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Salivary Gland Anatomy
Published in John C Watkinson, Raymond W Clarke, Terry M Jones, Vinidh Paleri, Nicholas White, Tim Woolford, Head & Neck Surgery Plastic Surgery, 2018
Superficial to the maxillary and superficial temporal arteries lie the corresponding veins, which unite to form the retromandibular vein within the gland. The retromandibular vein emerges from the lower pole of the gland and divides into two branches. The anterior branch joins the facial vein before entering the internal jugular vein. The posterior branch joins the posterior auricular vein to form the external jugular vein. The division may occur within the gland and two branches emerge from the lower pole.
Anatomy
Published in Jonathan M. Fishman, Vivian A. Elwell, Rajat Chowdhury, OSCEs for the MRCS Part B, 2017
Jonathan M. Fishman, Vivian A. Elwell, Rajat Chowdhury
The facial nerve is the most superficial structure within the parotid gland and hence is extremely vulnerable to injury during parotid surgery. If the retromandibular vein comes into view, the facial nerve has already been severed! A facial nerve monitor should be used throughout and it is important to identify and protect the various branches of the facial nerve, which may be remembered by the mnemonic ‘Ten Zulus Baited My Cat’ (from top to bottom): Ten = Temporal branchZulus = Zygomatic branchBaited = Buccal branchMy = Marginal mandibular branchCat = Cervical branch
Ultrasound imaging, including ultrasound-guided biopsy
Published in John Dudley Langdon, Mohan Francis Patel, Robert Andrew Ord, Peter Brennan, Operative Oral and Maxillofacial Surgery, 2017
The parotid gland lies in the parotid space which is the most lateral space in the nasopharyngeal area, extending from the external auditory canal superiorly to the level of the angle of the mandible inferiorly. The gland is arbitrarily divided into superficial and deep lobes by the facial nerve, but this structure cannot be identified with ultrasound. The retromandibular vein passes superiorly through the parotid and can be used as a landmark for dividing the parotid into superficial and deep lobes, i.e. as a predictor of likely proximity of a mass to and involvement of the facial nerve. The external carotid artery passes through the gland deep to the retromandibular vein. Intra- and extraglandular nodes are seen in the parotid space. Stenson’s duct may be visualized as bright parallel echogenic lines, 3 mm in diameter within the superficial lobe.
Intravenous sinus meningioma with intraluminal extension to the internal jugular vein: case report and review of the literature
Published in British Journal of Neurosurgery, 2023
Kei Yamashiro, Mitsuhiro Hasegawa, Saeko Higashiguchi, Hisayuki Kato, Yuichi Hirose
The tumour had also invaded the peripheral veins, such as the common facial vein and the retromandibular vein (Figure 6(E)). These veins were ligated and cut after confirming the end of the tumour. The cranial side of cervical intraluminal tumour was excised with the wall of the internal jugular vein at the level of the atlas. The excision cavity was connected to the cranial side. The resected internal jugular vein was not reconstructed as it had already nearly occluded prior to the surgery.
Refinement of the surgical indication and increasing expertise are associated with a better quality of pathology specimen in pleomorphic adenomas
Published in Acta Oto-Laryngologica, 2021
Konstantinos Mantsopoulos, Ann-Kristin Iro, Matti Sievert, Sarina Katrin Müller, Abbas Agaimy, Michael Koch, Heinrich Iro
Over time, therefore, our department consolidated for establishing the indication for the surgical modality in managing PAs. Firstly, all patients with parotid gland lesions are examined preoperatively in our department by means of ultrasound as well as magnetic resonance imaging in selected cases. The correct indication is based upon the correct interpretation of preoperative sonographic findings (distance from the parotid capsule [17,18], localisation in the parenchyma, contact with the cervical muscles, and relationship to the retromandibular vein) as well as intraoperative palpation after raising the flap (palpability and mobility of the tumour, fixation to underlying tissue). The indication for ED is given by easily palpable, mobile PAs located in the superficial lobe of the gland without the expected broad contact with the facial nerve trunk and its branches. The contact of a tumour with a solitary nerve branch for a short distance seen intraoperatively, in the course of electromyographically-guided dissection around the tumour, does not obligatorily preclude extracapsular dissection in the remaining part of the tumour periphery. Contact with the sternocleidomastoid or the digastric muscle is very helpful in localising the lesion and achieving clear margins on this side of the tumour. Furthermore, ED is performed through a submandibular incision for tumours arising from the parapharyngeal prolongation of the parotid gland, without extensive contact with the lateral parotid flap [10]. It is easy to understand that in the areas in contact with the facial nerve, all available surgical modalities would lead to a marginal excision with focal capsule exposure of a PA. If the PA is cannot be easily palpated or extensive contact with the facial nerve is suspected from the depth of the lesion on preoperative imaging, no attempt is made to carry out an ED and the main trunk of the facial nerve is dissected out directly. The surgical modality is further determined by the site and size of the tumour. Contact with a solitary nerve branch allows dissection of only this nerve and a partial superficial parotidectomy can be performed. Extensive contact with more than one branch of the facial nerve automatically necessitates a lateral parotidectomy. If the PA is located in the deep lobe of the parotid gland or at a parapharyngeal site in extensive contact with the facial nerve, a CP is obligatory.