A.B.

Tonchev
Dept. of Anatomy, histology & embryology

Digestive system

Salivary glands
 The salivary glands are associated with
the mouth
 Three pairs of major salivary glands (parotid,
submandibular and sublingual) and numerous minor
salivary glands (labial, buccal, palatal, lingual) open into
the mouth.
 Secrete saliva (750-1500 mL/day)
 Major glands – 90%
 Minor glands – 10%
 Functions of saliva
 digestive
 lubricating
 protective
 buffering (pH of 6.5–6.9)
The salivary glands
General structure of the major salivary glands

 Collagenous connective tissue

capsule
 Capsule sends septae (strands
of connective tissue) into the
gland, subdividing it into
smaller compartments known
as lobes and lobules
 Vascular elements, nerves, and
ducts utilize the connective
tissue septa to enter and exit
the gland. In addition, the
connective tissue elements
provide structural support for
the gland.
Salivary glands – general structure

 The major salivary glands are

branched tubuloalveolar glands
 Their connective tissue capsule
provides septa that subdivide the
glands into lobes and lobules.
 Individual acini are also invested
by thin connective tissue elements.
 The vascular and neural
components of the glands reach
the secretory units via the
connective tissue framework.
Multicellular exocrine glands - overview
 Salivary glands are exocrine glands
Classification on the basis of the nature of their secretion

 Mucous
 secrete mucinogens - large glycosylated proteins that, upon
hydration, swell to become a thick, viscous, gel-like protective
lubricant known as mucin, a major component of mucus
 examples
 unicellular: goblet cells
 multicellular: minor salivary glands of the tongue and palate
 Serous
 secrete an enzyme-rich watery fluid
 examples – pancreas, parotid salivary
 Mixed – have both mucous and serous components
Serous vs mucous cell
Serous gland with ducts (arrows)
Serous acinar cells at TEM – rich in RER
Mucous gland with a duct (arrow)
Mucous acinar cells at TEM – rich in RER
Mucous cells have large, hydrophilic granules like those of goblet cells
Mixed gland with serous demilunes (SD)
SA – serous acinus
MA – mucous acinus
StD – striated duct

Serous demilunes - a group of cells in

mucous acini that secrete a serous fluid
 Myoepithelial cells
 Stellate or spindle-shaped cells located between the
basal lamina and the basal pole of secretory or duct
cells in several exocrine glands (eg, sweat, lacrimal,
salivary, mammary)
 Possess processes which embrace an acinus as an
octopus – connected via gap junctions and
desmosomes
 Specialized for contraction (contain myosin and a large
number of actin filaments) - contract around the
secretory or conducting portion of the gland and thus
help propel secretory products into the duct
Myoepithelial cells
 Organization of a
large multicellular
gland – a salivary
gland
Epithelial components of a submandibular gland
lobule
 Secretory portion
 serous (light blue) cells - typical
protein-secreting cells, with
rounded nuclei, accumulation of
rough ER in the basal third, and an
apex filled with protein-rich
secretory granules
 mucous (light brown) cells - their
nuclei cells, flattened with
condensed chromatin, are located
near the bases of the cells
 Conductive portion
 intercalated ducts - short, lined
with cuboidal epithelium
 striated ducts - columnar cells with
characteristics of ion-transporting
cells: basal membrane
invaginations with mitochondrial
accumulations
Intercalated vs striated ducts

 Intralobular ducts
 intercalated
↓
 striated
↓
 Interlobular ducts

Parotid gland
Intercalated vs striated ducts
 Specific features of major salivary glands
 Parotid gland - exclusively serous cells surrounding very small
lumens
 contain secretory granules with abundant amylase and proline-rich
proteins. Amylase activity is responsible for most of the hydrolysis of
ingested carbohydrates which begins in the mouth. Proline-rich proteins,
the most abundant factors in parotid saliva, have antimicrobial properties
and Ca2+ binding properties that may help maintain the surface of
enamel.
 Submandibular gland - both mucous (10%) and serous (90%)
cells
 serous demilunes - mucous tubules capped with serous cells
 lateral and basal membrane infoldings of the serous cells increase the ion-
transporting surface area and facilitate electrolyte and water transport
 serous cells secrete other enzymes, including lysozyme, which hydrolyzes
the walls in many types of bacteria.
 Sublingual gland - mucous cells predominate
 serous cells only present in demilunes on mucous tubules
 major salivary product – mucus (cells of the serous demilunes secrete
amylase and lysozyme)
 Parotid vs submandibular gland
intralobular duct
ducts

trabecula
(connective
tissue)

