SALIVARY GLANDS

ANATOMY & APPLIED

ASPECTS

Joel Dsilva
Department of Oral & Maxillofacial Surgery
The salivary glands are exocrine glands, glands with
INTRODUCTION
ducts, that produce saliva and pour their secretion in
the oral cavity
Major (Paired)
Parotid
Submandibular
Sublingual
Minor
Those in the Tongue, Palatine Tonsil,
Palate, Lips and Cheeks
DEVELOPMENT
STAGES OF
DEVELOPMENT
STAGE 1
Bud formation:
Introduction of the oral epithelium by
underlying mesenchyme
STAGE 2
Formation and growth of epithelial cord
STAGE 3
Initiation of branching in terminal parts of
epithelial cord and continuation of glandular
differentiation
STAGE 4
Dichromatous branching of epithelial cord and
lobule formation
STAGE 5
Canalization of presumptive ducts
STAGE 6
Cytodifferentiation
UNDERSTANDING THE HISTOLOGY
PAROTID GLAND

Largest
Average Wt - 25gm
Irregular lobulated mass lying mainly below the
external acoustic meatus between mandible and
sternomastoid.
On the surface of the masseter, small detached
part lies b/w zygomatic arch and parotid duct-
accessory parotid gland or socia parotidis
Parotid Capsule
Derived from investing layer of deep cervical
fascia.

Superficial lamina-thick, closely adherent-sends

fibrous septa into the gland.

Deep lamina-thin- attached to styloid process,

mandible and tympanic plate.

Stylomandibular ligament.
 External Features

Resembles an inverted 3 sided

pyramid

Four surfaces
Superior(Base of the Pyramid)
Superficial
Anteromedial
Posteromedial
 Separated by three borders
Anterior
Posterior
Medial
Relations
Superior Surface
Concave
Related to
Cartilaginous part of ext acoustic
meatus
Post. Aspect of
temperomandibular joint
Auriculotemporal Nerve
Sup. Temporal vessels
 Apex
Overlaps posterior belly of digastric and
adjoining part of carotid triangle
Superficial Surface
Covered by
Skin
Superficial fascia containing facial
branches of great auricular N
Superficial parotid lymph nodes and
post fibers of platysma
 Anteromedial Surface
Grooved by posterior border of ramus
of mandible

Related to
Masseter
Lateral Surface of
temperomandibular joint
Medial pterygoid muscles
Emerging branches of Facial N
 Posteromedial Surface

Related
to mastoid process with sternomastoid and
posterior belly of digastric.

Styloid process with structures attached to it.

External Carotid A. which enters the gland

through the surface

Internal Carotid A. which lies deep to styloid

process
BORDERS
 Anterior border

Separates superficial surface from

anteromedial surface.

Structures which emerge at this

border

Parotid Duct
Terminal Branches of facial
nerve
Transverse facial vessels
 Posterior Border

Separates superficial surface from

posteromedial surface
Overlaps sternomastoid
 Medial Border

Separates anteromedial surface from

posteromedial surface
Related to lateral wall of pharynx
Structures within the
parotid gland
ARTERIES
VEINS
NERVES
 Facial Nerve trunk lies approximately 1
cm inferior and 1 cm medial to tragal
cartilage pointer of external acoustic
meatus.
Parotid Duct
ductus parotideus; Stensens duct

5 cm in length

Appears in the anterior border

of the gland

Runs anteriorly and downwards

on the masseter b/w the upper
and lower buccal branches of
facial N.
 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
Surface anatomy of Parotid Duct

Corresponds to middle third of a line drawn from

lower border of tragus to a point midway b/w nasal
ala and upperlabial margin
 Blood supply
Arterial
Branches of Ext.
Carotid A
Venous
Into Ext. Jugular Vein

Lymphatic Drainage
Upper Deep cervical nodes
via Parotid nodes
NERVE SUPPLY
 Parasymapthetic N
Secretomotor via
auriculotemporal N

Symapathetic N
Vasomotor
Delivered from plexus around
the external carotid artery
Sensory N
Reach through the Great
auricular and auriculotemporal N
Applied aspects
Parotid swellings are very painful due to the
underlying nature of the parotid fascia.
Mumps is infection of salivary gland caused by
paromyxovirus which will cause severe pain
 Incision
Lazy S incision
Pre-auricularmastoid-cervical incision
 During surgical removal of parotid gland for
any tumour the facial nerve is preserved by
removing the glands in two parts superficial
and deep lobe separately.
 Superficial parotidectomy
Hypotensive anaesthesia
Head up position
Infiltration with 1:80,000 LA with adrenaline
Long term paralytic agents should be avoided for
C VII monitoring whenever indicated
Facial Nerve injury
 A parotid abscess may be caused by the spread
of infection from the oral cavity.
An infection may also spread due to the parotid
lymph node draining an infected area
 Parotid abscess is best drained by horizontal
incision according to Hiltons method of incision
and drainage.

