P R E S E NT OR : DR .

AR UN
MODE R AT OR : DR . VI NAY B AB U
ANATOMY AND PHYSIOLOGY
OF SALIVARY GLANDS
OVERVIEW
Introduction
Developmental anatomy
Parotid gland
Submandibular gland
Sublingual gland
Minor salivary glands
Histology
Physiology of salivary glands
INTRODUCTION
Divided into two groups

Major salivary glands:
Parotid.
Submandibular.
Sublingual glands.

Minor salivary glands.

Their major function is to secrete saliva.
DEVELOPMENTAL ANATOMY
Begins during 6
th
- 8
th
week of
embryogenesis.

Site of origin Solid epithelial
buds of ectodermal origin
form the wall of the primitive
mouth and invaginate into
the surrounding
mesenchyme.

A groove which later forms a
tunnel is formed.

At the blind end of the
tunnel parotid gland is
formed by proliferation.
Development of Major salivary glands
Consist of 3 main stages:

1
st
stage: Presence of primordial analge and
formation of branched duct buds due to repeated
epithelial cleft and bud development.

2
nd
stage: Lobules and duct canalization.

3
rd
stage: Maturation of acini and intercalated ducts
and reduction of interstitial connective tissue.

The first gland to develop
is parotid develops
from posterior
stomodeum elongates
laterally into solid cords
across the developing
masseter muscle.

The cords then canalize
to form ducts, and acini is
formed at distal ends.

During 6
th
wk, small buds
appear lateral to tongue in
floor of mouth and extend
posteriorly around the
mylohyoid muscle
Submandibular gland.

During 9
th
month, multiple
endodermal epithelial buds
in the paralingual sulcus of
floor of mouth Sublingual
gland.

All the glands are covered by capsule which is
formed by the surrounding mesenchyme
exception sublingual gland.

Minor salivary glands formed during 12
th

Intrauterine wk, from simple tubuloacinar units in
upper respiratory ectoderm.
PAROTID GLAND
Largest salivary gland, weighs 15-30
gms.
Location: Preauricular region along
the posterior surface of mandible.
Divided into superficial and deep
by facial nerve.
Superficial lobe lateral to facial
nerve and overlies the lateral
surface of masster.
Deep lobe medial to facial nerve
and located between mastoid
process and ramus of mandible.
Bounded superiorly by zygomatic arch and inferiorly
the tail of parotid extends up to anteriomedial
margin of sternocleidomastoid.

Posteriorly the tail extends over superior border of
sternocleidomastoid muscle toward mastoid tip.

Accesory parotid gland: lies over masseter muscle
between parotid duct and zygoma. Here the duct
drains directly to parotid duct through one tributary.
PAROTID FASCIA
Formed by Deep cervical fascia splits into superficial
and deep layers to enclose parotid gland.

Superficial layer extends from masseter and
sternocliedomastoid to zygomatic arch.

Deep layer extends to stylomandibular ligament.

The parotid fascia forms a dense inelastic capsule and,
covers the masseter muscle deeply, so sometimes
known as the Parotid masseteric fascia.

STENSONS DUCT
Lined by low cuboidal epithelium surrounded by
smooth muscle and fibrous tissue wall.

Arise from anterior lateral edge of the gland

Travels parallel to zygoma, approx 1cm below it

At anterior region of masseter muscle turns medially to
pierce buccinator muscle

Enters oral cavity opposite 2
nd
upper molar tooth.
It follows a line from the floor of the external auditory
meatus to just above the commissure of the lips.
NEURAL ANATOMY
Facial nerve exits skull base
through stylomastoid
foramen.
Before entering the posterior
portion of the parotid gland,
three motor branches are
given off:

Posterior belly of the
digastric muscle.
Stylohyoid muscle.
Postauricular muscles.
Main trunk of the facial nerve passes through the
parotid gland divides into the temporofacial and
lower cervicofacial at the pes anserinus.
Approximately 1.3 cm from the stylomastoid foramen.
Temporal
Zygomatic
Buccal

Marginal mandibular
Cervical

Temporofacial
Cervicofacial
KATZ AND CATALANO
CLASSIFICATION
5 patterns of branching:
Type 1: No anastamotic links b/w main branches, but in
two subtypes there is splitting and reunion of zygomatic
and mandibular branches.( 25% )


