SALIVARY GLANDS

BY: SHRIKANT PATEL

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In order to form for one's self a just notion of the operations which result in the production of thought, it is necessary to conceive of the brain as a peculiar organ, specially designed for the production thereof, just as the stomach is designed to effect digestion, the liver to filter the bile, the parotids and the maxillary and sublingual glands to produce saliva.

PIERRE-JEAN-GEORGES CABANIS

Death is caused by swallowing small amounts of saliva over a long period of time.
GEORGE CARLIN
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CONTENTS
INTRODUCTION OF GLANDS SALIVA

PROPERTIES
COMPOSITION FUNCTION FORMATION SECRETION

COTROL OF SECRETION
CLASSIFICATION DEVELOPMENT
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 STRUCTURE OF TERMINAL UNIT DUCTAL SYSTEM CONNECTIV TISSUE MAJOR SALIVARY GLAND MINOR SALIVARY GLAND SALIVARY AS DIAGNOSTIC TOOL CONCLUSION

REFRENCES

GLANDS A gland is an organ in an animal's body that synthesizes a substance for release of substances such as hormones, often

into the bloodstream (endocrine gland) or into cavities inside

the body or its outer surface (exocrine gland).
Glands are composed of epithelial cells specialized to synthesize and secrete special products.

Glandular epithelium consist of single cells or group of cells specialized for secretion.
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GLANDULAR EPITHELIUM

EXOCRINE GLANDS

ENDOCRINE GLANDS

EXOCRINE

GLANDS: Develop as downgrowths of an

epithelial membrane and secrete onto its surface through their ducts

ENDOCRINE GLANDS : Develop in a similar way but lack

ducts because they lose their connection with the surface

epithelium, they release their secretory products close to the external surface of thin-walled blood vessels these products enter the blood stream.

EXOCRINE GLANDS FURTHER CLASSIFIED : 1) NUMBER OF CELLS: A) UNICELLULAR B) MULTICELLULAR 2) BASIS OF STRUCTURE OF DUCTAL SYSTEM: A) SIMPLE B) COMPOUND C) TUBULAR 3) BASIS OF SECRETORY PORTION: A) TUBULAR B) ACINAR C) TUBULOACINAR 4) TYPE OF SECRETION: A) SEROUS B) MUCOUS C) MIXED 5) MECHANISM OF SECRETION: A) MEROCRINE B) APOCRINE C) HOLOCRINE
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 UNICELLULAR: single cells interspersed among other

epithelial cells of different function. Simplest in structure.

MULTICELLULAR: Occurs as many adjacent secretory cells

within the epithelium (surface mucous cells of stomach); or as complex glands with ducts. SIMPLE GLAND: single unbranched duct, which may be straight or coiled. EG: SWEAT GLANDS COMPOUND GLANDS : branched duct system leading from a number of secretory unit. EG: FOUND IN LIVER AND PANCREASE
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TUBULAR GLANDS: Secretory units are shaped like tubules.

ACINAR GLANDS: Secretory units are more round like berry or

grape.
TUBULOALVEOLAR GLANDS: Glands contain both tubular and

alveolar secretory units. EG: SUBMANDIBULAR SALIVARY

GLAND

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APOCRINE SECRETION: Is the mechanism whereby both the

secretory products and a portion of apical secretory cells

cytoplasm are pinched off and released.Example: mammary gland.

However, the idea of apocrine secretion is no longer useful, and

almost all the glands once described as apocrine are now considered to be merocrinE HOLOCRINE SECRETION the entire cell disintegrates to secrete its substances (e.g., sebaceous glands)

MEROCRINE GLANDS cells secrete their substances

by exocytosis (e.g., mucous and serous glands). Also called "eccrine".
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SALIVARY GLANDS: The salivary gland are a group of the compound exocrine gland secreting saliva.

Salivary glands are either absent or very rudimentary

in animals living in water

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oral cavity fills with considerable amounts of liquid upon opening of the jaws.
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Parasitic jawless vertebrates that feed by boring into the flesh of various species of bony fishes to suck their blood.

lampreys have a sucking mouth that does not let water get into the oral cavity.
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They are compound gland as they have more than one tubule entering the main duct.

The duct is the passage that allows the saliva to flow directly in to the anatomic location where the secretion is to be used.

They have numerous ducts associated with in them hence they are called exocrine gland.
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The architectural arrangement of the salivary gland is tubuloacinar, where acini are the secretary units. The tubuloacinar units are merocrine as they release only the secretion of the cell from the secreting unit. Basic functional unit of a salivary gland, Irrespective of size and location is made up of epithelial secretory cells namely serous and mucous cells and central lumen.
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SALIVA
The salivary glands are the groups of the exocrine glands secreting saliva. Saliva has one meaning clear liquid secreted into the mouth by the salivary glands and mucous glands of the mouth which moistens and form coating around the teeth and mucosa and starts digestion of starches. DORLAND Saliva is a clear, alkaline, somewhat viscid secretion from the parotid, submandibular, sublingual & smaller mucous glands of the mouth. . STEDMEN Saliva is a clear, tasteless odorless, slightly acidic, viscous fluid consisting of secretions from the parotid, submandibular & mucous glands of the oral cavity.

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Saliva

Acini

Ductal System The system is a

Oral cavity

1) Internal luminal layer - Acini & Ductal epitelium 2) external reserve layer - myoepithelium & reserve cells Saliva serves multiple and important functions. Three major gland:

600-1,000 minor salivary glands

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800 to 1500 ml secreted per day. Approx 1 ml/ minute.

