The Temporal , Parotid , Infratemporal and Submandibular regions

Applied anatomy



  • The parotid gland is enclosed by thick tight investing cervical fascia. Therefore inflammation of the gland is very painful and compresses the structures contained especially the facial nerve and retromandibular vein

  • During parotid surgery due care must be taken to avoid injury to the facial nerve as this will cause paralysis of muscles of facial expression

  • Because of the close relationship of parotid gland and external auditory meatus, inflammation of the parotid gland may present with ear aches

  • MUMPS (Parotiditis) presents with swelling and pain around the ear made worse on chewing or sucking on lemon

  • The location of the opening of the parotid duct is important in sialography

Infra temporal fossa

  • The lingual nerve passes submucosally along the lingual aspect of the alveolar area of the 3 rd molar tooth.

    The inferior alveolar nerve , as it passes through the mandibular canal, is close to the root of the 3 rd molar tooth.

    Accordingly, these two nerves are at risk of injury during extractions of the 3 rd molar or mandibular fractures .

  • Mandibular nerve block is the procedure of applying local anaesthesia to the mandibular nerve. The injection

    needle is passed through the mandibular notch, into the infratemporal fossa where the local anaesthetic is injected.

    This procedure blocks all the sensory branches of the mandibular nerve.

  • Inferior alveolar nerve block : In this procedure, the inferior alveolar nerve is anaesthetised by injecting the anaesthetic fluid around the mandibular foramen.

    All the mandibular teeth are anaesthetised to the midline. The skin and mucous membrane of the lower lip, the labial alveolar mucosa and the gingivae and the sskin of the chin are also anaesthetised.


Submandibular region

A common site of swellings which could be due to:

  • Inflammation of lymph nodes due to infection of the:
  1. Upper respiratory tract,
  2. Oral cavity,
  3. Pharynx
  4. Scalp
  5. Face
  • Submandibular abscess
  • Cystic hygroma
  • Lymphoma
  • Submandibular gland inflammation and tumors

During surgery in this region, care must be taken not to damage

  • Hypoglossal nerve
  • Marginal mandibular and cervical branches of facial
  • Lingual nerve
  • External Carotid artery and its branches
  • Internal jugular vein and its tributaries

Temporomandibular Joint


  • May follow yawning or taking a large bite, a blow to the chin when the mouth is open, fracture mandible

  • Is uncommon posteriorly because of post glenoid tubercle

  • Strong intrinsic lateral ligament

  • Is associated with injury to articular branches of the auriculotemporal nerve

    TMJ Surgery

    Care must be taken to preserve the closely related facial and auriculotemporal nerves and their branches.

    TMJ Arthritis

    Follows degeneration but occassionaly infection
    Causes abnormal function that may result in dental occlusion and joint clicking