SA
interlobular duct

SA (serous acini)
МА (mucous acini)

Parotid – 30% of saliva Submandibular – 60% of saliva

Submandibular (submaxillary) gland
Sublingual gland

Serous cells

МА
 Parotid gland – clinical correlations

 Benign pleomorphic adenoma, a nonmalignant

salivary gland tumor, usually affects the parotid and the
submandibular glands. Surgical removal of the parotid
gland must be performed with care because of the
presence of the facial nerve plexus within the substance
of the gland.
 The parotid gland (and occasionally other major salivary
glands) is also affected by viral infections, causing
mumps, a painful disease that usually occurs in
children and that may result in sterility when it affects
adults.
 Gross anatomy of the parotid gland

 The parotid gland is the largest salivary gland and is situated in front
of the external ear
 The parotid duct runs through the cheek and drains into the mouth
opposite the maxillary second permanent molar tooth
Parotid gland

 anterior to and below the

lower half of the ear
 superficial, posterior, and
deep to the ramus of the
mandible
 extends down to the
lower border of the
mandible
 extends up to the
zygomatic arch
 Important relationships of the parotid gland

 The facial nerve [VII] forms a plexus in the gland -

surgical removal of the parotid gland is difficult
 External carotid artery (ECA) and its branches
 ECA enters into or passes deep to the inferior border of the
gland → gives off the posterior auricular artery before dividing
into its two terminal branches
 Retromandibular vein - formed in the substance of the
gland when the superficial temporal and maxillary veins
join
 Innervation of the parotid gland

 Sensory - provided by the auriculotemporal nerve,

a branch of the mandibular nerve [V3]
 Parasympathetic postganglionic - originate in the
otic ganglion associated with the mandibular
nerve [V3]
 Preganglionic parasympathetic fibers to the otic
ganglion come from the glossopharyngeal nerve [IX]
 N. glossopharyngeus (IX) → parotid gland

Parasympathetic fibers from gang.oticum

 Submandibular gland is hook-shaped

mylohyoid muscle

mylohyoid muscle

 Superficial part - the hook, below the mylohyoid muscle; outside the
boundaries of the oral cavity; in the submandibular fossa, inferior to the
mylohyoid line
 Deep part - the hook above the mylohyoid muscle; within the floor of
the oral cavity where it is lateral to the hyoglossus muscle of the tongue
 Submandibular duct

 Emerges from the medial side of the deep part of the gland in the
oral cavity and passes forward to open on the summit of a small
sublingual papilla beside the base of frenulum of the tongue
 The lingual nerve loops under the sublingual duct
Lingual nerve (CN V3)

 Passes through the gap

between the mylohyoid,
superior constrictor,
and middle constrictor
muscles
 Loops under the
submandibular duct,
and ascends into the
tongue on the external
and superior surface of
the hyoglossus muscle
 Sublingual glands
 The sublingual glands are the smallest of the
three major paired salivary glands. Each is
almond shaped and is immediately lateral to the
submandibular duct and associated lingual nerve
in the floor of the oral cavity.
 Each sublingual gland lies directly against the
medial surface of the mandible where it forms a
shallow groove (sublingual fossa) superior to the
anterior one-third of the mylohyoid line.
Position of the sublingual gland under the tongue

Removal of the fascia around the

sublingual gland (slg) and the deep part of
the submandibular gland (sm) allows to
visualize the remainder of the structures of
the mouth. sublingual gland (slg)
Muscles:
Styloglossus muscle (sg)
Hyoglossus muscle (hg)
Genioglossus muscle (gg)
Mylohyoid muscle (mh)
Geniohyoid muscle (gh)
Nerves & duct:
Lingual nerve (1)
Submandibular ganglion (2)
Hypoglossal nerve (3) 3 4

C1 nerve to geniohyoid (4) The tip of the tongue has been displaced posteriorly
Submandibular duct (5)

From: Wesley Norman, PhD, DSc,

DSc, 1999
 The lingual artery supplies also
the sublingual gland

Passes deep to the hyoglossus muscle,

and accompanies the muscle through
the aperture formed by the margins of
the mylohyoid, superior constrictor,
and middle constrictor muscles, and
enters the floor of the oral cavity
 Innervation of the salivary glands

