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Anatomy And Physiology Of Salivary Glands

Dr. Supreet Singh Nayyar, AFMC For more topics, visit www.nayyarENT.com

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Anatomy of Parotid, Submandibular, Sublingual

glands
Physiology structure of glands, secretion of

primary fluid, neuronal control, neurotransmitters


Factors affecting salivary flow & composition

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Anatomy
3 Pairs Major

salivary glands
Parotid Submandibular

Sublingual

Collection of salivary

tissue within oral mucosa Minor salivary glands


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Development Of Parotid Gland


Ectoderm of oral cavity Solid bulb from oropharyngeal epithelium
6 weeks - parotid gland

Dichotomous branching of solid bulb,

development of lumen, condensation of mesenchyme


Formation of primitive ducts

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Contd
Engulfment of facial nerve 16th- 21st wk

Functional maturation after feeding is established

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Parotid Gland
Lobulated, inverted

pyramid, extent
Superficial, deep lobes Parotid space Borders - ant, post Surfaces superficial,

superior, anteromedial, posteromedial


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Capsule
Condensed deep cervical fascia, tough, inelastic

surface component, thin deep layer


Stylomandibular ligament

Fibrous septa arise from capsule


Contents of fascia superficial lymph nodes, greater

auricular nerve

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Structures Within The Gland


Facial nerve, division of gland Retromandibular vein, anterior and posterior divisions
External carotid artery, terminal branches
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Lymphoid Tissue In The Gland


Capsule Periparotid Nodes Mostly superficial to Facial Nerve Part of MALT, secrete IgA Salivary gland tissue may be present within the

lymph nodes

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Intraparotid Facial Nerve


Stylomastoid foramen Methods of identification

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

Unpredictable preoperatively, to be precisely

defined during surgery

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Autonomic Nerve Supply


Parasympathetic
Inferior salivatory nucleus IX nerve Plexus around ECA Lesser Petrosal nerve Otic ganglion Auriculotemporal nerve PAROTID PAROTID

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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Submandibular Salivary Gland


Development
6th IU wk Ectoderm in floor of primitive oral cavity Lateral to primitive tongue

Development of acini 12th wk

Large superficial, small deep lobe Located in Submandibular triangle Well defined capsule

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Surgical Anatomy Superficial Lobe


Inferior surface Digastric, Deep fascia, Platysma, Skin Lateral surface Submandibular fossa, Facial artery Medial surface Mylohyoid, Hyoglossus, Lingual nerve, XII nv, Submandibular ganglion, Deep lingual vein

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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

Distally b/w Genioglossus & Sublingual gland


Opening on sides of frenulum of tongue Relation to Lingual nerve

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Blood Supply & Lymphatic Drianage

Branches of Facial & Lingual arteries Lymph nodes adjacent to the superficial part

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Autonomic nerve supply


Parasympathetic
Superior Salivary Nucleus Nervus Intermedius Facial Nerve Chorda Tympani Plexus around Facial Artery

Sympathetic
Superior Cervical Ganglion

Submandibular Ganglion
Lingual Nerve Submandibular Ganglion SUBMANDIBULAR GLAND
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Surgery Of Submandibular Gland


Skin incision 4 cm below Mandible Ligation of Facial vessels above & below Dissected away from Lingual Nerve

Lymph nodes in substance of 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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Relations Of Sublingual Gland


Sup Oral floor mucosa Inf Mylohyoid Post Deep part

Submandibular gland
Med Lingual nerve,

Submandibular duct, Genioglossus


Lat Med surface of lower

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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Physiology Of Salivary Glands

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Function of Salivary Glands


Produce saliva 1L / day (1ml/min/gm)

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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Structure of Salivary Gland


Parotid
Largest, serous (Compound Tubuloacinar Gland)

Submandibular and Sublingual


Mixed (Compound Tubuloacinar Glands)

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Secretory End Pieces (Acini)


Serous Acini Pyramid shaped, basal nucleus, apical secretory granules Mucus Acini Larger, columnar cells, basal nucleus Mixed Acini Mucus acini capped by serous cells forming Serous Demilunes
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Duct System
Acini Intercalated Ducts Striated Ducts Interlobular Excretory Ducts

