Where is Stensen's duct located and how does it run?
Stensen's duct is the excretory pathway of the parotid gland (glandula parotidea). Its topography on the face has the following landmarks:
- Direction — the duct runs transversely, parallel to the zygomatic arch and 1.5–2.0 cm below it.
- Relation to fascia and muscles — the duct runs along the outer surface of the masseter muscle (m. masseter). In this area, it lies within the splitting of the parotideomasseteric fascia (fascia parotideomasseterica), then passes into the subcutaneous tissue.
- Penetration into the oral cavity — the duct pierces the buccinator muscle (m. buccinator), which presses the cheek against the teeth.
- Orifice — the duct opens into the oral vestibule (vestibulum oris) at the parotid papilla (papilla parotidea). The opening is located on the buccal mucosa at the level of the second upper molar or in the space between the first and second upper molars.
What structures accompany the duct?
On the outer surface of the masseter muscle (m. masseter), Stensen's duct is accompanied by structures that also run transversely:
- Transverse facial artery and vein (a. et v. transversa faciei).
- Buccal branches of the facial nerve (rr. buccales n. facialis).
Clinical significance and diagnostics
- Palpation — the excretory duct of the parotid gland can be palpated on the face as a dense cord running parallel to the zygomatic arch, 1–2 cm below it.
- Parotitis infection — when the parotid gland is affected, decreased salivation (hyposalivation), dry mouth, and thirst are possible. A specific local sign of the disease is Mouradian's sign — edema and hyperemia of the excretory duct orifice (ductus parotideus) on the buccal mucosa on the affected side.
- Surgical approaches — when opening abscesses of the parotid region via external incisions, only the skin and subcutaneous tissue are incised, while the deeper layers are dissected bluntly to avoid damaging the branches of the facial nerve.
How is the duct repaired after injuries?
Surgical treatment is used for injuries or the formation of parotid duct fistulas. For complete fistulas, plastic reconstruction to restore the natural outflow of saliva is considered the most physiological method.
Plastic reconstruction according to G.A. Vasiliev includes the following stages:
- Isolation of the duct — mobilization of the damaged area.
- Flap formation — a tongue-shaped flap is fashioned from the buccal mucosa with its base directed anteriorly.
- Passage of the flap — the formed flap is passed through a specially created vertical incision. The anterior border of the masseter muscle (m. masseter) serves as the topographical landmark for this incision.
- Anastomosis — the tongue-shaped flap is sutured directly to the isolated parotid duct to restore saliva outflow pathways.
- Suturing — final closure of the surgical wound.
As an alternative method, excision of the fistulous tract en bloc together with the salivary gland lobule connected to the fistula can be performed.
Class and exam questions
At what level does Stensen's duct open into the oral cavity?
The duct orifice (papilla parotidea) is located on the buccal mucosa in the oral vestibule. It is situated at the level of the second upper molar or in the space between the first and second upper molars.
Which muscle does the excretory duct of the parotid gland pierce?
Before opening onto the buccal mucosa, the duct pierces the thickness of the buccinator muscle (m. buccinator).
What is Mouradian's sign?
This is a sign of parotitis infection. It manifests as edema and hyperemia of the parotid excretory duct orifice on the affected side.
How to locate the duct during facial palpation?
The duct is palpable on the face as a dense cord. It runs parallel to the zygomatic arch and 1–2 cm below it.
What else to study on this topic
- Parotid gland (glandula parotidea)
- Buccinator muscle (m. buccinator)
- Masseter muscle (m. masseter)
- Oral vestibule (vestibulum oris)
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