Oral and maxillofacial surgeon, Surat,Gujarat

1. Anatomy of
Salivary
Glands

2. Embryology
Salivary glands develop as outgrowths of buccal epithelium.
Parotid – ectodermal in origin
Submandibular &
Sublingual – endodermal in origin
Parotid – 4th Wk of gestation
Submandibular – 6th Wk of gestation
Sublingual – 9th Wk of gestation

3. Introduction
Salivary Gland is any cell or organ
discharging a secretion into the oral
cavity.
Major and minor Salivary Glands
Major (Paired)
Parotid
Submandibular
Sublingual
Minor
Those in the Tongue, Palatine
Tonsil, Palate, Lips and
Cheeks

4. •Main function of Salivary
Gland-secretion of saliva
•Daily secretion -800 to
1500 ml
•pH : 6-7

5. Saliva Compositon
Water (99.5%) Solid (0.5%)
Organic Inorganic
Ptyalin
Mucin
Lysozyme
IgA
Lactoferrin
Na+
K+
Ca+
Cl-
HCO3
Mg

6. Functions of Saliva
Keep the mouth moist
Aids in swallowing
Aids in speech
Keeps the mouth and teeth
clean
Antimicrobial action
Digestive function
Bicarbonate acts as buffer

7. Parasympathetic stimulation-
profuse secretion of watery saliva
Sympathetic stimulation-
scanty viscous secretion
Sympathetic supply comes from cervical
sympathetic chain along the blood vessels

8. Salivatory nuclei are excited by
Taste and tactile stimuli from tongue
and other areas of mouth and
pharynx
Stimuli from esophagus and stomach
(due to stimulation of vagal afferent
fibers
(unconditioned reflex)
Stimuli arising from higher centers of
brain due to sight, smell or thought
of food
(conditioned reflex).

9. Largest salivary paired gland
(weighs15gms)
Secretions of which is serous in nature
2 lobes
1)Superficial
2)Deep

10. Site
Angle of Mandible
Sternomastoid
Auricle

11. Head of
Mandible
Middle of
Masseter m.
2 cm below
Angle of
Mandible
Mastoid
Process

12. Surface Anatomy of Parotid Duct
Tragus of
the ear
Midway between
the ala of the nose
and the angle of the
mouth
Middle ⅓ of the
horizontal line

13. RELATIONS

14. 1. Superficial Temporal vessels.
Auriculotemporal nerve.
2. Cartilaginous part of
External Auditory Meatus.
3. Temporal branch of Facial n.
Upper Part

15. 1. Cervical branch of Facial n.
2. Retromandibular vein.
3. Posterior belly of digastric.
4. External Carotid artery.
Lower Part

16. • Zygomatic branch of Facial n.
• Transverse Facial artery.
• Buccal branch of Facial n.
• Accessory Parotid gland.
• Parotid duct.
• Mandibular branch of Facial n.
Anterior Border

17. 1. Great Auricular nerve.
2. Parotid lymph nodes.
3. Skin and Fascia
Lateral Surface

18. 1. Ramus of the mandible.
2. Masseter muscle.
3. Medial pterygoid muscle
Medial Surface-Antero

19. 1. Mastoid process
2. Sternomastoid muscle
3. Posterior belly of Digastric
4. Styloid process and the muscle &
ligaments attached to it.
5. Internal carotid artery & Internal
jugular vein
(carotid sheath).
Medial Surface-Postero

20. 1. External carotid artery
2. Retromandibular vein
3. Facial nerve –enters the gland
posteromedially,and divides into
terminal branches within gland,and
leaves the gland through anteromedial
surface.
Structures within the Gland

21. Capsule
1.False Capsule

22. Capsule
1.False Capsule
2.True Capsule

23. Accesory Part
Semidetached part of the gland,
which lies just above the parotid
duct

24. Parotid Duct
5 cm long &
emerges from
the anterior
border & runs
superficial to
masseter m.

25. •At the anterior border of
masseter it pierces
•Buccal pad of fat
•Buccopharyngeal fascia
•Buccinator Muscle
•It opens into the vestibule of
mouth opposite to the 2nd
upper molar

26. ARTERIAL SUPPLY
External Carotid Artery
Venous Drainage
Retromandibular Vein drain into the internal jugular vein
LYMPHATIC DRAINAGE
Lymph first drains into parotid nodes and then
upper deep cervical nodes

27. Nerve Supply
1. Sensory:
a. Gland:
Auriculotemporal nerve
a. Capsule:
Great Auricular nerve

28. Nerve Supply
2. Sympathetic:
From the sympathetic plexus around the
external carotid.

29. 3. Parasympathetic:
The preganglionic secretomotor fibers
arise from the inferior salivary nucleus in
the medulla oblongata.
Joins the glossopharyngeal nerve (9th
cranial) , tympanic branch ,tympanic
plexus,Lesser Petrosal nerve
Enters the foramen ovale to relay in the
otic ganglion
The post ganglionic fibres pass through
auriculotemporal nerve through which they
reach the gland
Medulla
Oblangata
Inferior
Salivary
Nucleus
Glossopharyngeal n.
Tympanic
Plexus
Lesser
Petrosal n.
Otic
Ganglion
Auriculotemporal n.