1)Parotid Glands - 25% 2)Submandibular Glands 70% 3)Sublingual 5%

Reaction : Acidic pH 6.0 to 7.0 : 1.002-1.012 : Hypotonic to Plasma
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COMPOSITION

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SALIVA
ORGANIC SUBSTANCES INORGANIC SUBSTANCE

GASES

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 ORGANIC:
1.PROTIEN: Amylase Lysozyme Glycoprotein's IgA Traces of blood proteins Albumin,IgM,IgG Transferrin Lipoproteins 2.NITROGENOUS CONSTITUENTS: Amino acids Urea Uric acid Ammonia Creatin Statherin

3.GLUCOSE

4.BLOOD GROUP SUBSTANCES A, B, O.

8.Other organic compounds: Citrates Nitrates 9.Anti bacterial Proteins: Lysozyme Sialoperoxidase Lactoferrin

5.VITAMINS- WATER SOLUBLE

6.LIPIDS : Cholesterol, fatty acids, tri gycerides, phospholipids.

7.Enymes : Acid phosphatase Esterase's, Lysozyme

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INORGANIC

SUBSTANCES:
1. sodium

GASES:
1. Oxygen 2. Carbon dioxide 3. Nitrogen

2. calcium
3. potassium 4. bicarbonate 5. bromide 6. chloride 7. fluoride 8. phosphate

Normally is absent in the saliva but, it is found during diabetes mellitus.

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Salivary Functions

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FORMATION AND SECRETION

Secretion of each Major salivary glands is Different. Parotid Gland Watery Serous Saliva Rich in Amylase.

Submandibular Gland Mixed Saliva.

Sublingual Gland Viscous mixed saliva.

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Salivary Secretion is a 2 Stage process: 1st Stage Primary saliva Acini and intercalated ducts. isotonic fluid

It contains oraganic components and all of the water. 2nd Stage Salivary Ducts.

Primary saliva is reabsorbed and secretion of electrolytes. Final saliva is hypotonic.

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MACRO MOLECULAR COMPONENTS

Abundant rough endoplasmic reticulum and golgi complex. RER is placed basal & lateral to the cell nucleus. Ribosomes consist

of

RNA & PROTEIN.

Ribosomes

Nucleus by way of m RNA

encoded message

Protein have a NH2 terminal extension of 16 - 30 amino acids called SIGNAL SEQUENCE.

Signal sequence is attached to membrane of RER.

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 Signal are recognized by RER with the help of certain proteins

& crosses the RER membrane along with the growing polypeptide chain.

Single peptidase, a proteolytic enzyme removes the signal

sequence and protein newly synthesised reaches the cisternal space of RER. From here by small vesicles protein is transferred to golgi complex, here they undergo modification followed by condensation & packing into secretory granules. Golgi complex is attached to RER by budding vesicles at end of RER.
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 Golgi complex : cis or convex face & trans or concave face.

Buddy vesicles enter through cis face

fuse with the golgi saccules .

Protein migrate from cis - trance face.

Packed into vacuoles.

Vacuoles are know as 1) condensing vacuoles, 2) pale secretory granules 3) immature granules.
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 The transport mechanism is not yet clear;

However a number of hypotheses currently exist. VESICULAR transport mechanism was favoured but now evidence is coming to light to support CISTERNAL MATURATION. The two proposed models may actually work in conjunction with each other, rather than being mutually exclusive. This is sometimes referred to as the combined model.

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 Immature granules are connected to the smooth membrane of the trance face. Immature granule increase in size and density to become mature.

These granules are stored in the cytoplasm until they receive any
secretory stimulus.

Granule membrane fuse with the cell membrane at the luminal

surface & contents are released into the lumen by the process of EXOCYTOSIS . SYMPATHETIC NEUROTRANSMITTER NOREPINEPHRINE
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PRIMARY SECRETION {AT ACINI LEVEL}

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SECONDARY SECRETION{AT STRIATED DUCT LEVEL}

ATP

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Final electrolyte compostion

rate of salivary flow.

At high flow rates saliva: in Na+ and Cl- concentration K+ concentraction At low flow rates REGULATED BY : 1) AUTONOMIC NERVOUS SYSTEM 2) MINERALOCORTICOIDS Sympathetic innervations Ducts
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opposite direction.

REGULATION OF SALIVARY SECRETION

Controlled mainly by Parasympathetic nerve signals. Superior and Inferior Salivatory Nuclei in the brain stem.

Located at the juncture of the Medulla and the pons.

Exited by the tactile stimuli from tongue and other areas of mouth.

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Nerve supply : i)Parasymapathetic for parotid

Preganglionic Fibers aries from the inferior salivatory Nucleus in upper part of medulla oblongata Tympanic branch of the Glossopharyngeal nerve Tympanic Plexus Lesser Petrosal nerve

End in otic ganglion

Reach Gland Passing through Auricotemporal Branch in the Mand division of trigeminal nerve.
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Parasymapathetic Fibers to submandibular & sublingual

Arise from the Superior Salivatory Nucleus Situated in Pons

The preganglionic fibers pass through Nervous intermedius Wrisberg

Geniculate Ganglion Motor fibers of the Facial nerve Chorda tympani Branch of Facial Nerve Lingual branch of trigeminal nerve join to ganglion near gland
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SYMAPATHETIC FIBERS Arise from lateral horns 1st and 2nd thoracic segments of spinal cord.

