Salivary Glands

Flashcards about Salivary Glands.

Site of Minor Salivary Glands

All over the mucosa in the oral cavity.

Minor Salivary Glands

There are thousands of these glands in the oral cavity, pharynx and para-nasal sinuses.

Minor Salivary Glands

Contributes 10% of total salivary volume.

Minor Salivary Glands Tumors

90% of these tumors are Malignant.

Major Salivary Glands

Parotid, Submandibular, and Sublingual Glands

Parotid glands

Secrete serous secretion.

Submandibular salivary glands

Secrete sero-mucinous saliva.

Sublingual salivary glands

Secrete Mainly mucinous saliva.

Site of Sublingual gland

Lying in the anterior part of the floor of mouth between the mucous membrane, the mylohyoid muscle and the body of the mandible close to the mental symphysis.

Submandibular gland

Paired salivary glands that lie below the mandible on either side.

Mylohyoid Muscle

Muscle related to the Submandibular gland

The duct of the Submandibular gland

Wharton's duct

Wharton's duct

Runs in the space between the Hyoglossus and Mylohyoid muscles and Drains into the anterior floor of mouth at the sublingual papilla

Swelling at the Sub-Mandibular Gland

Rolling at the lower border of the mandible indicates the problem is in the lymph nodes

Swelling at the Sub-Mandibular Gland

If you can Bidigitally feel in the neck and in the floor of the mouth, it indicates the problem is in the gland

Why Eighty percent of all salivary stones occur in the submandibular?

Secretions are highly viscous (Mucous), with higher pH (Alkaline)

Why Eighty percent of all salivary stones occur in the submandibular?

The Duct (Wharton's) is larger with up hill course (Tortous) and narrow orifice

Why Eighty percent of all salivary stones occur in the submandibular?

The opening of its duct is in the floor of the mouth so, food debris can precipitate in it

Submandibular stones

Eighty per cent of submandibular stones are radio-opaque

Parotid gland

Contained within the investing layer of the deep fascia of the neck, called the parotid fascia which is firm and inelastic (unyielding)

Parotid gland

Separated from the submandibular gland by a fascial thickening, the stylomandibular ligament

Parotid gland

The gland is arbitrarily divided into deep and superficial lobes, separated by the Facial Nerve

Parotid gland

Eighty percent of the parotid gland is superficial and 20% deep to the nerve.

Site of parotid gland

Anterior, Masseter muscle, ramus of the mandible.

Site of parotid gland

Posterior, Mastoid process, sternocleidomastoid muscle.

Site of parotid gland

Superior: External auditory meatus and tempromandibular joint.

Site of parotid gland

Inferior: Sternocleidomastoid muscle and posterior belly of the digastric muscle.

Site of parotid gland

Lateral: Investing layer of the deep cervical fascia and platysma muscle and skin.

Site of parotid gland

Medial: Investing layer of the deep cervical fascia, styloid process, internal jugular vein, internal carotid artery and pharyngeal wall.

Parotid duct

Called Stensen, 5cm

Parotid duct

Arises from the anterior part of the gland

Parotid duct

Runs over the masseters a finger's breadth below the zygomatic arch.

Parotid duct

Pierce the Buccinator muscle and Open opposite the second upper molar tooth.

Parotid swelling

Site: at the angle of the jaw, deeply seated below and infront of the auricle

Parotid swelling

Obliterating the furrow behind the ramus of the mandible

Parotid swelling

Raising the lobule of the ear

Parotid swelling

Bulge on clenching teeth because it is superficial to masseter

Parotid swelling

Made less prominent with opening mouth because it is deep to a capsule

Structures within the Parotid gland

Branches of the facial nerve, the terminal part of the external carotid artery that divides the maxillary artery and the superficial temporal artery, the retromandibular vein, intraparotid lymph nodes

Artery of Parotid gland

The external carotid artery enters the inferior surface of the gland and divides at the level of the neck of the mandible into the maxillary and superficial temporal arteries

Vein of Parotid gland

The superficial temporal vein enters the superior surface of the parotid gland

Nerve of Parotid gland

Emerge from the skull through stylomastoid foramen

How to test Facial Nerve?

Raise eyebrow (occipto frontalis)

How to test Facial Nerve?

Frowning (corrugator specilli)

How to test Facial Nerve?

Close eye (orbicularis occuli)

How to test Facial Nerve?

Blow cheek (buccinator)

How to test Facial Nerve?

Whistle(orbicularis oris)

How to test Facial Nerve?

Show teeth (orbicularis oris)

The parasympathetic innervation of the parotid gland

Originates from the glossopharyngeal nerve, Synapse in otic gangilion, Reach the gland via the auriculotemporal neve, a branch of the mandibular division of the trigeminal cranial nerve.

The sympathetic supply to the parotid

Originates from spinal cord segments TI-T3

Frey's Syndrome

Damage to the autonomic innervation of the salivary gland with inappropriate regeneration of parasympathetic nerve fibres that stimulate the sweat glands of the overlying skin - Clinical Picture: gustatory sweating

Lymphatic drainage of Parotid gland

The preauricular lymph nodes in the superficial fascia and Parotid nodes within the gland

80%

Of all salivary tumors occurs within Parotid gland.

