Parotid Duct Research Articles

Anatomical Evaluation of Zygomaticus Major Muscle With Relation to Orbicularis Oculi Muscle and Parotid Duct

To evaluate morphological properties of the zygomaticus major (ZMj) and demonstrate its detailed anatomical relationships with the orbicularis oculi (OOc) and the parotid duct (PD). Fifteen formalin fixed adult cadaver heads (7 males /8 females) aged between 45 and 92 years were dissected to reveal the ZMj, OOc, PD. Shape, lengths and thickness of the ZMj, positional relationships of the ZMj with respect to the OOc and PD (overlap, neighboring, being separate) were determined. Topographic localization of the ZMj according to lateral and medial canthi, tragus, mental tubercle and angle of mandible was evaluated. The shape of the ZMj was observed as band like in 15/29 (51%), fan like in 10/29 (34%) and bifid in 4/29 (13%) sides. Position of the ZMj with respect to the OOc and distal part of the PD was not constant. The ZMj was overlapped by the OOc in 15/29 (52%) sides while they were adjacent in 14/29 (48%) sides. The ZMj overlapped the distal part of PD in 16/29 (%55) sides. They were separate in 10/29 (35%) sides and adjacent in 3/29 (10%) sides. Topographic location of the ZMj with respect to lateral and medial canthii, tragus, angle of mandible and mental tubercle was demonstrated. No statistically significant relationships were found between the ZMj measurements with head circumference and face length. No statistically significant differences were found between sides and gender in terms of the ZMj morphology (P > 0.05). This study demonstrates the morphological features and topography of the ZMj along with its relationships with the OOc and PD that would be essential for clinical implications.

Description and relationships of the parotid gland levels proposed by the European Salivary Gland Society staging system: an anatomical study.

To perform an anatomical study to analyze the size, weight, and the relationships of the parotid levels proposed by the European Salivary Gland Society (ESGS). Anatomical dissections of the parotid region in 19 human specimens were performed. All dissections were systematically carried out to study the dimensions and weight of each level. We also studied the facial nerve distribution between the different levels and the relative position of the facial nerve main trunk and parotid duct in regard to the Frankfort line plane. The facial nerve trunk and the parotid duct were identified in all the 19 specimens, which made it feasible to define the 4 principal levels of the parotid gland body (levels I-IV). Level V was identified in 9 out of 19 dissections (47.5%). For the whole gland, the mean for the height and width dimensions were 66.37mm and 46.84mm, respectively, and it weighted 18.13g. In terms of relative weight regarding the whole gland, level II was always the heaviest, representing from 41 to 47% of the gland's weight, depending on the presence of level V. Levels I and III represent almost the same amount of relative weight as they range from 20 to 22% for each one. Level IV was the lightest body level representing 8-10% of the whole, and when present, level V represented less than 5% of the whole parotid weight. The temporal and zygomatic terminal branches were always found between the cranial levels, whereas the cervical and marginal nerves lie in all cases between the caudal levels. The buccal branches had multiple ramifications that lie between both cranial and caudal levels in 47% of the cases, being found exclusively between cranial levels in 21% and between the caudal levels in the remaining 32%. As traditionally reported, the caudal superficial portion of the gland represents the most voluminous portion of the gland, being labeled in our classification as level II. Levels I and III represent similar amounts of gland, though presenting a significantly different morphological disposition. Level IV is the smallest portion of the body gland and level V, when present represents a scarce 5% of the whole body gland weight. The ESGS levels have a clear anatomical basis and the basic references needed to define them are always present.

On the history of discovery of ductus parotideus

An article provides author’s translation from Latin of Niels Stensen’s letter to his teacher Thomas Bartholin, describing circumstances of Stensen’s discovery of parotid duct as well as vicissitudes of recognition of his priority but not Gerard Blaes’ one, who credited himself discovery of ductus parotideus. Brief data on Niels Stensen’s life is given, his contribution to medicine and geology is described.