Fibers leave the cord through Anterior Nerve Roots

End in Superior Cervical Ganglion of Symapathetic chain.

Travel along the Surfaces of Blood Vessels

Salivary Glands

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Functions of Nerve Fibers :

I. PARASYMPATHETIC : - Secrete profuse and watery saliva. - Amount of Organic constituents is less. - Activate the acinar cells and Dilate the Blood Vessels of Salivary Gland.

II. SYMPATHETIC :

- Stimulation causes less secretion.

- Thick and rich in Mucus. - Activate the Acinar Cells and cause Vasoconstriction.
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CLASSIFICATION
I. According to Size. II. According to Branching of Ducts. III. According to Damage of Secreting Cells. IV. According to Secretion.

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BASED ON SIZE

Major

Minor
1) Lingual mucus glands.

Parotid

Sublingual

2) Lingual serous glands. 3) Buccal glands. 4) Labial glands. 5) Palatal glands.

Submandibular

According to Branching of Ducts

A. Simple Non-Branching Minor Glands. B. Compound Racemose Major Glands.

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According to Damage of Secreting Cells

1) Apocrine Glands. - Glandular secretion - Free end of secreting cell is cast off along with the secretory produts accumulated.

2) Holocrine Glands. - Glandular Secretion Entire Secretory cell laden along with its Secretory Products is Cast off.
3) Merocrine Glands. - Discharge only the secretory products. - Leave the secretory cell intact.
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ACCORDING TO SECRETION
SEROUS Serous Cell MUCUS Mucus Cells Thick & Viscous Saliva. Lingual Mucus & Buccal glands MIXED Both Serous & Mucus Cells

Thin & Watery Saliva

Parotid gland & Lingual Serous

Submanidubular, Sublingual & Labial glands.

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DEVELOPEMENT OF GLAND
Parotid gland first to form during 4 6 weeks Submandibular gland 6 weeks

Sublingual gland 8 12 weeks

All salivary gland develop similarly as initial discrete thickening of the epithelium of the stomodeum.

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Although its not clear parotid gland is believed to develop from oral ectoderm where as submandibular and sublingual are believed to develop from endodermal or ectodermal germ layers.

In absence of a general endodermal marker, it is difficult to conclude either way.

However, the endoderm is clearly capable of supporting salivary gland development given that minor salivary glands developing in the tongue, including von Ebners glands.

Despite this controversy, major salivary glands are widely regarded as ectodermal organs.
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All ectodermal organs originate from two adjacent tissues of distinct embryonic origin, (1) the epithelium (2) the mesenchyme.

Development proceeds through constant, sequential and reciprocal interactions between these two tissues translated at the molecular level by signalling molecules.

1) ORAL EPITHELIUM is derived from the first branchial arch. 1) MESENCHYMAL CELLS derived from the cranial neural crest, a migratory cell population that detaches from the embryonic neural epithelium.

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The epithelial compartment give rise to the

1) secretory end pieces of the salivary glands.

2) extensive network of ducts leading the salivary secretions into the oral cavity. 3) myoepithelial cells.

The mesenchymal compartment will produce the capsule surrounding the gland.
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Taking the e.g. of submandibular gland development

Identification of the submandibular gland in 13 mm

embryo as an out growth of the floor of oral cavity at lingulogingival groove.

An epithelial thickening appears in floor of mouth at

the back of the first mandibular molar, adjacent to the developing tongue. This thickening develops at the bottom of the alveololingual sulcus, a gutter-like groove that forms in the floor of the mouth as the result of the upward growth of

the tongue rudiment.

This early stage is known as the PRE BUD STAGE.
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Importantly SMG dont develop where their major excretory ducts open.
Later epithelial thickening invaginates in the underlying mesenchyme of the first branchial arch. Sustained epithelial proliferation in a downward direction leads to the formation of a thick solid epithelial stalk terminated by a bulge constituting the INITIAL BUD STAGE of SMG development. mesenchymal cells condense around the SMG primordium.

This well-defined mass of connective tissue represents the

capsular rudiment of the gland. The initial bud,surrounded by condensed mesenchyme, will form the parenchyma of the SMG, whereas the main excretory duct of this gland is formed by closure, in a rostral direction, of the alveolo-lingual sulcus.

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Recently in the rat submandibular gland development two basement membrane

components i.e. 1) laminin & 2) type IV collegen are synthesized by the cell of glandular epithelium. Basal lamina help in primary lobe branching Type IV collegen in out growth. A thick layer of extracellular matrix (ECM) separates the epithelial and mesenchymal compartments of the salivary gland primordium. This layer, called basement membrane, is secreted partly by epithelial cells, partly by surrounding mesenchymal cells and amongst other functions primarily serves to anchor the epithelium to the underlying connective tissue. ECM is not only found in the basement membrane, but also in the interstitial matrix

between cells of the connective tissue of the developing salivary gland.

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Mitosis is seen in inner cells only and rarely in outer layers. In later stage a series of morphogenetic changes, collectively referred to as branching morphogenesis, occurs in the developing salivary gland turning an initial single epithelial bud into an array of epithelial branches that will eventually differentiate into a network of ducts, each terminating in a secretory end piece. The period is called the PSEUDOGLANDULAR STAGE.

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During this phase, small invaginations or clefts form in the distal part of the initial epithelial bud, which deepen and separate the bud into usually two or three parts. This parting process establishes branch points end bud clefting is followed by outgrowth of epithelial branches (stalks) & new subsequent cleft formation in newly

formed distal bud.

