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Anatomy of Parotid, Submandibular, Sublingual
glands
Physiology structure of glands, secretion of
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Anatomy
3 Pairs Major
salivary glands
Parotid Submandibular
Sublingual
Collection of salivary
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Contd
Engulfment of facial nerve 16th- 21st wk
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Parotid Gland
Lobulated, inverted
pyramid, extent
Superficial, deep lobes Parotid space Borders - ant, post Surfaces superficial,
Capsule
Condensed deep cervical fascia, tough, inelastic
auricular nerve
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lymph nodes
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during surgery
TM Sulcus
PBD Tragal pointer Mastoid
Retrograde
Styloid process
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Branching Patterns
Varied, Surgically important Single trunk, divides into
Zygomaticotemporal, Cervicomandibular
Temporal, upper / lower
zygomatic, buccal
Buccal, cervical, mandibular
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Contd
Type1-5 ( Katz and Catalano, 1987)
Type 1 (25%) No anastomotic links Type 2 (14%) Buccal fuses distally with Zygomatic Type 3 (44%) Major communication between Buccal &
others Type 4 (14%) Anastomosis between major divisions Type 5 (3%) More than one Facial Nv trunk
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Sympathetic
Superior cervical ganglion
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Parotid duct
Formed near the anterior
border
Lies on superficial surface of
Masseter
Opens in the mouth at
parotid papilla
Accessory Parotid tissue
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Large superficial, small deep lobe Located in Submandibular triangle Well defined capsule
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Deep Lobe
Extends for a variable distance between Mylohyoid &
Hyoglossus
Relations
Superior Lingual nerve Inferior XII Nv, Deep lingual vein, Submandibular duct
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Whartons duct
5 cm in length Middle of deep part Crosses Sublingual space Proximally b/w Mylohyoid & Hyoglossus
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Branches of Facial & Lingual arteries Lymph nodes adjacent to the superficial part
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Sympathetic
Superior Cervical Ganglion
Submandibular Ganglion
Lingual Nerve Submandibular Ganglion SUBMANDIBULAR GLAND
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Sublingual Gland
Development
8th wk
Epithelial buds present in
paralingual sulcus
Almond shaped
Located in anterior part
of floor of mouth
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Submandibular gland
Med Lingual nerve,
Mandible
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Contd
Ducts
Multiple Drain into oral cavity directly or into Submandibular duct
Blood supply
Nerve supply
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Contents
Mucin (glycoprotein) Salivary amylase Secretory Immunoglobulins Other enzymes DNase, RNase, lysozyme, lactoperoxidase, lingual lipase Kallikerin Inorganic compounds Na+, K+, HCO3-, Ca2+
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Function Of Saliva
Lubrication and protection
Buffering and clearance Maintenance of tooth integrity Antibacterial activity Taste and digestion
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Duct System
Acini Intercalated Ducts Striated Ducts Interlobular Excretory Ducts
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muscle
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Secretion Of Saliva
Active transport process under neuronal control
Composition
Hypotonic to plasma Tonicity more when rates of production are high( at max rate -
70% to that of plasma) K+,HCO3- higher than in plasma pH acidic during resting phase, basic during active phase( HCO3- secretion)
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exocrine protein
HCO3- to saliva
No addition in volume More of Na+, Cl- removed than addition of K+, HCO3- responsible
for hypotonicity
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Mechanism 1
Stimulation rise in cytosolic
Ca2+
, Na+, H2O
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Mechanism 2
Cl-/HCO3-, Na+/H+ exchanger KCl outflow
exchanger
Mechanism 3
Involves acinar HCO3-
secretion
molecule
exchanger
Na+, H2O follow into the
lumen
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exocytosis
Conc and rate varies with level and type of
stimulation
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understood
Produce final hypotonic solution
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Parasympathetic Stimulation
Primary fluid secretion
Protein secretion
Vasodilatation
Increased metabolism and growth Myoepithelial cell contraction
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Sympathetic Stimulation
High protein secretion
Vasoconstriction decreased blood flow
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Parasympathetic
Ach binds to M3
Receptors
Activation of G protein
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Phospholipase C IP3 & DAG Intracellular Ca2+ release, Protein www.nayyarENT.com exocytosis
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Contd
Sympathetic
Noradrenaline binds to
1, 1 receptors
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Adenylate Cyclase activation cAMP dependant Protein Kinase protein www.nayyarENT.com exocytosis
Activation of G protein
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Contd
Psychic factors
Circadian rhythm Diurnal variation
Age
Drugs
Tricyclic antidepressants Phenothiazines
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Contd
Salivary Gland diseases
Radiation sialadenitis Autoimmune sialadenitis HIV infection Iron overload Sarcoidosis Amyloidosis Cystic fibrosis
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Diurnal variation
Diet Drugs flow dependant components
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Contd
Disease states
Sialadenitis Radiation damage Sjorgens syndrome Cystic fibrosis HTN DM Alcoholic cirrhosis Aldosteronism Chronic pancreatitis
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Hormone monitoring
Unconjugated steroids Proportional to free unbound plasma levels Useful in field studies Estradiol, progesterone, testosterone
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Contd
Drugs
Factors lipid solubility, protein binding, molecular size,
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concenteration, excretion
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Sialolithiasis
Concentric shells of calcareous material
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References
Scott-Browns Otolaryngology 6th ed, Vol 1, Vol
5 Otolaryngology Head & Neck Surgery Charles W Cummings, 4th ed, Vol 2 Skandalakis Surgical Anatomy Lasts Anatomy 9th ed Physiology Berne & Levy, 5th ed
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