Type 2: The buccal branch subdivides and fuses with
zygomatic branch. (14%)

Type 3: Major anastamotic links present b/w buccal
branch to other branches. (44%)









Type 4: Complex branching and anastamotic links b/w
two divisons. (14%)


Type 5: Facial nerve trunk divides before leaving the
stylomastoid foramen.( 3%)

LANDMARKS FOR FACIAL NERVE

1) Tragal pointer 1cm medial & inferior to tragal pointer
2) Tympanomastoid suture- Nerve lies 6-8mm deep to this
suture.
3) Nerve lies lateral to Styloid process.
4) Superficial to Retromandibular vein.
5) Insertion of posterior belly of digastric.
6) Retrograde dissection from terminal branches.
7) Junction of cartilaginous and bony EAC.

AUTONOMIC NERVE INNERVATION
Glossopharyngeal nerve provides visceral secretory
innervation to the parotid gland.

It carries preganglionic parasympathetic fibers from the
inferior salivatory nucleus in the medulla.

Pre ganglionic fibers travel as lesser petrosal nerve and
synapses in otic ganglion.

Postganglionic parasympathetic fibers joins the
auriculotemporal nerve Secretion of saliva.

Postganglionic sympathetic fibers innervate salivary
glands, sweat glands, and cutaneous blood vessels
through external carotid plexus from the superior
cervical ganglion.

Acetylcholine serves as the neurotransmitter for both
postganglionic sympathetic and parasympathetic
fibers.


CLINICAL CORRELATION
Responsible for
development of Freys
syndrome post
parotidectomy.

Due to aberrant
autonomic reinnervation
of the sweat glands by
the regenerating
parasympathetic fibers
from any residual parotid
gland.
The risk for Freys syndrome can be minimized by

Complete and meticulous superficial
parotidectomy.

By developing skin flaps of appropriate thickness,
so that the exposed apocrine glands of the skin
are protected from ingrowth and stimulation by
the severed branches of the auriculotemporal
nerve.
Blood supply and venous drainage
Blood supply is by mainly by Transverse facial artery
which is a branch of superficial temporal artery given
out within substance of parotid gland.

Venous drainage is by retromandibular vein, which is
formed by union of maxillary + superficial temporal vein
and joins external jugular vein.
Lymphatic drainage
Only salivary gland with two nodal layers, both drain
into Superficial and deep cervical lymph systems.

90% of nodes located in superficial layer between
glandular tissue and its capsule.

Superficial drains parotid gland, external auditory
canal, pinna, scalp, eyelids, and lacrimal glands.

Deep drains parotid gland, external auditory canal,
middle ear, nasopharynx, and soft palate.

SUBMANDIBULAR GLAND
Aka submaxillary gland
2
nd
largest salivary gland 7-
16gms.
Located in submandibular
triangle
Bounded superiorily by
inferior edge of mandible
Inferiorly by ant and post
belly of digastric muscle
Other structures lying within submandibular
triangle:
Submandibular lymph nodes.
Facial artery and vein.
Mylohyoid muscle.
Lingual, hypoglossal, and mylohyoid nerves.

The middle layer of the deep cervical fascia
encloses the submandibular gland.


Facial V
Facial A
Clinical significance:
Marginal mandibular branch
of facial nerve lies superficial
to Submandibular gland
fascia.

Division of the submandibular
gland fascia, is a reliable
method of preserving and
protecting the nerve during
neck dissection or
submandibular gland
resection.


WHARTONS DUCT
The main excretory duct of the submandibular
gland, approximately 45 cm long, runs superior to
the hypoglossal nerve and inferior to the lingual
nerve.
Submandibular gland has both mucous and serous
cells empty into ductules empty into the
Whartons duct.
It opens lateral to the lingual frenulum through a
papilla in the floor of the mouth behind the lower
incisor tooth.

Neural anatomy
Parasympathetic innervation from superior
salivatory nucleus in the pons passes through
Nervus intermedius into the internal auditory
canal to join the facial nerve.
Fibers are then conveyed through chorda tympani.
The lingual nerve, then carries the presynaptic fibers
to the submandibular ganglion.
The postsynaptic nerve leaves the ganglion to
innervate both the submandibular and sublingual
glands to secrete watery saliva.