Eventually this leads to the formation of an increasingly forger and complex tree. This parting process establishes branch points end bud clefting is followed by

outgrowth of epithelial branches (stalks) & new subsequent cleft formation in newly
formed distal bud. Eventually this leads to the formation of an increasingly forger and complex tree.

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Mesenchymal cells become looser, separated by extracellular matrix. Members of fibroblast growth factor protein family and their receptor along with transforming growth factor B, play a major role. Development of lumen within the branched epithelium occurs first in the distal

end of the main cords, than in the proximal , finally in the central portion.
Lumina is formed within the duct before they develop within the terminal buds. lumen formation may involve apoptosis of centrally located cells in the cell cords. With the formation of lumina in the terminal bulbs, further clefting occurs in the surrounding cells.

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 Terminal bulb is divided into a number of subunits called terminal tubules.

The epithelium in terminal tubules consists of two layers of cells.

The cells of inner layer eventually differentiate into the secretory cells of mature gland, mucous or serous, depending on the specific gland. cells of outer layer form the contractile myoepithelial cells that are present around the secretory end pieces and intercalate ducts. As epithelial components increases in size and number, the associated mesenchyme ( connective tissue ) is diminished. Thicker partitions of the connective tissuedivide the gland into lobes and lobules.

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STRUCTURE OF TERMINAL SECRETORY UNITS

The acini made up of epithelial secretory cells, namely serous and mucous cell n myoepithelial cells.

The cells rest on basement membrane. They are arranged in single layer.
The intercellular spaces of the apical end of the cells are separated from the lumen by the junctional complexes . The junctional complexes hold the cells together in an acinus and regulate the permeability. The myoepithelial cells are located on the surface of the acini. Central lumen have star shaped morphology. The lumen via fine series of the tubes which get together to form ductal system.
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Cells in Terminal secretory end piece:

1) Serous cells

2) Mucous cells

3) Myoepithelial cells.

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SEROUS CELLS
Pyramidal in shape with broad baseand narrow apex Spherical nucleus

are specialised for the

Deep eosinophillic secretory granules are present. ominent feature of the serous

rage and secretion of proteins.

The basal cytoplasm contain cumulation of secretory

numerous cistrenae of endoplasmic reticulum. he apical cytoplasm. Golgi apparatus located apical or lateral to the nucleus.

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 In electron microscope the immature granules appear paler in density as compared to electron dense granules. Large number in resting call than stimulated cell In stimulated cell they are depleted into the lumen through exocytosis. Granules discharge through break in plasmalemma.

More

microvilli in luminal plasmalemma

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MUCOUS CELL

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MUCOUS CELLS
The mucous secretion differ from that of the serous in two different ways: 1. Little or no enzymatic activity 2. Lubrication and protection of the oral tissue. In electron microscope the granules appear swollen, their membrane are disrupted, and fused with one another. Small granules form at the trans face of the golgi apparatus increase in size & join the rest of the granules in the apical cytoplasm. Secretion of the mucous droplets occurs by EXOCYTOSIS. When a single droplet is discharged its limiting membrane appear separating the droplet from lumen. Separating membrane may then fragment, being lost with discharge of mucous or the droplet may be discharge with the membrane .

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SEOROUS ACINI
ACINI CIRCULAR SHAPE CELL SMALLER SIZE LESS N0. OF CELLS SMALL LUMEN CELLS PYRAMIDAL
NUCLEUS ROUND PLACED BASAL 1|3
APICAL CYTOPLASM EOSINOPHILIC

MUCOUS ACINI
ACINI TUBULAR SHAPE

CELL LARGER SIZE

MORE NO. OF CELLS LARGE LUMEN CELLS COLUMNAR NUCLEUS FLATTENED
APICAL CYTOPLASM EMPTY

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MYOEPITHELIAL CELLS:
Conctractile cells found in relation to terminal Secretory end pieces and intercalated ducts. Occupy space between the basal lamina and duct cells. Similar to smooth muscle cell but derived from epithelium. STELLATE SHAPE numerous branching processes extended from the cell body to surround and embrace the end piece. The process are filled with ACTIN and soluble MYOSIN.

In intercalated ducts short processes.

FUSIFORM shape & elongated with few

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The processes in the acini lie in the gutter, hence the outline of the acini appears smooth, but in intercalated duct the processes runs longitudinally on the surface creating a bulge, hence k\a BASKET CELL

Ctyokeratin intermediate filament and contractile actin filaments.

In Intercalated ducts they have a fusiform shape with fewer processes & oriented length wise along the duct.

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DUCTAL SYSTEM

INTERCALATED DUCT

STRIATED DUCT

TERMINAL DUCTS

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INTERCALATED DUCT CELL

Simple cuboidal The Diameter pieces. epithelium.

SMALLER &

lumen

LARGER than end

Length of the duct is variable In major n minor salivary

gland.

RER basal in position with apical Golgi regions.

few

small SECRETORY GRANULES in

the apical cytoplasm.

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Few

short

MICROVILLI projecting into the lumen.

Adjacent cells junctional complexes & desmosomes.

Due to small size & lack of distinctive features, intercalated ducts

are difficult to identify in routine histological sections.

LYSOZYME and LACTOFERRIN are secreted by this cells.

