tailieunhanh - Marco Lucioni Practical Guide to Neck Dissection - part 4

Hình 4,10 mang tai khu vực: máy bay sâu p = mang tai 1 = bức tường phía trước của kênh âm thanh bên ngoài 2 = mastoid 3 = sternocleidomastoid gân 4 = lợi nhuận trước cơ sternocleidomastoid 5 = dây thần kinh mặt 6 = styloid quá trình 7 = stylohyoid cơ 8 = stylopharyngeus cơ 9 = styloglossus cơ 10 = sau bụng của cơ nhị phúc | 26 Parotid Region 4 Fig. Parotid region deep plane p parotid 1 anterior wall of external auditory canal 2 mastoid 3 sternocleidomastoid tendon 4 anterior margin of sternocleidomastoid muscle 5 facial nerve 6 styloid process 7 stylohyoid muscle 8 stylopharyngeus muscle 9 styloglossus muscle 10 posterior belly of digastric muscle 11 internal jugular vein 12 external carotid artery 13 ascending palatine artery 14 glossopharyngeal nerve 15 lymph node 16 thyrolinguofacial trunk and tongue base may also cause injury to the glossopharyngeal nerve with functional sequelae of dysphagia and dysgeusia secondary to surgical excision. In tonsillectomy the glossopharyngeal nerve running in deep proximity to the inferior tonsil pole may be injured during dissection or electrocoagulation however damage is usually reversible. Last it should be borne in mind that intraoperative stimulation through manipulation of either the glossopharyngeal or vagus nerve may induce transitory bradycardia and hypotension. We now expose the intraglandular tract of the facial nerve. There is some debate about the existence of a superficial and deep parotid lobe. Indeed there is no real cleavage plane between the two so-called lobes and the superficial parotid portion is far more voluminous than the deep portion comprising about 90 of the whole glandular parenchyma. Following the facial trunk from its emergence at the periphery we find the goose s foot . the subdivision of the nerve into its two terminal trunks the temporofacial and the cervicofacial. The first is appreciably more voluminous than is the second and has more collateral branches. An imaginary horizontal line crossing the labial commissure roughly divides the areas of musculocutaneous innervation of the two trunks. In particular it can be seen how the most important of these the marginal branch is situated laterally to the retromandibular vein. Remember that the conformation of the facial trunk is rather inconstant. .