80%

Of parotid tumors are Benign.

80%

Of benign parotid tumors are Pleomorphic adenoma.

80%

Of parotid tissue are superficial.

Pleomorphic Adenoma

Mixed cell tumor: epithelial and stromal elements.

Pleomorphic Adenoma

A pseudo-capsule arising from compression of the surrounding gland tissue.

Treatment of Pleomorphic Adenoma

Parotidectomy - Enucleation of the pleomorphic adenoma is not carried out due to the high recurrence (rate 40% at 25-30 years).

Warthin's tumour (adenolymphoma)

Fourth to seventh decade, with a 7:1 male preponderance

Warthin's tumour (adenolymphoma)

Ten per cent can be bilateral but are often not synchronous and Usually in the tail of the parotid gland

Warthin's tumour (adenolymphoma)

Soft consistency and Known to develop from the Lymphoid Tissue

Treatment of Warthin's tumour (adenolymphoma)

Enucleation is recommended in this tumor

Acinic Cell Carcinoma

It is low grade tumor with very late lymph node and distant metastasis and Prognosis is good in comparison with other types.

Mucoepidermoid Carcinoma

Low grade malignancy type and High grade variant with lymph nodes

Adenoid Cystic Carcinoma (Cylinderoma)

It is aggressive and has tendency to perineural spread even intracranially

Clinical Picture of a Malignant Salivary Tumors

Pain, Rapid rate of growth, Mainly hard in consistency, Facial nerve dysfunction even paralysis, Fixity to the skin (Ulceration), Fixity to deeper structures (Muscles and bones), Cervical lymph node metastasis, Bone and lung metastasis.

Acute Inflammation of Salivary Glands

Viral: Mumps Parotitis

Acute Inflammation of Salivary Glands

Bacterial: Acute Suppurative Parotitis (Parotid Abscess)

Chronic Inflammation of Salivary Glands

Chronic parotitis (Sialectasis): Dilation of ductules of parotid due to fibrosis of its tender, usually bilaterally with attacks of acute exacerbations with high fever and pain.

Mikulicz' syndrome

Enlargement of all salivary glands and lacrimal gland and Auto-Immune Disease.

Sjogren's syndrome

Similar to previous syndrome plus dryness of mouth and eye (Xerstomia and Xerophthalmia) autoimmune condition causing progressive destruction of salivary and lacrimal glands

Sjogren's syndrome

Manifested by xerostomia and keratoconjunctivitis sicca

Primary Sjogren's syndrome

No associated connective tissue disorder.

Secondary Sjogren's syndrome

Associated connective tissue disorder

Ranula

Mucous retention cysts develop in the floor of the mouth either from an obstructed minor salivary gland or from the sublingual salivary gland

Plunging Ranula

If the cyst perforates through the mylohyoid muscle diaphragm to enter the neck and present as lateral cystic neck swelling

Ranula

It is a Mucocele of the sublingual salivary gland, it presents as a large tense Bluish swelling in the floor of the mouth which displaces the tongue

Mucocele

It is a retention cyst which affect either minor salivary gland (Specially in buccal mucosa) Or major glands

Meatal Submandibular stones

The Stone اتكونت عند ال Orifice بتاعت ال Duct

Intra-ductal Submandibular stones

The Stone اتكونت جوا ال Duct فى اى مكان بس مش عند ال orifice

Juxtaglandular Submandibular stones

The Stone اتكونت بين ال Gland وبين ال Duct

Intra-glandular Submandibular stones

The Stone اتكونت جوة ال Gland نفسها

Clinical Picture of Submandibular gland stones

The obstruction caused by the stone together with the superadded infection leads to acute or chronic submandibular sialdenitis

Clinical Picture of Submandibular gland stones

This condition is manifested by pain and swelling of the gland on eating, swelling Or seeing food and It may be associated with fever

Treatment of Meatal Submandibular stone

Only Meatotomy and extraction

Treatment of Intra-ductal Submandibular stone

Open the duct in the floor of the mouth under local anaesthesia (Nerve Block) Or general anaesthesia, extract the stone and do not close the incision.

Treatment of Juxtaglandular Submandibular stone

Do not try to extract the stone intra-orally to avoid injury to lingual nerve which hooks on the duct at this point, So, excision of gland is mandatory

Treatment of Intra-glandular Submandibular stone

Sialadenectomy

Sialadenosis (Sialosis)

Is a non-inflammatory selling affecting the salivary gland usually in association with a variety of conditions including Diabetes, Alcoholism other endocrine diseases, Pregnancy and Bulimia and Commonly Involves Parotid Gland

Siallithiasis

Formation of stones in the salivary glands and commonly involves Submandibular Gland

Sialadenitis

Most commonly affects the parotid salivary glands on the side of the face and means inflammation of the salivary gland

Sialography (Dey

Study is beneficial in diagnosing sialectasis