Undifferentiated cells may proliferate & undergo differentiation to replace damaged or dying cells in the end pieces and striated ducts.
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LIGHT MICROGRAPH OF BRANCHING INTERCALATED DUCT ( ARROWHEADS) JOINING SEVERAL SEROUS AND PIECES IN THE HUMAN SUBMANDIBULAR GLAND. THE DUCT CELLS ARE LOW CUBOIDAL AND LIGHTLY STAINED WITH HEMATOXYLIN AND EOSIN
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STRIATED DUCT CELL :

Receive saliva from intercalated ducts. LARGEST PORTION

Main ductal components located intra lobular .

Tall columnar cells with centrally place nucleus & pale, acidophilic cytoplasm. Diameter is greater than secretory end pieces & lumen is larger than secretory end pieces and intercalated ducts. Basal lamina encloses the connective tissue.
Modify the primary saliva by reabsorption and secretion of electrolytes.

duct, and a capillary plexus is present in

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Basal cell have nucleus located lower than other cells

Apical cytoplasm contains small secretory granules and electron lucent vesicles. lysosomes and peroxisomes , and deposits of glycogen. Prominent golgi regions - BASALLY Adjacent cell joined by desmosomes & junctional complex but lack gap junctions.

Basal end have prominent striations due to numerous elongated

mitochondria in narrow cytoplasmic partition, separated by highly infolded & inter digited basolateral cell membrane.
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TERMINAL EXCREATORY DUCT

Are located in the connective intralobular location. Larger in diameter than striated ducts and have pseudostratified epithelium with columnar cells and small basal cells. A large excretory duct is surrounded by dense connective tissue. tissue septa between extralobular or

In smaller excretory duct the structure of the columnar cell is similar to that in
striated ducts.

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Tufts ( caveolated cells or brush ) cells, with long siff microvillai and apical vesicles are thought to be the receptor of some type of cell.

Nerve

endings

are found adjacent to this macrophages are present.

cells

Lymphocytes and

Dendritic cells or antigen presenting cells are present.

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Light micrography of excretory duct of the human salivary gland A. Small excretory duct in the interlobular connective tissue. The duct epithelium is pseudostratified, with tall columnar cells and few basal cells. Numerous capillaries and venules ( arrow head ) are present around the duct B. A large excretory duct is surrounded by dense connective tissue . Pseudostratified epithelium contains several mucous gob let cells.
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CONNECTIVE TISSUE

Surrounding capsule

Demarcates the gland from adjacent structures.

Cells present are: 1) Fibroblasts 2) Macrophages 3) Dendritic cells 4) Mast cells Extracellular components : # Collagen # Elastic fibre transcystosis

5) Plasma cells 6) Adipose cells 7) Granulocytes 8) Lymphocytes

# Proteoglycan # Glycoprotein

Plama cells IgA as dimer complexed + j chain.

Immunoglobulins IgA, IgM, IgG

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BLOOD SUPPLY
ARTERY SMALL ARTERY & ARTERIOLES

FOLLOW THE PATH OF EXCRETORY DUCTS

CAPILLARIES

AROUND THE SECRETORY END PIECES & STRIATED DUCTS 1 = retromandibular vein, 2 = external carotid artery, 3= facial artery and vein, 4 = lingual artery and vein, 5 = external carotid artery, 6 = internal jugular vein, 7 = external jugular vein.

CAPILLARY PLEXUS

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Venous returns follows the artery supply.

Arteriovenous anastomosis occurs in some gland.

As blood flow increases duing secretion , more blood is diverted through these anastomoses, resulting in increased venous and capillary pressures.

The resulting increases in fluid filtration across the capillary endothelim provides the fluid necessary to maintain secretion.

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MAJOR SALIVARY GLAND

PAROTID GLAND

SUBMANDIBULAR GLAND

SUBLINGUAL GLAND

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PAROTID
PAROTID GLAND

GLAND

Para = around ; otic = ear

Parotid region Contains

Largest Serous Salivary Gland Queen of the Face the facial nerve.

weighs about 20 to 30 gm.

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POSITION
Situated below the External Acoustic meatus.

Between the Ramus of the Mandible & SternoCleidomastoid.

Anteriorly the Gland overlaps the Masseter muscle.

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SURFACE MARKINGS
Marked by joining Four Points a) At the upper border of the head of the mandible.

b) Just above the centre of the masseter muscle.

c) Postero-inferior to the angle of the mandible d) Upper part of the anterior border of the mastoid process.

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EXTERNAL FEATURES
Three sided Pyramid. Apex of pyramid directed Downwards. Four Surfaces : a) Superior b) Superficial c) Antero-medial d) Postero-medial

Separeted by 3 borders: i) Anterior ii)Posterior iii) Medial

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A)Superior Surface:
- Forms the upper end of the gland. - Small and concave.

Related to : i) cartilaginous part of the external acoustic meatus. ii) Post surface of TMJ. iii) Superficial temporal vessels. iv) Auriculotemporal nerve.

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b) ANTEROMEDIAL SURFACE:
Related to : 1) The Masseter 2) Lateral surface of the TMJ 3) Post border of ramus of mandible 4) Medial Pterygoid 5)Emerging Branches of the Facial Nerve

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c)POSTERO MEDIAL SURFACE:

1)The mastoid process, with the sternocleidomastoid & the post bellly of the digastric. 2)Styloid Process with strutures attached to it. 3)External carotid artery enters the gland 4)Internal carotid artery lie deep to Styloid process.
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ARTERIAL SUPPLY
Branches of the external carotid artery The main branch to supply the gland is the transverse facial artery.

VENOUS SUPPLY
internal jugular veins. -The maxillary vein and superficial temporal vein meet to form the retromandibular vein

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LYMPHATIC DRAINAGE:
Lymphatic drainage is unique in the Parotid with Paraparotid

and Intraparotid nodes.