Malignant Myoepithelioma of the Parotid Gland in a Rat

Myoepitheliomas of the salivary glands have been described in laboratory mice, but not in rats. A 20-week-old Wistar (Han) female rat developed a white to grey firm mass at the left side of the neck. Histologically, the mass was unencapsulated and infiltrated the adjacent tissue. The tumour parenchyma was cell rich without acinar or tubular architecture. The tumour showed a palisading basal cell pattern adjacent to blood vessels. There were areas of necrosis filled with cellular debris. The tumour cells showed strong immunohistochemical labelling for pan-cytokeratin types I and II (AE1/AE3), pan-cytokeratin (cytokeratins 1, 5, 6 and 8), cytokeratin 5, cytokeratin 14, vimentin and podoplanin, and only very slight positivity for cytokeratin 8 in small areas. There was no expression of smooth muscle actin. Based on the histological appearance and the immunohistochemistry, the tumour was diagnosed as a malignant myoepithelioma of the parotid gland originating from the parotid duct.

Parotid sialolithiasis with Stenson’s duct stricture: a rare case report

Sialolithiasis is the most common disease that affects the major salivary glands and occurs mainly in the submandibular gland (80-90%), and to a lesser degree in the parotid gland (5-20%). In literature many papers have been published regarding the parotid calculi and their treatment. However, data on salivary duct strictures management is less with variable opinion. We present a case of 45-year-old female with swelling of right parotid for 6 months, USG showed duct calculi with sialadenitis and sialogram showed large duct calculi with high grade strictures. Duct calculi was removed by intra-oral approach and parotidectomy was done as endoscopic management of strictures failed. This was highlighted case as parotid duct calculi along with high grade strictures are rare.

Salivary gland ablation: introducing an interventional radiology treatment alternative in the management of sialorrhea

BackgroundSialorrhea is common in children with neurological disorders and leads to social isolation, aspiration pneumonia and increased caregiver burden. Sialorrhea management includes anticholinergic medications and a variety of surgeries, but these are limited by side effects, recurrence and risks.ObjectiveWe present our method of salivary gland ablation, an interventional radiology treatment for sialorrhea, and report safety and efficacy data from pediatric patients who underwent salivary gland ablation.Materials and methodsSalivary gland ablation uses image-guided sotradecol and ethanol dual-drug injection into the salivary glands. Submandibular and sublingual glands are injected percutaneously using ultrasound. Parotid glands are injected retrograde through Stensen ducts using fluoroscopy. We conducted a retrospective review of the medical records of patients who underwent salivary gland ablation at our institution between 2005 and 2019. Pre- and post-procedure Drooling Frequency and Drooling Severity (DFDS) scale scores were compared and caregiver satisfaction was assessed. We devised two cohorts, one to study patient safety and a subcohort to study clinical efficacy using DFDS scores.ResultsOne hundred and seventy salivary gland ablation procedures were performed in the 99 patients comprising the safety cohort. Of the procedures, 88.8% resulted in no or minimal complications. Respiratory difficulty, temporary nerve palsy and infection represent the majority of the 11.2% of patients who experienced periprocedural complications. There were no complications resulting in permanent sequelae. Twenty-seven patients met our inclusion criteria for the efficacy subcohort with a mean follow-up time of 5.4 years. DFDS at follow-up decreased from a median score of nine to a seven post-procedure (P=0.000018). The proportion of caregivers who were satisfied with the procedure increased as more glands were ablated, which suggests a causal link between the number of glands ablated and the outcome.ConclusionSalivary gland ablation is a safe and effective procedure with the potential for permanent decrease in symptoms related to sialorrhea.

Sphingosine-1-phosphate alleviates irradiation-induced parotid injury in a miniature pig model.