 All salivary glands above the level of the oral fissure

(+ all nasal glands & lacrimal gland) are innervated by
parasympathetic fibers carried in the greater petrosal
branch of the facial nerve [CN VII]
 All glands below the level of the oral fissure are
innervated by parasympathetic fibers carried in the
chorda tympani branch of the facial nerve [CN VII]
 Innervation of the salivary glands

All glands above

the level of the
oral fissure –
greater petrosal
nerve (CN VII)

All glands below

the level of the
oral fissure –
chorda tympani
nerve (CN VII)
N. facialis (VII) – SM & SL glands
Submandibular ganglion
Digestive system

Pharynx
 The pharynx
 A musculofascial half-cylinder that
links the oral and nasal cavities in the
head to the larynx and esophagus in
the neck
 The pharyngeal cavity is a common
pathway for air and 'food'.
 Lingual, pharyngeal, and palatine
tonsils are on the deep surface of the
pharyngeal walls.
 The pharynx is separated from the
vertebral column behind by a thin
retropharyngeal space containing
loose connective tissue.
 The pharynx is subdivided into three regions

 The posterior apertures

(choanae) of the nasal
cavities open into the
nasopharynx
 The posterior opening of the
oral cavity (oropharyngeal
isthmus) opens into the
oropharynx
 The superior aperture of the
larynx (laryngeal inlet) opens
into the laryngopharynx
 Skeletal framework of the pharynx

 The superior and anterior margins of the pharyngeal

wall are attached to bone and cartilage, and to ligaments
 The two sides of the pharyngeal wall are welded
together posteriorly in the midline by a vertically
oriented cord-like ligament (the pharyngeal raphe) -
descends from the pharyngeal tubercle on the base of
the skull to the level of C6 vertebra it blends with
connective tissue in the posterior wall of the esophagus
Line of attachment of the pharynx to the
base of the skull


Attachments of the lateral pharyngeal wall

 Pterygomandibular raphe - a
ligament that spans the distance
between the tip of the pterygoid
hamulus and a triangular
roughening immediately
 posterior to the third molar on
the mandible → joins the
 superior constrictor with the
buccinator
 Lower aspect of the stylohyoid

ligament → lesser horn →
greater horn of the hyoid
 Thyroid cartilage → cricoid
cartilage
 Pharyngeal wall

 Pharyngeal muscles

 Pharyngeal fascia
 Pharyngeal muscles
 Constrictor muscles – oriented circularly → narrow the
pharyngeal cavity
 Superior constrictor
 Middle constrictor
 Inferior constrictor
 Longitudinal muscles – oriented longitudinally →
increase the pharyngeal cavity
 Stylopharyngeus
 Salpingopharyngeus
 Palatopharyngeus
 Constrictors of the pharynx

lig.stylohyoideum

 Joined together by the pharyngeal raphe

 Overlap each other
 Constrictors of the pharynx

The palatopharyngeal
sphincter originates from
the anterolateral surface
of the soft palate and
circles the inner aspect of
the pharyngeal wall,
blending with the inner
aspect of the superior
constrictor.
Longitudinal muscles of the pharynx
(named according to their origins)

n.IX n.X

n.X

n.IX
Pharyngeal muscles and their innervation

n.X

n.IX

n.X n.IX

lig.stylohyoideum

n.X
 Pharyngeal fascia
 Layers
 Buccopharyngeal fascia - coats the outside of the
muscular part of the wall
 Pharyngobasilar fascia - lines the inner surface of the
muscular part of the wall
 Function - reinforces the pharyngeal wall →
above the level of the superior constrictor the
pharyngeal wall is formed almost entirely of fascia
Gaps between muscles in the pharyngeal wall

(above the superior constrictor)

