parotid

• adj.

• 耳下腺の

関

parotid gland

　

WordNet

1. relating to or located near the parotid gland

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2012/02/19 21:09:33」(JST)

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"Parotids" redirects here. For the carotids (arteries), see Common carotid artery.

For the toad gland, see parotoid gland.

Parotid gland
Salivary glands: 1 is Parotid gland 2 is Submandibular gland 3 is Sublingual gland
Latin	glandula parotidea
Gray's	subject #177 693
Artery	transverse facial artery
Nerve	otic ganglion
Lymph	preauricular deep parotid lymph nodes
MeSH	Parotid+Gland

The paired parotid glands are the largest of the salivary glands. They are each found wrapped around the mandibular ramus, and secrete saliva through Stensen's ducts into the oral cavity, to facilitate mastication and swallowing and to begin the digestion of starches.

Anatomy

Location

The parotid glands are found overlying the mandibular ramus and anterior and inferior to the external ear. The glands occupy the parotid fascial spaces, an area posterior to the mandibular ramus, anterior and inferior to the ear on each side of the head. Each gland extends irregularly from the zygomatic arch to the angle of the mandible. This gland is effectively palpated (can be felt) bilaterally by starting anterior to each ear, moving to the cheek area and then inferiorly to the angle of the mandible.

Above the parotid gland lies the external auditory meatus and temporomandibular joint. Below, the parotid overlaps the posterior belly of the digastric muscle. Medially lies the styloid process. Posteriorly, the parotid overflows the sternocleidomastoid and anteriorly it overlies the mandible with the overlying masseter.

The parotid gland resembles a three sided pyramid. The apex of the pyramid is directed downwards. the gland has four surfaces: (1) superior (2) superficial (3) anteromedial & (4) posteromedial.

The surfaces are separated by three borders: (1) anterior (2) posterior & (3) medial

Structures which pass through the parotid gland:

• The facial nerve and its branches run through the gland superficial to the retromandibular vein
• The external carotid artery, which gives off its two terminal branches, the maxillary artery and the superficial temporal artery, inside the gland
• The retromandibular vein, which is formed by convergence of the maxillary veins and superficial temporal vein.

Vascularization

Branches of the external carotid artery traverse the glandular tissue and supply the parotid gland with oxygenated blood. The main branch to supply the gland is the transverse facial artery, whereas numerous local veins drain the organ. These veins drain into tributaries of external and internal jugular veins.

The maxillary vein and superficial temporal vein meet to form the retromandibular vein within the parotid gland, but are not responsible for draining it.

Lymphatics comprise pre-auricular lymph nodes.

Innervation

Although the facial nerve passes through the parotid gland it does not receive innervation from it. Instead, the parotid gland is innervated by parasympathetic fibers (of inf. salivatory nucleus) of the glossopharyngeal nerve arising from the otic ganglion, & sympathetic fibers originating from the middle meningeal plexus.

Pathology

Inflammation of of one or both parotid glands is known as parotitis. The most common cause of parotitis is mumps. Widespread vaccination against mumps has markedly reduced the incidence of mumps parotitis. Other infections such as bacterial infections can cause parotitis as may blockage of the duct, whether from salivary duct calculi or external compression. Stones mainly occur within the main confluence of the ducts and within the main parotid duct. The patient usually complains of intense pain when salivating and tends to avoid foods which produce this symptom. In addition, the parotid gland may become enlarged upon trying to eat. The pain can be reproduced in clinic by squirting lemon juice into the patient's mouth. Surgery depends upon the site of the stone: if within the anterior aspect of the duct a simple incision into the buccal mucosa with sphinterotomy may allow removal; however, if situated more posteriorly within the main duct, complete gland excision may be necessary.

Swelling of the parotid gland may also indicate the eating disorder bulimia nervosa, creating the look of a heavy jaw line.

Eighty-five percent of tumors of the parotid gland are benign. The most common of these include pleomorphic adenoma (70% of tumors, affecting predominantly females (60%)) and Warthin's tumor. Their importance is in relation to their anatomical position and tendency to grow over time. The tumorous growth can also change the consistency of the gland and cause facial pain on the involved side since the facial nerve travels through the gland.

Twenty percent of parotid tumors are malignant with the most common tumors being mucoepidermoid carcinoma and adenoid cystic carcinoma. Critically, the relationship of the tumor to the branches of the facial nerve (CN VII) must be defined because resection may damage the nerves, resulting in paralysis of the muscles of facial expression. If the tumor is deep within the gland, the patient should give consent with specific regard to potential damage of the facial nerve.