Our aim was to verify the alleviation effect of sphingosine-1-phosphate (S1P) in a miniature pig model. Thirty male miniature pigs were randomly separated into 10 groups in our experiment. We administered S1P through the parotid duct in a retrograde fashion 2hr before irradiation (IR). The salivary flow rate and blood flow rate were tested 20weeks after IR. The apoptotic level was checked at 12, 24hr and 7days post-IR. Twenty weeks after IR, the salivary flow rate of the IR-side parotid gland in IR+S1P group can be maintained at about 40% of the non-IR side, while only 20% was maintained in the IR group. The blood flow rate and microvascular density were significantly higher in the IR+S1P group than in the IR group. The apoptotic level and cleaved caspase-3 expression were downregulated in IR+S1P group, and the ratio of Bcl-2/Bax was increased. The blood flow rate and CD31 level were significantly restored at 12, 24hr and 7days post-IR. Sphingosine-1-phosphate may partially alleviate IR-induced parotid dysfunction by decreasing apoptosis of microvascular endothelial cells and maintaining the blood flow rate.

Gross Anatomical, Radiographic and Doppler Sonographic Approach to the Infra-auricular Parotid Region in Donkey (Equus asinus)

The present study was performed on 12 heads of donkey’s cadavers of both sexes for different anatomic techniques and on 20 live adult donkeys for ultrasonographic approaches of local anesthetic techniques. The aim was to achieve safe desensitization of the ear canal and tympanic membrane in addition to measuring different parameters of the structures occupying the infra-auricular parotid region. The internal auricular nerve was divided into two fine branches and constituting, at its origin, a characteristic V-shape with the caudal auricular nerve. The styloid process of auricular cartilage was an adequate landmark for ultrasonographic needle-guided anesthesia for internal auricular and auriculopalpebral nerves, whereas the great auricular nerve was easily palpated subcutaneously that showed safety and success in all cases. The auricular branch of mandibular nerve joined the auriculopalpebral branch of facial nerve. The maxillary vein was descending, partially embedded within the texture of the parotid glandular tissue. The parotid gland divided into five segments was clearly demarcated by maxillary vein tributaries with three main collecting radicles pouring into the parotid duct. The mandibular duct received about 12–15 fine radicles and supplied with a separate branch from the external carotid artery. Using the Doppler sonographic technique in donkeys for diagnosis of ear affections, evaluation of retrograde sialography to salivary glands with their blood vasculature and their indices might be helpful for the detection of different critical abnormalities, such as stenosis, thrombosis, and other vasopathological affections through measuring their resistivity and pulsatility indices.

Self‐induced pneumoparotid: Case report of a rare cause

AbstractPneumoparotid is a rare, difficult to diagnose cause of parotid gland swelling resulting from air insufflation inside the parotid gland or duct. We report a case of self‐induced pneumoparotid in a 14‐year‐old boy, presented with intermittent painless left parotid swelling for 7 months. Foamy saliva was expressed from the left Stenson's duct with manual compression of the crepitant mass. CT scan confirmed the diagnosis of pneumoparotid. The patient admitted the habit of blowing his cheeks against a closed mouth and was educated to abstain from the triggering habit. There was no recurrence in 2 years.

Preliminary application and evaluation of autograft reconstruction of parotid duct defect with submandibular gland duct for buccal cancer

Background: We aimed to preserve parotid function in patients with buccal carcinoma by applying a new surgical protocol based on reconstruction of parotid ductal defect with submandibular gland ductal.Aims/Objectives: The aim of this study is to introduce the method of autologous submandibular gland duct reconstruction for the treatment of parotid duct defect in buccal carcinoma, and to evaluate its clinical application in follow-up.Material and methods: A total of 28 patients with buccal carcinoma who underwent buccal and neck combined with radical surgery and vascularized flap transplantation were enrolled. Function of the reconstructed duct was reviewed in 6 months after surgery.Results: Both groups achieved good short-term results within 1 month after surgery. The 6-month postoperative angiography examination of the submandibular gland duct showed that 6% of patients in the submandibular gland duct graft group had a blockage or was not smooth. At the same time, 45% of the patients in the vein graft group had failure or obstruction, and the VAS score of pain was higher than that of the submandibular gland ductal graft group (p < .05).Conclusion and significance: Compared with vein grafting, the reconstruction of parotid ductal defect with submandibular gland ductal graft has better long-term effects.