 The pharynx is subdivided into three regions

 The posterior apertures

(choanae) of the nasal
cavities open into the
nasopharynx
 The posterior opening of the
oral cavity (oropharyngeal
isthmus) opens into the
oropharynx
 The superior aperture of the
larynx (laryngeal inlet) opens
into the laryngopharynx
 Nasopharynx
 Behind the choanae and above the soft palate
 Continuous below with the cavity of the
oropharynx at the pharyngeal isthmus (formed
by the fold of palatopharyngeal sphincter)
 Roof – pharyngeal tonsil (collection of lymphoid
tissue)  adenoids can occlude the nasopharynx
Prominent features on each lateral wall of
the nasopharynx
 Opening of the pharyngotympanic tube (lateral
to the top of the soft palate)
 Mucosal elevations and folds
 torus tubarius (rim of the tube)
 pharyngeal recess

 salpingopharyngeal fold (salpingopharyngeal muscle)

 torus levatorius (levator veli palatini muscle)

Features of the nasopharynx
 Oropharynx
 Posterior to the oral cavity, inferior to the level
of the soft palate, and superior to the upper
margin of the epiglottis
 Palatoglossal folds mark the boundary between
the oral cavity and the oropharynx
 Palatine tonsils are on the lateral walls of the
oropharynx
 Laryngopharynx (hypopharynx)
 From the superior margin of the
epiglottis to the top of the
esophagus at the level of vertebra
C6
 Vallecula - a mucosal pouch
between the base of the tongue
and epiglottis
 Piriform fossa - mucosal recess
between the central part of the
larynx and the lamina of the
thyroid cartilage  direct solids
and liquids from the oral cavity
around the raised laryngeal inlet
and into the esophagus
 Histology of the pharynx
 Stratified nonkeratinized squamous epithelium
in the region continuous with the esophagus
 Ciliated pseudostratified columnar epithelium
containing goblet cells in the regions close to the
nasal cavity
 Oropharynx
(stratified nonkeratinized squamous epithelium)

Lamina propria

The mucosa of the pharynx has many small mucous

salivary glands (MG); also – skeletal muscle fibers (SM)
 Nasopharynx
(ciliated pseudostratified columnar epithelium)
 Pharyngeal tonsil

 E – epithelium (flat squamous

non-keratinizing)
Ly
 Gc – germinative center
 Ly – lymphocytes infiltrating the
connective tissue (СТ)
 Arrows – lymphocytes, migrating
toward the lumen of the tonsil via
the epithelium
 Vessels of the pharynx
 Arteries - from the external carotid artery
 Upper parts of the pharynx
 the ascending pharyngeal artery
 the ascending palatine and tonsillar branches of the facial
artery;
 numerous branches of the maxillary and the lingual
arteries.
 Lower parts of the pharynx - pharyngeal branches
from the inferior thyroid artery (thyrocervical trunk
of the subclavian artery)
 Palatine tonsil - from the tonsillar branch of the
facial artery, which penetrates the superior
constrictor muscle
Arteries of the pharynx
Veins & lymphatics of the pharynx
 Veins - form a plexus, which
drains superiorly into the
pterygoid plexus in the
infratemporal fossa, and
inferiorly into the facial and
internal jugular veins
 Lymphatics - include
retropharyngeal (between
nasopharynx and vertebral
column), paratracheal, and
infrahyoid nodes
 Palatine tonsil - jugulodigastric
nodes
The pharyngeal plexus

 The pharyngeal branch

of the vagus nerve [X]
 Branches from the
external laryngeal nerve
from the superior
laryngeal branch of the
vagus nerve [X]
 Pharyngeal branches of
the glossopharyngeal
nerve [IX]
Digestive system

Esophagus
 Esophagus
 Muscular tube passing between the pharynx and the
stomach
 Begins at the inferior border of the cricoid cartilage
(level C6) and ends at the cardia of the stomach (level
T11)
 In the newborn – between C4/C5 and T9
 Length - at birth 8-10 cm; 1 year - 12cm, 5 yr - 16cm
 Diameter - varies whether bolus of food/fluid passing
 At rest in adults - 20 mm, can stretch up to 30 mm
 At birth - 5mm; at 5 years - 15mm
The normal constrictions of the esophagus

 At the junction of the

esophagus with the pharynx
 Where the esophagus is
crossed by the arch of aorta
 Where the esophagus is
compressed by the left main
bronchus
 At the esophageal hiatus in
the diaphragm
 Localization of the normal esophageal
constrictions

 At 15 cm from incisor teeth is

crico-pharyngeal sphincter
(normally closed) (UES)
 At 25 cm aortic arch and left
main bronchus
 At 40 cms where it pierces the
diaphragm where a
physiological sphincter is sited
(LES, lower esophageal
sphincter)
 These constrictions are the areas where most
esophageal foreign bodies are entrapped