Vertical incision on skin but transverse incision

on the parotid fascia to safeguard facial nerve
and branches
 Frey's syndrome
 The lobule of the ear is often pushed up in
parotid swelling
For tumours of the parotid gland incision biopsy
is not indicated as it will cause the seeding of
the tumour
Inflamatory diseases of parotid
Neoplasms of the salivary gland
75% occur in the parotid glands.
In parotid glands, 80% of tumors are benign.
Of these 80% are Pleomorphic adenomas.
15% of salivary tumors occur in submandibular
glands.
Of these 50% are benign and 50% and malignant.
In carcinomas mucoepidermoid ca> adenoid
cystic ca > adenocarcinoma
 10% of salivary tumors occur in sublingual
and minor salivary glands
60-70% of these are malignant
Classification
 Epithilial tumors
Benign
Pleomorphic adenoma (Mixed tumor)
Oxyphil adenoma
Papillary cystadenoma lymphomatosum (Warthins
tumor)
Basal cell adenoma
 Epithelial tumors
Malignant
Mucoepidermoid carcinoma
Adenoid cystic carcinoma
Acinic cell ca
Papillary adenocarcinoma
SCC
Undifferentiated ca
Ca arising in pleomorphic adenoma
 Connective tissue tumors
Benign
Hemangioma
Lipoma
Neurilemmoma
Fibroma
Malignant
Malignant lymphoma
Above mentioned benign tumors may turn malignant.
submandibular
salivary gland
Submandibular Glands are.
Irregular in shape

Large superficial and small deeper part

continous with each other around the post.
Border of mylohyoid
Superficial Part
Situated in the digastric triangle
Wedged b/w body of mandible and
mylohyoid
3 surfaces
Inferior, Medial, Lateral
Capsule
Derived from deep cervical fascia

Superficial Layer is attached to base of mandible

Deep layer attached to mylohyoid line of mandible

Relations
Inferior- covered by
Skin
Superficial fascia containing platysma and
cervical branches of facial N
Deep Fascia
Facial Vein
Submandibular Nodes
 Lateral surface
Related to submandibluar fossa on the
mandible
Madibular attachment of Medial
pterygoid
Facial Artery
 Medial surface

Anterior part is related to myelohyoid

muscle, nerve and vessels

Middle part - Hyoglossus, styloglossus,

lingual nerve, submandibular ganglion,
hypoglossal nerve and deep lingual vein.

Posterior Part - Styloglossus, stylohyoid

ligament,9th nerve and wall of pharynx
 Deep part
Small in size

Lies deep to mylohyoid and superficial to

hyoglossus and styloglossus

Posteriorly continuous with superficial

part around the posterior border of
mylohyoid
Submandibular 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
Blood supply and lymphatics
 Arteries
Branches of facial and lingual arteries
Veins
Drains to the corresponding veins

Lymphatics
Deep Cervical Nodes via submandibular nodes
Nerve supply
Parasymapthetic fibers from chorda tympani

Sensory fibers from lingual branch of

mandibular nerve

Sympathetic fibers from plexus on facial A

Applied aspects
The formation of calculus is more common in
the submandibular gland than in the parotid.
For excision of the submandibular salivary
gland( for calculus or tumour), a skin crease
incision is as a rule, given more than 1inch(
2.5cm) below the angle of the jaw
A stone in the submandibular duct(whartons
duct) can be palpated bimanually in the floor
of the mouth and can even be seen if
sufficiently large.
Tumors of submandibular glands
Tumors in this gland are uncommon
Enlargement is more due to calculus
Of all tumors, mixed tumor is most common
Swelling is hard but not stony hard and should be
differentiated from submandibular lymph node
Submandibular gland excision
Indications :
Chronic sialoadenitis
Stone in submandbular gland
Submandibular gland tumors
Incision
Placed 2-4 cm below the mandible, parallel to it
Preserve :
Marginal mandibular nerve
Lingual nerve
Hypoglossal nerve
Complications
Hemorrhage
Infection
Injury to mandibular nerve, lingual nerve ,
hypoglossal nerve
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.
Relations
Above
Mucosa of oral floor, raised as sublingual fold
Below
Myelohyoid Infront
Anterior end of its fellow
Behind
Deep part of Submandibular gland
 Lateral
Mandible above the anterior part of
mylohyoid line
Medial
Genioglossus and separated from it
by lingual nerve and submandibular
duct
Duct
Ducts of Rivinus
8-20 ducts
Most of them open directly into the floor
of mouth
Few of them join the submandibular duct
 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)
 Sublingual and minor salivary
gland diseases
Mucous cyst (retention cyst) : Ranula, sailoliths
Inflammatory salivary gland diseases
Tumors as described before but it rarely effects
sublingual glands
 Applied aspects
The structures at risk during dissection of the
gland are the submandibular duct and the
lingual nerve.
The duct lies superficially in the floor of the
mouth medial to the sublingual fold, and is
crossed inferiorly by the nerve which then
enters the tongue
The sublingual artery and vein also lie on the
medial aspect of the gland close to the
submandibular duct and lingual nerve.
Incision

Ann R Coll Surg Engl 1994; 76: 108-109

REFERENCES
Anatomy by B.D.Chaurasia
Oral anatomy- by Sicher and DuBruls
Grays anatomy
Oral and maxillofacial surgery-by Nilima Malik
Oral and maxillofacial surgery- Kruger
Ann R Coll Surg Engl 1994; 76: 108-109