Stensons, Whartons duct

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Control of Blood Flow And Metabolism


High rates

Rate of saliva production 1ml/min/gm


Blood flow 10 times that of equal mass of skeletal

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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Secretion Of Water And Electrolytes


Acini Primary Fluid Secretion
Isotonic to plasma, electrolyte composition fairly constant,

exocrine protein

Excretory ducts extract Na+, Cl- and add K+,

HCO3- to saliva
No addition in volume More of Na+, Cl- removed than addition of K+, HCO3- responsible

for hypotonicity

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Mechanisms Of Primary Fluid Secretion


Osmotic process
Transepithelial salt gradients Four ion transport systems - luminal and basolateral

membranes generate the gradient


Three mechanisms proposed operate concurrently

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Mechanism 1
Stimulation rise in cytosolic

Ca2+

Opening of K+, Cl- channels

KCl outflow follow

Cl- conc in lumen

, Na+, H2O

Cl- entry sustained via

Na+K+2Cl- cotransporter lumen per ATP hydrolysed by Na+/K+ ATPase


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6 Cl- translocated to acinar

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Mechanism 2
Cl-/HCO3-, Na+/H+ exchanger KCl outflow

Cl- entry via Cl-/HCO3-

exchanger

Acidification buffered by Na+/H+ exchanger

3 Cl- translocated to lumen

per ATP hydrolysed


Na+ & water follow into the
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Mechanism 3
Involves acinar HCO3-

secretion

3 HCO3- secreted per ATP

molecule

H+ extruded via Na+/H-

exchanger
Na+, H2O follow into the

lumen

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Mechanism Of Macromolecule Secretion


Contained in zymogen granules present in serous

acinar cells, ductal cells


Upon stimulation release contents in lumen by

exocytosis
Conc and rate varies with level and type of

stimulation

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Mechanism Of Ductal Secretion


Inconstant, underlying mechanisms partially

understood
Produce final hypotonic solution

Influence of tubular cells more when flow rate is slow

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Neural Control Of Gland Function


Predominant control PARASYMPATHETIC

Sympathetic stimulation shorter and less strong


Probable synergistic action

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Parasympathetic Stimulation
Primary fluid secretion
Protein secretion

Vasodilatation
Increased metabolism and growth Myoepithelial cell contraction

LARGE VOLUME LOW PROTEIN OUTPUT

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Sympathetic Stimulation
High protein secretion
Vasoconstriction decreased blood flow

Myoepithelial cell contraction

LOW VOLUME HIGH PROTEIN OUTPUT

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Neurotransmitters & Receptors

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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Factors Affecting Salivary Flow


Unstimulated Submandibular
Stimulated Parotid 2/3rd Acidic tastes Max stimulation

Sweet tastes Least stimulation

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Contd
Psychic factors
Circadian rhythm Diurnal variation

Age
Drugs
Tricyclic antidepressants Phenothiazines

Depression and anxiety states


Dehydration, hemorrhage,

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Contd
Salivary Gland diseases
Radiation sialadenitis Autoimmune sialadenitis HIV infection Iron overload Sarcoidosis Amyloidosis Cystic fibrosis
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Factors Affecting Composition Of Saliva


Flow rate
Source of secretion Type of stimulus

Diurnal variation
Diet Drugs flow dependant components

Hormones mineralocorticoids, ovulation

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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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Salivary Assays In Diagnosis


Valid medium, painless, non-invasive

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,

flow rates Constant saliva / plasma ratio not established

Microbial antigens, antibodies


Hepatitis A, B, C HIV Immunisation status

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Radioisotope Salivary Function Tests


Tc
99m pertechnitate

Scintigraphy objective measure of its uptake,

concenteration, excretion

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Sialolithiasis
Concentric shells of calcareous material

alternating with organic material


Stasis of flow Distribution
Submandibular gland 92% Parotid 6%

Sublingual / minor salivary glands 2%

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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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