Surgical treatment of parotid gland tumors is sometimes difficult, on the one hand because of the anatomical relations of the facial nerve parotid lodge, but also through the increased potential for postoperative relapse. Thus, detection of early stages of a parotid tumor is extremely important in terms of postoperative prognosis.

Operative technique is laborious, because of relapses and incomplete previous treatment made in other border specialties.

Secretion

The parotid gland secretes alpha-amylase which is the first step in the decomposition of starches during mastication. It breaks down amylose (straight chain starch) and amylopectin (branched starch) by hydrolyzing alpha 1,4 bonds.

Additional images

• Lateral head anatomy detail

See also

• Parotitis
• Sjögren's syndrome
• John Leonora

References

External links

• Illustration at yoursurgery.com
• lesson4 at The Anatomy Lesson by Wesley Norman (Georgetown University)
• Histology at usc.edu
• Parotid+gland at eMedicine Dictionary

Additional images

• Mandibular division of the trifacial nerve.

• Sympathetic connections of the otic and superior cervical ganglia.

• Horizontal section through left ear; upper half of section.

• Outline of side of face, showing chief surface markings.

• microscopic ducts surrounded by connective tissue

UpToDate Contents

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• 1. 唾石症 salivary gland stones
• 2. 成人における化膿性耳下腺炎 suppurative parotitis in adults
• 3. 唾液腺腫瘍：疫学、診断、評価、および病期分類 salivary gland tumors epidemiology diagnosis evaluation and staging
• 4. 唾液腺腫瘍：限局性疾患の治療 salivary gland tumors treatment of locoregional disease
• 5. 深頸部の感染症 deep neck space infections

English Journal

• Pre- and post-operative dizziness and postural instability in temporal arachnoid cyst patients.

• Tunes C1, Flønes I, Helland C, Wilhelmsen K, Goplen F, Wester KG.Author information 1Department of Surgical Sciences, University of Bergen, Bergen, Norway.AbstractOBJECTIVES: Arachnoid cysts (AC) are benign, congenital malformations of the leptomeninges, with a predilection for the temporal fossa. In our clinical experience, patients with temporal AC often complain of dizziness and imbalance. However, these symptoms and the effect of surgery on them have not been studied before.
• Acta neurologica Scandinavica.Acta Neurol Scand.2014 May;129(5):335-42. doi: 10.1111/ane.12190. Epub 2013 Oct 1.
• OBJECTIVES: Arachnoid cysts (AC) are benign, congenital malformations of the leptomeninges, with a predilection for the temporal fossa. In our clinical experience, patients with temporal AC often complain of dizziness and imbalance. However, these symptoms and the effect of surgery on them have not
• PMID 24117227

• The QUANTEC criteria for parotid gland dose and their efficacy to prevent moderate to severe patient-rated xerostomia.

• Beetz I1, Steenbakkers RJ, Chouvalova O, Leemans CR, Doornaert P, van der Laan BF, Christianen ME, Vissink A, Bijl HP, van Luijk P, Langendijk JA.Author information 1Department of Radiation Oncology, University of Groningen, University Medical Center Groningen , Groningen , the Netherlands.AbstractAbstract Background. Recently, the Quantitative Analysis of Normal Tissue Effect in the Clinic (QUANTEC) Group defined dose-volume constraints for the parotid glands to avoid severe xerostomia. The aim of this study was to determine if application of these QUANTEC criteria also protected against moderate-to-severe patient-rated xerostomia. Material and methods. The study population consisted of 307 head and neck cancer patients treated with primary (chemo)radiotherapy, either with 3D-CRT (56%) or with IMRT (44%). All patients participated in a standard follow-up program in which radiation-induced toxicity and quality of life were prospectively assessed. Patients who met the QUANTEC criteria were classified as low risk and otherwise as high risk. Results. In total, 41% of the patients (treated with 3D-CRT and IMRT) were classified as low risk patients. In the group treated with 3D-CRT and IMRT, it was possible to meet the QUANTEC criteria in 47% and 32% of the patients, respectively. Sparing the parotid glands with IMRT was considerably more difficult in patients with lymph node metastases and in patients with nasopharyngeal and oropharyngeal tumours. Low risk patients reported significantly less moderate-to-severe xerostomia than high risk patients. However, the predicted risk of elderly patients and patients with pre-existing minor patient-rated xerostomia at baseline was > 20%, even when the QUANTEC criteria were met. Conclusions. Significantly lower rates of radiation-induced patient-rated xerostomia were found among low risk patients treated according to the QUANTEC criteria, but these criteria do not completely protect against xerostomia. Particularly in elderly patients and patients already suffering from minor xerostomia at baseline, the QUANTEC criteria do not sufficiently protect against persistent, moderate-to-severe patient-rated xerostomia.
• Acta oncologica (Stockholm, Sweden).Acta Oncol.2014 May;53(5):597-604. doi: 10.3109/0284186X.2013.831186. Epub 2013 Sep 2.
• Abstract Background. Recently, the Quantitative Analysis of Normal Tissue Effect in the Clinic (QUANTEC) Group defined dose-volume constraints for the parotid glands to avoid severe xerostomia. The aim of this study was to determine if application of these QUANTEC criteria also protected against mod
• PMID 23998646