 The most common site of

oesophageal impaction is at the
thoracic inlet
 Defined as the area between the
clavicles on chest radiograph, this
is the site of anatomical change
from the skeletal muscle to the
smooth muscle of the
oesophagus. The
cricopharyngeus sling at C6 is
also at this level and may "catch"
a foreign body.
 About 70% of blunt foreign
bodies that lodge in the
oesophagus do so at this Source: www.bhj.org/journal/2001_4303_july01/case_442.htm

location.
 Esophagus has functional sphincters

 Upper Oesophageal Sphincter

 a 2-3 mm zone of elevated pressure between
pharynx & oesophagus
 relates to cricopharyngeal muscle

 Lower Oesophageal Sphincter (LES)

 located at the junction between the esophagus and
stomach, usually localized at or just below the
diaphragmatic hiatus
 despite its distinct physiological function, it is not
easily distinguished anatomically
 Relationships of the esophagus to other
structures in the posterior mediastinum

 In the thorax, the

esophagus descends on the
anterior aspect of the
bodies of the vertebrae
 Thoracic duct - posterior to
the esophagus, on right side
inferiorly, on left side
superiorly
 Thoracic aorta - on left side
of esophagus
 Tracheal bifurcation -
anterior to the esophagus
 The arterial supply of the esophagus is derived from
vessels feeding mainly other organs

 Cervical Oesophagus: Right &

Left superior & inferior thyroid
arteries
 Thoracic Oesophagus: Up to
tracheal bifurcation - Right & Left
inferior thyroid Artery; direct
supply from aorta (tracheo-
bronchial tree)
 Abdominal Oesophagus - 11
branches off L gastric artery and
branches of splenic artery
posteriorly

Source: http://www.nature.com/gimo/contents/pt1/fig_tab/gimo6_F2.html
Venous Drainage
 Intra-oesophageal (intrinsic)
drainage
 Longitudinally arranged
in Submucosa
 Distal end – portal
anastamoses
 Extra-oesophageal
(Extrinsic) Drainage into
locally corresponding veins
 Inf. thyroid (into
innominate vein),
 Azygos, hemiazygos
 L gastric & splenic

Source: http://www.nature.com/gimo/contents/pt1/fig_tab/gimo6_F3.html
Porto-caval anastomoses via the esophageal
plexus
 Innervation of the esophagus (CN X)

 Anterior vagal trunk consists of several smaller trunks

whose fibers mostly come from the left vagus nerve-
rotation of the gut during development moves these
trunks to the anterior surface of the esophagus;
 Posterior vagal trunk consists of a single trunk whose
fibers mostly come from the right vagus nerve and
rotational changes during development move this trunk
to the posterior surface of the esophagus.
 Sensory innervation
 Visceral afferents from CN X - information - about normal
physiologic processes and reflex activities (not pain)
 Visceral afferents via the sympathetic trunks and the
splanchnic nerves – information about esophageal pain
Innervation of the esophagus
Hiatal hernia
 Part of the esophagus
into the thorax
General structure of GI tube
Structure at different levels of GIT
 Histology of the esophagus

 Squamous epithelium, circular inner muscle

layer, outer longitudinal muscle layer
 NO SEROSA
 Upper esophagus: striated muscle
 Lower esophagus: smooth muscle
Histological structure of the esophagus
 Esophagus

Lamina
propria

muscularis
mucosae

epithelium

submucosa
Muscularis mucosae
(internal circular layer)

Muscularis mucosae
(external longitudinal layer)

Serosa
 Esophagus

epithelium

mucosa
lamina propria

muscularis mucosae

submucosa
 Esophagus
epithelium
blood vessel
lamina ly vessel
propria

muscularis
mucosae

submucosa

gll. propriae
Gastro-esophageal junction

 The transition between

oesophagus and stomach
is difficult to define
because mucosa of
gastric fundal pattern
extends a variable
distance up into the
abdominal oesophagus
 A valve-like structure is
formed by the angle of
the wall at the cardiac
orifice
 Esophageal Esophagus-stomach
epithelium
transition

Serosa Esophageal glands

Gastric Continue a short distance in

epithelium
the submucosa of the stomach

muscularis of stomach – much

thicker than the muscularis of
the esophagus
Esophageal cancer
The end
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