Blood supply and Venous drainage
Main arterial supply facial artery
Runs medial to the posterior belly of digastric
muscle and then hooks over to supply deep to the
gland.
Venous drainage anterior facial vein.
Anterior facial vein + posterior facial vein
common facial vein over the middle aspect of
gland.
It then courses lateral to the gland and exits the
submandibular triangle to join the internal jugular
vein.
Lymphatic drainage
The prevascular and postvascular lymph nodes
draining the submandibular gland are located
between the gland and its fascia.

They lie in close approximation to the facial artery
and vein at the superior aspect of the gland
drains into the deep cervical and jugular lymph
nodes.

Clinical significance
Prone for Sialolithiasis (80-90 %)
Reasons suggested:
Duct is long and large.
Genu of the duct predisposes to the stasis of
saliva and thereby encourages salivary stone
(sialolith) formation.
The flow of saliva is slow and against gravity.
The saliva is more alkaline with a high mucin and
calcium content.

SUBLINGUAL GLAND
Smallest of the major salivary glands weighs 24 g.

Consists mainly of mucous acinar cells.

Lies as a flat structure in a submucosal plane within the
anterior floor of the mouth, superior to the mylohyoid
muscle and deep to the sublingual folds opposite to
the lingual frenulum.
Mandible and
genioglossus muscle
are located laterally
to it.
No true fascial
capsule surrounding
the gland, but is
covered by oral
mucosa on its superior
aspect.

Bartholins duct and Duct of Rivinus
Main duct is Bartholins duct.

Several ducts of Rivinus drains the gland from the
superior portion.

They either secrete directly into the floor of mouth,
or empty into Bartholins duct which then empties
into Whartons duct of submandibular gland.
Neural Anatomy
Supplied by both sympathetic and parasympathetic
fibers.

The presynaptic parasympathetic fibers are carried by
the chorda tympani nerve to synapse in the
submandibular ganglion SECRETOMOTOR

Postganglionic fibers from submandibular ganglion join
the lingual nerve to supply the sublingual gland.

Sympathetic nerves innervating the gland arise from
the cervical ganglion.
Blood supply and lymphatics
By the submental and sublingual arteries which are
branches of lingual and facial respectively.

Venous drainage is by the submental and
sublingual veins.

Lymphatic drainage is submandibular lymph nodes.

Clinical significance
Ranula cysts or mucoceles of
sublingual gland.

They exist either simply within the
sublingual space or plunging
posteriorly through the mylohyoid
muscle into the neck (plunging
ranula)

Presentation:
Bluish, non tender mass in floor
of mouth.
Soft painless cervical mass
Plunging ranula.
MINOR SALIVARY GLANDS
Ranges about 600 to 1000.
Size about 1 to 5 mm.
Location- lines the oral cavity and oropharynx.
Highest number in- lips, tongue, buccal mucosa,
palate.
Each gland has single duct secrete directly into
oral cavity.
Secretions- serous/ mucous/ mixed.
Innervated by lingual nerve.
Superior palatal glands by palatine nerves.
HISTOLOGY
All glands are derived from epithelial cells.

Consists of parenchyma and stroma.

They are exocrine gland as they secrete through their
ducts salivary acinus.

Acinus is divided into 3 main types
Serous acini
Mucinous acini
Mixed or seromucous
SEROUS ACINI
Serous acini in salivary
glands release via exocytosis
a watery protein secretion
that is minimally
glycosylated or
nonglycosylated from
secretory granules.
Here the acinar cells are
pyramidal, with basally
located nuclei surrounded
by dense cytoplasm and
secretory granules that are
most abundant in the apex.

SEROUS ACINI

MUCINOUS ACINI
Mucinous acini store a
viscous, slimy glycoprotein
(mucin) within secretory
granules that become
hydrated when released to
form mucus.

Mucinous acinar cells are
commonly simple columnar
cells with flattened, basally
situated nuclei and water-
soluble granules that make
the intracellular cytoplasm
appear clear.
MUCINOUS ACINI
MIXED ACINI

Mixed, or seromucous, acini contain components of
both types, but one type of secretory unit may
dominate.

They are commonly observed as serous demilunes
(or half-moons) capping mucinous acini.

MIXED ACINI
HISTOLOGY OF GLANDS
Single secretory unit is
called Salivon.

