The otic ganglion is a parasympathetic ganglion located in the infratemporal fossa immediately below the foramen ovale, medial to the mandibular nerve (V3). It receives preganglionic parasympathetic fibres from the lesser petrosal nerve (tympanic plexus, derived from CN IX) and synapses here; postganglionic fibres reach the parotid gland via the auriculotemporal nerve. It also relays the nerve to tensor tympani and nerve to tensor veli palatini as passthrough fibres.
The otic ganglion is the target for sphenopalatine ganglion-equivalent block for parotid gland secretion modulation, though this is rarely performed. More importantly, it explains the anatomical basis for Frey syndrome (auriculotemporal nerve syndrome) after parotid surgery: aberrant regenerating parasympathetic postganglionic fibres from the otic ganglion reach sweat glands in the facial skin via the auriculotemporal nerve instead of the parotid, causing gustatory sweating. The ganglion is traversed without synapsing by the somatic motor fibres to tensor tympani and tensor veli palatini.
After parotidectomy, regenerating parasympathetic fibres from the otic ganglion grow into the severed auriculotemporal nerve and then aberrantly innervate facial skin sweat glands, producing gustatory sweating and flushing during meals, managed with topical glycopyrrolate cream or botulinum toxin injection into the affected skin.
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