The Paraparotid nodes are more numerous and drain the temporal region, scalp, and auricle.

The Intraparotid nodes drain the posterior nasopharynx, soft palate, and ear.

The Parotid lymphatics drain into the superficial and deep cervical lymph nodes.
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PAROTID DUCT
JANURARY 10 1638
On this date, the Danish
geologist and anatomist Nicolaus Steno (also known as Niels

Steensen, or Stensen) was born.

During

medical Steno

studies

in

Amsterdam,

discovered

Stensens duct, which provides saliva from the parotid gland to the mouth.
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PATH OF PAROTID DUCT

At the anterior border of masseter

It turns medially and pierces

Buccal pad of fat Buccopharyngeal fascia Buccinator

Forward for a short Distance b/w the buccinator & oral mucosa
Turns Medially and Opens into the Vestibule of the mouth Opposite the crown on Max 2nd molar
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HISTOLOGY
Secretory end pieces are all serous. Pyramidically spherical shaped acinar cells.

Spherical & basally situated nucleus.

Basal cytoplasam stains with basophilic dyes & granules by acidophilic dyes.

Fat cells spaces often seen.

Intercalated duct are long and numerous & lined by cuboidal epithelium and have lumina larger than of acini. Nuclei of myoepithelial cell may be present at basal surface of cells. Striated ducts are numerous and appears acidophilic, round, or elongate d tubules.
97

 Nuclei of myoepithelial cell may be present at basal surface of cells. Striated ducts are numerous and appears acidophilic, round, or elongate d tubules.

Duct consists of simple columnar epithelium, with round, centrally

placed nuclei. Faint striation representing the infolded basal cell membrane and

mitochondria, may be visible below the nucleus.

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SUBMANDIBULAR SALIVARY GLAND

Situated in the Ant Part of the Digastric Triangle. Size of walnut Roughly J- SHAPED. Indented by the Post border of Mylohyoid which divide into Larger Part Superficial to muscle & small

Part lying deep to Muscle.

Weighs abt 8-10 gm WHARTONS DUCT 40 mm
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SURFACE MARKING
Marked by an oval area Over the posterior half of the Base of the Mandible including posterior Border of the ramus. Submandibular region extends 1.5 cm above the base Below the Greater Cornu of the Hyoid Bone
101

Superficial Part :
-

Part fills the Digastric triangle. Extends upwards deep to the mandible up to the Mylohyoid line. 3 surfaces --- Inferior ,Lateral, Medial Enclosed between 2 layers of deep cervical fascia.

SUPERFICIAL LAYER OF FASCIA covers inferior surface of the gland attached to base of mandible

Deep Layer Covers medial surface of the gland

attached to mylohyoid lines of the mandible.

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Relations :
A)Inferior Surface is covered by - Skin - Platysma - Cervical Branch of Facial Nerve - Deep Fascia - Facial Vein - Submandibular Lymph Nodes .

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B) Lateral Surface Related to : - Submandibular fossa on the mandible. - Insertion of medial Pterygoid. - Facial Artery

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C) Medial Surface
i)

Anterior Part Related to mylohyoid muscles, nerves and vessels.

ii) Middle part Hyoglossus Styloglossus Lingual nerve Submandibular ganglion Hypoglossal nerve iii)
-

Posterior part Styloglossus Stylohyoid ligament Wall of pharynx.

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Deep Part :
- Small in size
- Lies deep to Mylohyoid - Superficial to the Hyoglossus and

Styloglossus.
Posteriorly

Continues with Superficial Part round

the Post Border of Mylohyoid.
Anteriorly

- Extends upto the posterior end

of the Sublingual Gland.

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SUBMANDIBULAR DUCT
Opening into the mouth at side of the frenum linguae. It had been previously described by Alessandro Achillini (14631512) in 1500, but was rediscovered by Wharton in 1656. The duct is about 5 cm Known as Whartons Duct Thin walled. Emerges at the ant end of the Deep part

THOMAS WHARTON 1614 - 1673

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PATH
Emerges at the ant end of the Deep part Runs forward on the Hyoglossus B/w the lingual and the Hypoglossal nerve Open on the Floor of the mouth Sides of the Frenulum of the tongue

OF

DUCT

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ARTERIAL SUPPLY:

The facial artery.

Submental artery. Partly by the lingual artery and External jugular artery.

VENOUS DRAINAGE The venous drainage : - Anterior facial vein, -The venae comitantes of facial artery -The vein close to the Whartons duct (the hilum vein) -Seldom drained to external jugular vein and other veins
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HISTOLOGY
Contains serous end pieces and mucous tubules capped with seous demilunes: hence mixed gland Serous to mucous secretory end pieces vary in ratio but serous cells significantly outnumber the mucous cells. Serous end pieces are similar to that found in the parotid gland. Mucous secretory cells are filled with pale staining secretory

material and little cytoplasm is avaliable.

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 Nucleus is compressed against the basal cell membrane and contain densely stained chromatin. Lummina of mucous tubules are larger than serous end pieces.

Serous demilune cells are similar in structure to the serous end

pieces and discharge their secretion into intercellular canaliculli.

Intercalated and striated ducts are less numerous than in parotid

but structurally similar.