Its formed by
The acinus,
Intercalated duct,
Striated duct.

STRUCTURE OF SALIVON
Intercalated duct:
Comprised of an irregular myoepithelial cell layer lined
with squamous or low cuboidal epithelium.
Function Secretion of HCo
3
-
into lumen and absorption
of Cl
-

Striated ducts:
Has basal striations due to membrane invagination and
mitochondria and are lined by a simple columnar
epithelium.
Function Reabsorption of Na+ and secretion of K+.
Myoeipthelial cells:
Located between epithelial cells and basal lamina of
acinus.
Function helps in contraction of acinus due to the
presence of cytoplasmic filaments on their basal side.
The striated duct is followed by interlobular excretory
ducts.
They are located within the connective tissue of the
glandular septae.
The epithelial lining is comprised of sparse goblet cells
interspersed among the pseudostratified columnar
cells.
As the diameter of the duct increases, the epithelial
lining transitions to stratified columnar nonkeratinized
stratified squamous cells, within the oral cavity.
MICROSCOPIC STRUCTURE OF GLANDS
PHYSIOLOGY OF SALIVARY GLANDS
Secretion of saliva is controlled completely by the
parasympathetic and sympathetic divisions of
autonomic nervous system.
Plays an important role in digestion of
carbohydrates and fats through 2 main enzymes
1. Ptyalin An -amylase in saliva cleaves the
internal -1,4-glycosidic bonds of starches to yield
maltose, maltotriose, and -limit dextrins.
2. Lingual lipase Breaks down triglycerides.

Saliva is formed via
active transport
processes occurring
throughout the secretory
unit.

The secretory unit consists
of:
Acinus
Secretory ducts/
Salivary ducts


The fluid component derived from local vascular bed in the
form of an isotonic solution secreted into the acinar lumen
As secretion passes through the ducts:
-(Na
+
) and (Cl

) in primary secretion is reabsorbed

-(K
+
) and (HCO
3

) is secreted
Sodium reabsorption > > Potassium secretion creates
electrical negativity of about -70 mv in the salivary ducts.
This results in reabsorption of Cl
-
passively Cl
-
level in saliva
decreases equal to level of Na+ decrease.

Hco
3
-
secreted by the ductal epithelium into the lumen
duct.
Due to passive exchange of Hco
3
-
Cl
-
ions.
Also partly from an active secretory process.
Traverses the ductal system and empties into mouth
Some proteins are added to the salivary fluid as it
traverses the secretory duct
By the time the saliva enters the mouth, it has generally
been rendered hypotonic
Under resting conditions:
Conc of Na+ and Cl- ions in saliva15 mEq/L (1/7
th
-1/10
th
)
Conc of K+ ions 30 mEq/L ( 7x)
Conc of Hco
3
-
50 to 70 mEq/L (2- 3x)

During Maximal secretion
Rate of primary secretion from acini increases to 20 fold
This acinar secretion then flows through the ducts rapidly
ductal reconditioning of the secretion is reduced
Nacl concentration rises only to to 2/3
rd
of plasma
K+ concentration rises only to 4 times
FUNCTIONS OF SALIVA

1. Break down of carbohydrates and fats.

2. Dissolve and transport food particles towards
tastebuds.

3. Lubrication of food eases process of swallowing.

4. Salivary lubrication important for speech.

5. Antibacterial action due to presence of IgA,
lysozyme, Lactoferrin, Thiocyanate ions

6. Acts as a protective buffer for mouth by diluting
harmful substances and lowering the temperature
of solutions that are too hot.

7. Washes out foul-tasting substances from the mouth.

8. Neutralizes gastric juice to protect the oral cavity
and esophagus.

9. Prevention of dental carries due to presence of
protein antibodies secreted in saliva.

REFERENCES
Myers Salivary glands disorders.
Scott- Browns Otorhinolaryngology, Head and neck
surgery 7
th
edition.
Head & Neck Surgery - Otolaryngology, 4th Edition
Bailey, Byron J
Greys Anatomy 40
th
edition.
Ganongs Review of Medical Physiology, 23
rd
edition.
Guytons textbook of medical physiology 10 th edition.
Cummings Otolaryngology Head & Neck Surgery, 5
th

edition.

THANK YOU