31. Frey syndrome
Also called as auriculotemporal nerve syndrome or
gustatory sweating
It is condition wherein sweating in the area of
distribution of ATN occurs,which is caused by a
stimulus to secretion of saliva.
It is thought to be the result damage to ATN post
ganglionic parasympathetic fibres from otic
ganglion become united to sympathetic fibres
arising from superior cervical ganglion going to
supply sweat gland

33. Surgical approches
Pre auricular
Submandibular
Combination of both

34. Submandibular
Gland

35. Site
Anterior part of
Digastric triangle,
It is roughly j-shaped
Mixed secretion but
predominantly serous

36. Parts
1. Superficial part
2. Deep part
3. Submandibular duct
Superficial part
Deep part
Submandibular duct

37. Superficial Part
Wedge shaped, extending:
Posteriorly: to the angle of mandible.
Superiorly: to mylohyoid line of mandible.
Inferiorly: it overlaps the 2 bellies of digastric m

38. Relations
1. Inferolateral surface: related to skin, superficial fascia (containing
platysma, cervical branch of facial n., . facial vein, Lymph Nodes) &
deep fascia.
2. Lateral surface: related
to body of mandible,
facial artery, mylohyoid
nerve & artery
3. Medial surface: related
to 2 muscles (mylohyoid
& hyoglossus) & 2 nerves
(lingual & hypoglossal).

39. Deep Part
Small part lying deep to mylohyoid
Superficial to hyoglossus
Between lingual nerve above & hypoglossal nerve
below
Mylohyoid
Lingual n.

40. Submandibluar duct
Whartons duct
5 cm long
Emerges at the anterior end of deep part
of the gland
Runs forwards on hyoglossus b/w lingual
and hypoglossal N
At the ant. Border of hyoglossus it is
crossed by lingual nerve
Opens in the floor of mouth at the side of
frenulum of tongue

41. Blood Supply
Arteries
Branches of facial and
lingual arteries
Veins
Drains to the common facial
or lingual veins
Lymphatics
Deep Cervical Nodes via
submandibular nodes

42. Nerve Supply
1.Sensory:
Lingual nerve
2.Sympathetic:
Plexus around the facial artery
3.Parasympathetic:
Chorda tympani from Facial nerve

45. Sublingual Salivary Glands
smallest of the three glands
weighs nearly 3-4 gm
Lies beneath the oral mucosa in
contact with the sublingual
fossa on lingual aspect of
mandible.
Mixed secretion but
predominantly mucous

46. Relations
Above the mylohyoid
below the mucosa of
floor of mouth
Medial to sublingual fossa
Lateral to genioglossus

47. Duct
Ducts of Rivinus
8-20 ducts
Largest of all,sub lingual
joins sub(bartholin duct)duct
mandibular duct to drain through
sublingual caruncle,
Most of them open directly into the
floor of mouth

48. Blood supply
Arterial from sublingual and submental arteries
Venous drainage corresponds to the arteries
Nerve Supply
Similar to that of submandibular glands( via lingual nerve ,
chorda tympani and sympathetic fibers)

49. DISORDERS OF SALIVARY
GLAND

50. CLASSIFICATION OF SALIVARY
GLAND DISORDERS
A) Developmental disorders
Aberrancy
Aplasia & Hypoplasia
Hyperplasia
Atresia
Accessory ducts
Diverticuli
Congenital fistula

51. B) Functional disorders
Sialorrhoea
Xerostomia
C) Obstructive disorders
Sialolithiasis
Mucus plug
Stricture & stenosis
Foreign bodies
Extra ductal causes

52. D) Cyst
Mucocele
Ranula
E) Asymptomatic enlargement
Sialosis
Allergic
Associated with malnutrition and
alcoholism

53. F) Infection
Viral
Bacterial
Mycotic
G) Autoimmune disorders
Sjogren’s syndrome
Mikulicz’s disease
Uveoparotid fever
Recurrent non specific parotitis

54. Blue pigmented swelling
Plunging RanulaRanula

55. Non-invasive investigations
Radiographs
Computerized Tomography
Ultrasound scanning
Magnetic resonance imaging
Single Photon emission Computed
Tomography
Invasive Investigations
Biopsy
Fine needle Aspiration cytology
Sialography

56. Thank
You