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11 2

SUBLINGUAL SALIVARY GLANDS

Smallest of the Three Glands Almond shaped weighs abt 3 to 4 gms 15 ducts emerge from the glands Most open Directly in the mouth Few join Submandibular Duct

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Caspar Bartholin the Younger (secundus) Born1655Died1738

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HISTOLOGY
It is mixed gland but mucous secretory cells predominate. Mucous secretory and serous demilunes resemble those of mandibular gland. Serous end pieces are rare and appear as demilunes. Intercalated ducts are short and difficult to recognize.

Intralobular ducts are fewer in numbeer than in parotid or submandibular glands.

Some ducts lack the characteristic feature of infolded basolateral membranes.

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11 6

MINOR SALIVARY GLANDS

In addition to the three pair of large salivary glands several

smaller gland are located throughout the oral cavity.

They are found throughout the oral cavity, except in the anterior part of the hard palate and gingiva and anterior two third of the dorsum of the tongue.

There are 600 1000 minor salivary glands lying in oral cavity and oropharynx. They are predominantly mucous gland except for the lingual serous gland ( VON EBNERS GLAND )
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Located in submucosa below the epithelium of the oral cavity , the saliva secreted reaches the oral cavity through short ducts that connect the gland to the surface epithelium
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LABIAL GLAND BUCCAL GLAND MINOR SALIVARY GLAND LINGUAL GLAND PALATINE GLAND GLOSSOPALATINE GLAND

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Can be divided into several groups:

1) Anterior lingual gland ( gland of Blandin & Nuhn) 2) Posterior lingual mucous gland 3) Posterior lingual serous gland ( VON EBNERS

GLAND )
ANTERIOR region MUCOUS in character

POSTERIOR region

MIXED in character

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1) ANTERIOR LINGUAL GLAND:

Duct open on the ventral surface of tongue near the lingual

frenum. 2) POSTERIOR MUCOUS GLAND:

Located lateral and posterior to the vallate papillae and in

association with lingual tonsils.

Purely mucous in character and their duct open on the

dorsal surface of tongue.

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3) POSTERIOR SEROUS GLAND:

Group of serous gland located between the muscle fibres of the tongue below the vallate papilla.

Their ducts open into the trough of the vallate papillae and at the rudimentory foliate papillae on the side of the tongue.

122

Gland of lip and cheek have been describe as mixed,

consisting of the mucous tubules with serous demilunes.

Ultrastrcture studies have revealed the presence of mucous

cells.

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 Pure mucous gland Principally localized to the region of the isthmus in the glossopalatine fold but may extend from the posterior extension of the sublingual gland to the gland of soft palate.

Pure mucous variety Consists of several hundred glandular aggregates in the lamina propria of the posterolateral region of the hard palate & in the submucosa of the soft palate and uvula.
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 Consists of aggregates of secretory end pieces and ducts, locates

in submucosa or between muscle fibre of tongue. Duct usually open on the mucosal surface. Intercalated duct are poorly developed , and larger duct may lack

infolded basolateral membreane

Von ebners gland are serous in character . Their secretion are released in region with significant numbers of

taste buds, specifically , the trough surrounding the vallate

papillae and the cleft between the vallate papillae.

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Secrete digestive enzymes and protein.

Play role in taste process. Fluid secretion is thought to cleanse the tough and

prepare the taste receptor for a new stimulus.

Minor salivary gland are rich in mucin, antibacteriol protein, and secretory immunoglobulins.

They have continous slow secretory activity and thus

have important role in protecting and moistening the oral mucosa, especially at night when major salivary gland

are mostly inactive.

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HISTOLOGY OF MINOR SALIVARY GLAND

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Clinical aspects 1) AGE: With age generalized loss of parenchymal tissue occurs. Lost cells are often replace by adipose tissue. Decrease production of saliva Some studies suggested that unstimuated salivary secretion is in normal range but decrease in volume of saliva in stimulated stage. 2) DISEASES: 1.DEVELOPMENTAL DISORDERS a)Abberant salivary gland b)Aplasia & hypoplasia c)Accessory salivary duct d)Xerostomia 2.OBSTRUCTIVE DISORDERS a)mucus extravasation phenomenon b)mucus retention cyst b)sialolithiasis
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3.INFECTIOUS DISEASES BACTERIAL a)Acute bacterial parotitis b)Chronic bacterial parotitis c)Acute bacterial submandibular sialadenitis d)Chronic bacterial submandibular sialadenitis e)Cat-scratch diseases VIRAL a)Mumps b)HIV 4.IDIOPATHIC DISEASES a)Necrotizing sialometaplasia b)Cheilitis glandularis

5.AUTOIMMUNE DISEASES a)Beningn lymphoepithelial lesion b)Sjogrens sydrome c)Sarcoidosis

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3) XEROSTOMIA:

Also known as dry mouth is the often clinincal often. Loss of salivary function or reduction in volume of saliva lead to feeling of dryness in mouth . Side effect of medication taken for other problems.

Destruction of the salivary gland tissue is another common cause.

After radiation therapy Chemotherapy.

Sjogrens syndrome: by invasion of lymphocytes into the gland and

destruction of epithelial cells.

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 It leads to dryness of oral tissue and loss of protective effect of saliva buffers, proteins, and mucins. Oral tissue are more susceptible to caries, especially near the gingival margin. Speech, eating, and swallowing mbecomes difficult and painful. Temporary relief is achieved by sipping of water and artificial saliva.

Drugs like pilocarpine can be used.

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DIAGNOSTIC APPLICATIONS OF SALIVA FOR SYSTEMIC DISEASES

Collection of saliva Whole saliva can be collected non-invasively. No special equipment is needed
Saliva can be collected with or without stimulation. Stimulated saliva is collected by masticatory action

(i.e., from a subject chewing on paraffin) or by gustatory stimulation (i.e., application of citric acid on the subject's tongue; Mandel, 1993).

