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

  • Anatomic Bases of Medical, Radiological and Surgical Techniques
  • Published:
Surgical and Radiologic Anatomy Aims and scope Submit manuscript

Abstract

Objectives

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).

Materials and methods

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.

Results

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 66.37 mm and 46.84 mm, respectively, and it weighted 18.13 g. 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%.

Conclusion

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.

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Acknowledgements

The authors thank the human anatomy laboratory staff for their enthusiasm and collaboration in taking care of and making available the cadaveric anatomical specimens used to perform the present study.

Funding

Not applicable.

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Authors and Affiliations

  1. ENT Department, Servei ORL, Hospital de la Santa Creu i de Sant Pau, Carrer de Sant Quintí, 89, 08041, Barcelona, Spain

    Albert Pujol-Olmo & Miquel Quer-Agustí

  2. Human Anatomy and Embriology Department, Universitat Autònoma de Barcelona, Barcelona, Spain

    Rosa M. Mirapeix

  3. Human Anatomy and Embriology Department, Universidad Complutense de Madrid, Madrid, Spain

    Jose Ramón Sañudo-Tejero

  4. Multidisciplinary Salivary Gland Society, Geneva, Switzerland

    Miquel Quer-Agustí

Authors
  1. Albert Pujol-Olmo
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  2. Rosa M. Mirapeix
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  3. Jose Ramón Sañudo-Tejero
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  4. Miquel Quer-Agustí
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Contributions

AP: project development, data collection, management and analysis, and manuscript writing and editing. RM: project development and manuscript critical revision. JRS: project development and manuscript critical revision. MQ: project development, manuscript writing and editing, and manuscript critical revision. All authors have read and approved the final manuscript.

Corresponding author

Correspondence to Albert Pujol-Olmo.

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Conflict of interest

The authors declare not having any potential conflict of interest with respect of the research, authorship and/or publication of the present article.

Ethics approval

The research performed with human cadaveric specimens was carried out under the regulations and dissection normative of the Human Anatomy Dissection Laboratory in the Faculty of Medicine, Universitat Autònoma de Barcelona.

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No informed consent was needed for the present study.

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Pujol-Olmo, A., Mirapeix, R.M., Sañudo-Tejero, J.R. et al. Description and relationships of the parotid gland levels proposed by the European Salivary Gland Society staging system: an anatomical study. Surg Radiol Anat 42, 1101–1107 (2020). https://doi.org/10.1007/s00276-020-02483-x

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  • DOI: https://doi.org/10.1007/s00276-020-02483-x

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