External Approach to Buccal Fat Excision in Facelift: Anatomy and Technique.

Masculinization of the face is a common finding in facelift patients. It is attributed to deflation and decent of the midface-jowls coupled with skin laxity. Fullness is evident lateral to the jowl in a small percentage due to prominent buccal fat pad (BFP). The authors sought to examine the anatomy of the BFP, triangulate the prominent BFP with surgical landmarks, and describe an external approach to excise the BFP during facelift surgery. Eighteen cadaveric dissections were performed. Facelift flap was elevated and the prominent buccal extension of the BFP protruding through the superficial-musculo-aponeurotic-system was identified. Measurements were taken from the BFP to surgical landmarks: zygomatic arch, tragus, and gonial angle. The locations of the facial nerve, parotid duct, and vascular pedicle relative to the BFP were calculated. BFP was 4.1 cm inferior to the zygomatic arch, 7.5 cm anterior the tragus, and 4.5 cm medial the gonial angle. The middle facial artery supplied the BFP on the inferior-lateral quadrant in 61% and inferior-medial quadrant in 39% of specimens . In all specimens, the parotid duct traversed the BFP superiorly, and the buccal branches of the facial nerve traversed the capsule superficially. The buccal extension of the BFP can pseudoherniate in the aging face. Excision may improve lower facial contour. Measurements from facial landmarks may help surgeons identify the buccal extension of the BFP intraoperatively. The surgeon must be careful of the vascular pedicle, parotid duct, and the facial nerve. The external approach safely excises buccal fat during facelift dissection while avoiding intraoral incisions and unnecessary contamination.

Feasibility of ovine and porcine models for simulation training in parotid surgery and facial nerve dissection

To assess and compare the feasibility of using ovine and porcine models as surgical simulation training tools for otolaryngology trainees performing parotid surgery and facial nerve dissection. Trainees performed parotid surgery (total parotidectomy, retrograde facial nerve dissection and facial nerve grafting) on an ovine and porcine model. Participants completed a 22-item, five-point Likert scale questionnaire on each model, assessing three validation domains; face validity (FV), global content validity (GCV) and task-specific content validity (TSCV). Data were prospectively collected and analysed using descriptive and non-parametric statistics. Twelve trainees completed two consecutive parotidectomies and facial nerve dissections on an ovine and porcine model. Twenty-four dissections were completed. Validation questionnaires were completed for each model by all trainees. The ovine model achieved median validation threshold scores (≥ 4/5) for all aspects of FV, GCV and TSCV. The porcine model did not achieve validation threshold scores for any aspect of the validation questionnaire. Comparison of the ovine and porcine model demonstrated that the ovine model was statistically superior to the porcine model across most validation criteria excluding realistic appearance of skin, identification and ligation of the trans-oral parotid duct and facial nerve grafting. Adequate experience with facial nerve dissection during parotid surgery is vital to ensuring good outcomes and avoiding complications. This study is the first to compare validity of two animal models for simulation training in parotid surgery and facial nerve dissection. We have validated the ovine model as a useful tool for simulation training and advocate its incorporation into otolaryngology training programmes.