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 Unstimulated saliva is collected without exogenous

gustatory, masticatory, or mechanical stimulation. The best two ways{

draining method the spitting tube method (Navazesh, 1993).

Unstimulated saliva is not possible ,normal human salivary gland dosent secrete saliva without stimulation -saliva as an analytical tool in toxicology-KARIN M. HOLD et all
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HEREDITARY DISEASES
1) CYSTIC FIBROSIS (CF) which is considered a generalized exocrinopathy.
Saliva of patients contains increased calcium levels (Mandel

et al., 1967; Blomfield et al., 1976; Mangos and Donnelly, 1981}

Elevated levels of sodium and a decrease in flow rate were

reported for glands in patients with cystic fibrosis. (Wiesman et al., 1972}.

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2)21-HYDROXYLASE DEFICIENCY it is an inherited disorder which leads to congenital adrenal

hyperplasia

Early morning salivary levels of 17-hydroxyprogesterone (17-

OHP) were reported to be an excellent screening test for the

diagnosis of non-classic 21-hydroxylase deficiency, since the salivary levels accurately reflected serum levels of 17-OHP.

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AUTOIMMUNE DISEASESSJGREN'S SYNDROME is an autoimmune exocrinopathy

Predominantly CD4+ T-cells in the salivary gland parenchyma (Daniels, 1984; Daniels and Fox, 1992)

A low resting flow rate and abnormally low stimulated flow rate of

whole saliva are also indicators of Sjogrens syndrome. (Sreebny and Zhu,1996)

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VIRAL DISEASES
Acute hepatitis A (HAV) and hepatitis B (HBV) were diagnosed

based on the presence of IgM antibodies in saliva.

used for determining immunization and detecting infection with

measles, mumps, and rubella (Friedman, 1982; Perry et al., 1993; Brown et al., 1994)
PCR-based identification of virus in saliva is a useful method

for the early detection of HSV-1 reactivation in patients with Bell's palsy. (Furuta et al., 1998).
It was suggested that detection of IgA antibody to HIV in saliva

may, therefore, be a prognostic indicator for the progression of HIV infection (Matsuda et al., 1993).
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SALIVA

AS

DIAGNOSTIC TOOL
IN ORAL CANCER:

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 The most definitive procedure for oral cancer diagnosis is a scalpel biopsy, followed by the careful histopathological evaluation by a qualified pathologist. For this to be an effective procedure, it requires three consecutive events: a visit to the dentist/physicians office, the biopsy by the licensed health care provider, and a pathologists evaluation. Microscopic investigation results often are confimed too late for the cancer to treat in early stage.

Despite the advance treatment and diagnostic tool

invention the death rate of oral squamous cell car inoma remains the same ar before and is consider as worst

among all cancer.

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 The use of saliva in oral cancer is still in its infancy.

Its use begun with thew report bl lio et. Al. in 2000 that exon 4 of codon 63 is mutated in salivary DNA of oral

cancer patients.
Five of 27 control subjects (18.5 percent) had similar mutations in their p53 gene.

El-Naggar et al. in 2001 demonstrated genetic

heterogeneity in saliva from patients with oral squamous carcinomas and suggested the use of epithelial cells in

saliva from patients with head and neck squamous

tumorigenesis for genetic analysis.
140

 More recently Jiang et al. reported the increase of mitochondrial DNA content in the saliva of head and

neck cancer patients.

319 distict protein in human whole saliva was identified using shot gun proteomics.

IL-8 and thioredoxin which can discriminate slaiva of

oral cancer from contrrol group have been discovered.

IL-8 is significantly increasing in saliva of oral cancer

patient.
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CONCLUSION
SCIENCE AND THE FUTURE
The functional value of saliva has long been thought to outweigh its diagnostic possibilities. Recent evidence regarding saliva as a diagnostic tool for diseases such as HIV, various forms of cancer, diabetes, arthritis and heart disease has shown that much more information is contained in saliva than was previously thought With the abundance of information that may be contained within, saliva might play an even greater role in peoples daily lives than it does today. Scientists are transitioning from viewing saliva as a diagnostic outcast in comparison with blood or urine to viewing it as a valuable biofluid. 142

The advantages of using salivary testing for diagnostic purposes are

- its containment of highly diagnostic disease biomarkers. -its non invasivenature . -ability to obtain quick and reliable results. The NIDCR initiatives and current research efforts are closing the gap rapidly between the use of saliva and other bio fluids (blood, urine, cerebrospinal fluid) for disease diagnostics. It may well turn out that, similar to the finding that saliva is more accurate than blood in detecting oral cancer , saliva will outperform other biomedia in the diagnosis of other diseases as well

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 Refrences : Textbook of histology-WHEATERS Human Anatomy -Vol 3 ; - B D CHAURASIA Oral Histology 6th Ed.- A.R TEN CATE Text Book of Oral Pathology 5th Edition SHAFER Textbook of histology-WHEATERS ANATOMY AND PHYSIOLOGY OF THE SALIVARY GLANDS SOURCE: UTMB, Dept. of Otolaryngology DATE: January 24, 2001 Resident Physician: Frederick S. Rosen, MD

Salivary diagnostics powered by nanotechnologies, proteomics and genomics David

T. Wong, DMD, DMSc.
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ALWAYS THANKS TO GOD, FOR WHAT ALL WE HAVE

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