical fascia
b. Thick superficial lamina
c. Thin deep lamina - abuts medially on the lateral pharyngeal space
d. Septa penetrate gland

Answer 10

Parotid fascia

Question 11

Attachments of Parotid fascia

Answer 11

(1) Superior - zygomatic arch
(2) Inferior - fascia on sternocleidomastoid
(3) Anterior - masseteric fascia

Question 12

1. Arises from anterior surface of gland
2. Course - 1 to 2 cm inferior to zygomatic arch
   a. Curves around anterior border of masseter muscle
   b. Pierces buccinator muscle
3. Empties into buccal cavity
   a. At parotid papilla
   b. Opposite maxillary second molar tooth

Answer 12

Parotid Duct

Question 13

Arteries are branches of…

Answer 13

a. Maxillary artery
b. Superficial temporal artery
c. Transverse facial artery

Question 14

Veins & location of drainage

Answer 14

a. Maxillary vein
b. Superficial temporal vein
c. Transverse facial vein
d. Drain into retromandibular vein

Question 15

Lymphatics

Answer 15

a. Parotid nodes
b. Superficial cervical nodes
c. Superior deep cervical nodes

Question 16

Afferent fiber innervation

Answer 16

a. Great auricular nerve (1) From C2&3
(2) Cell bodies in dorsal root ganglia
b. Auriculotemporal nerve
(1) From V3
(2) Cell bodies in trigeminal ganglion

Question 17

Parasympathetic fiber innervation - Postganglionic

Answer 17

(1) Within auriculotemporal branch of V 3
(2) Cell bodies in otic ganglion
(3) Stimulation increases rate of parotid salivary flow
(4) Parotid salivary flow is also stimulated by chewing

Question 18

Parasympathetic fiber innervation - Preganglionic

Answer 18

(1) Cell bodies in inferior salivatory nucleus
(2) Peripheral course
(a) Tympanic branch of IX
(b) Tympanic plexus on medial wall of tympanic cavity
(c) Lesser petrosal nerve
(i) Through foramen ovale (ii) To otic ganglion

Question 19

Sympathetic postganglionic fiber innervation

Answer 19

a. Through external carotid plexus
b. Cell bodies in superior cervical ganglion
c. Stimulation increases glycoprotein and viscosity of parotid salivary flow

Question 20

Clinical correlates

Answer 20

1. Mumps: viral infection resulting in swelling of the parotid gland; causes severe pain due to the parotid sheath limiting swelling
2. Parotid tumors
   a. 80% are benign
   b. cancer rare but sometimes in parotid
   c. surgical intervention is risky CN VII.

Question 21

Origin of facial nerve:

1. From lateral aspect of brainstem at junction of ____ and _____.
2. This is a complex structure with a peculiar course through the ______.

Answer 21

1. pons and medulla

2. temporal bone

Question 22

In addition to the branchiomeric efferent fibers found in the branches on the face, the facial nerve contains _______ and _______ fibers. The distribution of these fibers within the visceral parts of the head will be considered in detail later.

Answer 22

1. Afferent (mainly taste) fibers

2. Preganglionic parasympathetic (secretomotor) fibers

Question 23

Fiber types of branches of the face

Answer 23

a. Efferent to branchiomeric muscle

b. Afferent

Question 24

(1) Muscles derived from second branchial arch
(a) Muscles of facial expression
(b) Three other muscles
(i) Posterior belly of the digastric
(ii) Stylohyoid
(iii) A small muscle of the middle ear (stapedius)
(2) Cell bodies in facial motor nucleus

Answer 24

Efferent to branchiomeric muscle

Question 25

(1) To auricular skin | (2) Cell bodies in geniculate ganglion

Answer 25

Afferent

Question 26

Course of branches of the face

Answer 26

a. Exits skull at stylomastoid foramen | b. Branches within parotid gland (parotid plexus)

Question 27

Peripheral branches

Answer 27

a. Two small branches below auricle b. Temporofacial division c. Cervicofacial division

Question 28

Two small branches below auricle

Answer 28

(1) Posterior auricular | (2) Branch to posterior digastric and stylohyoid muscles

Question 29

Temporofacial division

Answer 29

(1) Temporal branches (2) Zygomatic branches (3) Buccal branch

Question 30

Cervicofacial division

Answer 30

(1) Buccal branch (2) Marginal mandibular branch (3) Cervical branch

Question 31

Connections with cutaneous branches of the trigeminal nerve

Answer 31

a. Occur in areas of overlap | b. Mechanism to supply afferent fibers to facial muscles

Question 32

1. Raise the eyebrows 2. Close both eyelids tightly 3. Whistle 4. Smile to show the teeth 5. Pull down the corners of the mouth and raise (wrinkle) the skin of the neck

Answer 32

Test for function of the facial nerve

Question 33

Lesions resulting in facial paralysis

Answer 33

1. Peripheral lesions | 2. Central lesions (i.e. stroke)

Question 34

Paralysis of muscles of the lower face only; forehead is usually not affected.

Answer 34

Central lesions (i.e. stroke)

Question 35

Peripheral lesions are usually _____.

Answer 35

Unilateral

Question 36

(1) Smoothing of wrinkles and folds (2) Drooping of eyebrow (3) Sagging of lower eyelid (4) Sagging of corner of mouth (5) Deviation of mouth to unaffected side (6) Interference with normal facial movements (e.g., asymmetry) (a) Frowning or wrinkling forehead skin (b) Elevating eyebrow (c) Closing eye tightly (d) Pursing lips (e) Laughing, smiling, or showing teeth (f) Control of cheek in chewing (g) Wrinkling skin of neck (7) Depending on level of lesion, other manifestations may occur (e.g., changes in taste, dry mouth, etc.)

Answer 36

Results of peripheral lesions

Question 37

1. Trauma 2. Tumor 3. Inflammatory disorders 4. Bell's palsy

Answer 37

Etiology of peripheral lesions

Question 38

(a) Parotid neoplasms | b) Acoustic neuroma (benign sheath - cell tumor of VIII

Answer 38

Tumors

Question 39

(a) Idiopathic (b) Often preceded by mild upper respiratory illness (c) Progresses steadily to affect half of face (d) Thought to result from ischemic or pressure effects of nerve edema within narrow bony canal (e) Uncomplicated cases demonstrate some regeneration and varying degrees of functional recovery

Answer 39

Bell's palsy: characteristics