Late onset group B streptococcus disease manifesting as acute suppurative parotitis

Few patients with acute suppurative parotitis (ASP) due to group B streptococcus (GBS) have been documented. Limited data on clinical and microbiological features and infectious route are available. We present a 21-day-old boy with invasive GBS disease manifesting as ASP. The patient was admitted because of irritability, fever, and erythematous swelling over the right parotid area. No purulent material exuded from the Stensen's duct. Ultrasonography and computed tomography of the neck showed findings indicative of ASP. On the day after admission, blood culture yielded GBS. The isolate was determined as GBS serotype Ia and sequence type-23, and the patient was successfully treated with intravenous ampicillin for 10 days. A review of the literature revealed 11 GBS ASP infants including ours with age at onset between 13 days and 12 weeks. All infants had bacteremia while pus from the Stensen's duct was detected in only one case. This finding remarkably contrasts with ASP caused by pathogens other than GBS, where the infection usually spreads via a retrograde route from Stensen's duct. The present case and literature review indicate GBS ASP primarily arises from bloodstream infection, and that ASP should be included in an infectious focus as late onset GBS disease.

Surgical Management of Parotid Duct Injury Using a Feeding Tube.

The parotid duct (Stenson's duct) can be damaged during traumatic injuries and surgical interventions. Early diagnosis and treatment of a duct injury is of great importance because complications such as sialocele and salivary gland fistula may develop if the duct is not surgically repaired. We think that the feeding tube is an ideal material in the parotid duct repair because of its technical characteristics, availability, and low cost. In this article, we described the use of a feeding tube for the treatment of a parotid duct rupture in a facial stab wound laceration, as it is a low-cost and easy-to-access material readily available in every operating room.

Anatomical characteristics of the major salivary glands of puma (Puma concolor Linnaeus, 1771)

Abstract The morphological knowledge of the salivary glands in wild species is fundamental, since these studiescan be used as conservation strategies, clinical treatments and the preservation of species threatened with extinction. Thus, the aim of the study was to anatomically describe the larger salivary glands: parotid, mandibular, sublingual and molar of the jaguar. For this, two specimens of puma (Puma concolor) were used, after death by road traffic accident, donated by the Clinical Surgical Service Department of the Veterinary Hospital “Dr. Halim Atique “(UNIRP). The animals were fixed with 10% aqueous formaldehyde solution, dissected, descriptively analyzed and photographed. Morphologically, the parotid gland is grayish-yellow in color, distinctly lobulated, and has a semilunar shape. This gland is located in the posterolateral region of the face and at its ventral end we observe the parotid duct. The mandibular gland presents a slightly rounded outline, a grayish color and its surface is covered by a capsule of connective tissue. This gland is located in the posterolateral region of the face and we find the mandibular duct at its ventral end. The monostomatic sublingual gland is located on the rostral border of the mandibular gland and it is covered by the mandibular lymph nodes. The molar gland is a yellowish-gray membranous protuberance, elongated, with rectangular shape and it lies dorsally to the labial commissure. Based on the dissections, we conclude that the morphological and topographic characteristics of salivary glands of puma follow the same structural pattern described for other species of carnivorous mammals (domestic and wild).

A retrospective evaluation of systemic and/or topical pilocarpine treatment for canine neurogenic dry eye: 11 cases.

To assess the response to topical and/or systemic pilocarpine in dogs with neurogenic dry eye. Medical records of dogs diagnosed with dry eye between 2015 and 2018 were reviewed. Cases were excluded if STT values were decreased bilaterally, if dogs were lost to follow-up, or if surgical measures (parotid duct transposition) were undertaken within thirty days of presentation. Dogs were on treatment with topical pilocarpine (0.1%, every 6hours) and/or oral pilocarpine (starting dose 2%, one drop per 10kg every twelve hours). Eleven cases were included in the study, seven females and four males with mean age of 10years. Seven cases had xeromycteria, two cases had facial nerve paralysis, and one case had Horner's syndrome. Seven cases (63.6%) had successful outcome following pilocarpine treatment, return to normal STT (15-25mm/minute), in an average of 24±5.1days. Of these cases, five had both systemic and topical treatment, one had just topical treatment, and one had just systemic treatment. The average time to normal tear production on treatment with topical pilocarpine±systemic was 23days (range 9-48days). The number of systemic drops until a positive response varied between individuals from 0.8drops/10kg to 7drops/10kg. Pilocarpine treatment (topical±systemic) is an effective therapy for unilateral dry eye disease in cases suspected to be neurogenic in origin. Most cases responded within 30days. Side effects included topical irritation to the ophthalmic solution and systemic effects from oral pilocarpine, such as diarrhea and regurgitation.