• Treatment of chronic recurrent juvenile parotitis using sialendoscopy.

• Mikolajczak S1, Meyer MF, Beutner D, Luers JC.Author information 1Department of Otorhinolaryngology, Head and Neck Surgery, University of Cologne , Cologne , Germany.AbstractAbstract Conclusion: The combination of sialendoscopy and an intraductal application of corticosteroids can be recommended for children with chronic recurrent juvenile parotitis (CRJP) as there is growing evidence for a positive effect in the absence of side effects. Objective: CRJP is a disorder with painful, episodic swelling of the parotid gland in children. The majority of cases have a self-limiting character within 5-10 years, but the disease may also continue into adulthood. CRJP can occur on one or both sides and up to now the etiology has been unclear. The aim of this study was to analyze the therapeutic effect of a sialendoscopic application of corticosteroids on the clinical course of patients with CRJP. Methods: We retrospectively analyzed the clinical course of 9 children with 10 parotid glands affected by CRJP, who all underwent sialendoscopy and intraductal application of corticosteroids. In all cases the procedure was conducted under general anesthesia. The average follow-up period was 15 months. Results: There were no side effects associated with the sialendoscopy. All duct systems showed signs of chronic inflammation with an atrophic or thickened epithelium. At the follow-up visit, CRJP symptoms had completely resolved in eight children. One child still showed slight parotid swellings without the need for antibiotics. None of the parents reported that symptoms had continued at an equal level or worsened after sialendoscopy.
• Acta oto-laryngologica.Acta Otolaryngol.2014 May;134(5):531-5. doi: 10.3109/00016489.2013.879738. Epub 2014 Mar 6.
• Abstract Conclusion: The combination of sialendoscopy and an intraductal application of corticosteroids can be recommended for children with chronic recurrent juvenile parotitis (CRJP) as there is growing evidence for a positive effect in the absence of side effects. Objective: CRJP is a disorder wi
• PMID 24597494

Japanese Journal

• Carcinoma ex pleomorphic adenoma in minor salivary glands of the anterior tongue: A case report

• Yamada Shin-ichi,Yanamoto Souichi,Rokutanda Satoshi,Matsutani Kouhei,Kawasaki Goro,Kawano Toshihiro,Fujita Shuichi,Ikeda Tohru,Umeda Masahiro
• Journal of Oral and Maxillofacial Surgery, Medicine, and Pathology 25(2), 197-200, 2013-04-00
• … Most cases of CEPA occur in parotid glands, and CEPA arising in minor salivary glands is rare. …
• NAID 120005289674

• 臨床 サイバーナイフが著効した再発耳下腺腺房細胞癌例

• 清水 顕,伊藤 博之,渡嘉敷 亮二 [他]
• 耳鼻咽喉科臨床 106(1), 29-34, 2013-01-00
• NAID 40019552541

• 臨床 小児・若年者耳下腺腫瘍の検討

• 堀 龍介,庄司 和彦,濱口 清海 [他]
• 耳鼻咽喉科臨床 106(1), 23-28, 2013-01-00
• NAID 40019552508

Related Links

• Parotid gland - Wikipedia, the free encyclopedia

The parotid gland is a salivary gland in humans. It is one of a pair, and the largest of the salivary glands. It is wrapped around the mandibular ramus, and secretes saliva through Stensen's ducts into the oral cavity, to facilitate mastication and ...

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