Determination of Relationship of Maxillary Occlusal Plane with Ala-Tragus Line: A Customised Approach in Aryan and Mongolian Ethnicity.

Background: Determining occlusal plane is challenging and difficult aspect during complete removable partial denture prosthesis rehabilitation. Numerous soft tissue landmarks like commissures of the mouth by Gillis in 1933, parotid papilla by P. F. Foley and G. H. Latta in 1985, height of the retromolar pad, the lateral borders of the tongue etc. had been proposed to assist clinician for determining the occlusal plane. No universally accepted reliable anatomical measurement has been proposed to assist in determining of occlusion plane for different ethnic groups in context to Nepal.&#x0D; Material &amp; Methods: This cross-sectional study was conducted in the 60 dentate subjects visiting Nobel Medical College, Nepal, from February 2019 to July 2019. A customized occlusal plane relator was used to evaluate relative parallelism between occlusal plane and alatragal line with respect to different borders of tragus. All the data were collected and statistically analyzed.&#x0D; Results: Maxillary occlusal plane was found to be parallel with the line drawn from ala of the nose to the middle of tragus in 66.66%, followed by inferior border of tragus in 18.33% with the least parallelism in superior border of tragus 15%. Relationship of maxillary occlusal plane with alatragal line was not statistically significant among Aryans and Mongolian ethnicity&#x0D; Conclusion: This study showed line joining ala of the nose and middle border of tragus is parallel to maxillary occlusal plane. And no difference was found for Aryan &amp; Mongolian ethnicity in relation to alatragal line and maxillary occlusal plane.

Marsupialization of stensen’s duct: Revisiting sialolith management

Sialoliths, needless to say, are an extremely common entity for an otorhinolaryngologist. There’s a parade of causation behind the same. Parotid duct stone relatively stands as an uncommon occurrence. Not only proper and timed diagnosis arise as an important factor, but also clinical expertise and diagnostic simplicity play a vital role in providing patient relief. Keywords: Marsupialization, Stensens duct, Parotid duct, Parotid sialolith, Sialolithiasis, Salivary stone.

Acute Bacterial Parotitis in Early Infancy: A Case Report and Review of the Literature

Introduction: Acute parotitis is known as an uncommon disease in children and a rare condition in infancy. Dehydration, prematurity, immune deficiency, congenital anomalies of the parotid gland or ducts, and oral trauma are some of its important risk factors. The most common bacteria contributing to this condition is Staphylococcus aureus. Acute parotitis is managed with intravenous antibiotic therapy and surgery in complicated cases. Favorable prognosis is reported in early diagnosis and proper antibiotic therapy. Case Presentation: The present report presents the case of a 60-day-old breastfed female infant with a chief complaint of agitation referred to the Department of Pediatrics in a university-affiliated hospital in Tehran, Iran, in 2018. She underwent treatment for the infantile colic diagnosis. Conclusions: Timely diagnosis and treatment of acute bacterial parotitis prevented suppurative parotitis and formation of abscess.

Traumatic injury to the parotid salivary gland or duct and the subsequent development of ipsilateral severe peripheral dental caries in two horses

SummaryThis report describes two cases of unilateral traumatic injury to the parotid salivary gland or duct and the subsequent development of severe ipsilateral peripheral dental caries. Ultrasonographic examination of the parotid salivary gland and duct was indicative of parotid glandular atrophy in one case and demonstrated parotid duct obstruction in the second case. To the authors’ knowledge, the effects of the loss of function of the parotid salivary gland on the horse's dentition has not been documented and should be considered as a potential side effect of surgical ablation of the parotid salivary gland.