The salivary glands

Dr. Paiman Jamal

 The salivary glands
• are exocrine glands
• positioned in the head, in and around the oral
cavity and secrete their salivary contents into the
mouth.
• function
• 1. help keeping the oral mucosa protected and
lubricated.
• 2. help in the initial stages of digestion during
mastication of food, so that a food bolus is created
and ready to be swallowed for further processing.
The salivary glands
• The salivary glands are divided into the major and minor salivary
glands.

• The major glands are much larger in size and are a collection of
exocrine tissue that secretes as a whole into a salivary duct rather
than acting individually and therefore end up producing a much larger
amount of saliva per day than the minor glands.
• The main role of the minor glands is to lubricate the walls of the oral
cavity, while digestive and protective saliva is produced by the major
glands.
 Major glands:

Parotid gland

• The parotid gland is the largest of the

major salivary glands
• sits bilaterally in between the ramus of
the mandible and the sternocleidomastoid
muscle.
• Saliva is released through Stensen’s duct
(parotid duct) whose orifice can be seen
on the buccal wall at the level of the
maxillary second molar.
Parotid gland

• situated in the preauricular area

• Each gland is irregular,
• Anatomically, it can be divided into deep
and superficial lobes, which are separated
by the facial nerve.
• It lies within a deep hollow, known as the
parotid region.
 Parotid gland
• Borders:

• Superiorly – Zygomatic arch.

• Inferiorly – Inferior border of the mandible.
• Anteriorly – Masseter muscle.
• Posteriorly – External ear and sternocleidomastoid.
• The superior surface of the gland is covered by the
investing layer of the deep cervical fascia, posterior
fibers of the platysma, neighboring lymphatic tracts,
fibers of the great auricular nerve and skin.
• The deep surface of the gland is related to the
buccinator muscle.
• The secretions of the parotid gland are
transported to the oral cavity by the
Stensen duct.
• arises from the anterior surface of the
gland, traversing the masseter muscle.
• The duct then pierces the buccinator,
moving medially.
• It opens out into the oral cavity near
the second upper molar.
Anatomical Relationships

• The facial nerve (cranial nerve VII),

gives rise to five terminal branches
within the parotid gland. These
branches innervate the muscles of
facial expression.
• The part of the gland that is medial
to facial n. is the deep lobe, while
the part that is lateral to the nerve is
the superficial lobe.
 Anatomical Relationships
• The external carotid artery ascends
through the parotid gland. Within the
gland,
• gives rise to the posterior auricular artery,
then divides into its two terminal
branches – the maxillary artery and
superficial temporal artery.
• The retromandibular vein is formed
within the parotid gland by the
convergence of the superficial temporal
and maxillary veins. It is one of the major
structures responsible for venous
drainage of the face.
Parotid gland
• Occasionally, there is an isolated accessory parotid gland.
• It, along with the transverse facial artery, rests on the superior border
of the parotid duct.
• The accessory duct is also superiorly related to the mandibular branch
of the trigeminal nerve (CN V3). The buccal branch of the facial nerve
(CN VII) also travels with the parotid duct as it goes to innervate the
buccinator muscle.

• The accessory duct gives off about 5 to 6 ductules that join the main
parotid duct.
Parotid gland
• Vasculature
• Blood is supplied by the posterior
auricular and superficial temporal
arteries. They are both branches of the
external carotid artery, which arise within
the parotid gland itself.
• Venous drainage is achieved via
the retromandibular vein. It is formed by
union of the superficial temporal and
maxillary veins.
• Lymphatic fluid drains to the superior
deep cervical lymph nodes.
Parotid gland
• Is innervated by parasympathetic
(secretomotor) fibers of the glossopharyngeal
nerve by way of the lesser petrosal nerve, otic
ganglion, and auriculotemporal nerve.
• The postganglionic secretomotor fibers that
emerge from the otic ganglion reach the parotid
gland via the auriculotemporal nerve (a branch
of the mandibular division of the trigeminal
nerve [CN V3]).
• The sympathetic supply is derived from the
sympathetic plexus of the carotid sheath. The
auriculotemporal nerve is also responsible for
carrying general visceral afferent (sensory)
stimuli from the gland as well.
• Disorders of the parotid gland

• Calculi or stones (Sialoliths)

• Parotid Gland Tumours
• Parotitis
• Parotitis
• inflammation of the parotid gland, usually as a result of an
infection. The parotid gland is enclosed in a tough fibrous
capsule. This limits swelling of the gland, producing pain.

• The pain produced can be referred to the external ear. This is

because the auriculotemporal nerve provides sensory
innervation to the parotid gland and the external ear.
•
• Parotid gland surgery
• Concerning that it is related to several important anatomical
structures, the parotid gland has a special place in the world of
surgery.
• The main goal in the surgical procedures that involve the parotid
gland is to avoid injuring of the facial nerve, external carotid artery,
auriculotemporal nerve and retromandibular vein.
• These structures can be easily remembered by using the mnemonic
FEAR (Facial nerve, External carotid artery, Auriculotemporal nerve,
Retromandibular vein).
Submandibular gland
• It is situated inferior and deep to the ramus of the mandible in the
submandibular triangle of the neck and makes up part of the floor of
the oral cavity.
• Anatomical Position
• The submandibular gland is located
within the anterior part of the
submandibular triangle. The boundaries
of this triangle are:

• Superiorly: Inferior body of the mandible.

• Anteriorly: Anterior belly of the digastric
muscle.
• Posteriorly: Posterior belly of the
digastric muscle.
 Submandibular gland
• Borders
• The mylohyoid muscle runs through the lobules
of the gland and sections it off into superficial
and deep parts.
• The superficial portion can be seen in the
submandibular triangle of the neck and is
covered by the investing layer of deep cervical
fascia.

• The deep portion is that which limits the inferior

aspect of the oral cavity. It lies between the
hyoglossus muscle and the mandible, ends at
the posterior border of the sublingual gland.
Submandibular gland
• It’s duct, is known as Wharton’s duct and opens at the lingual papilla,
which can be found on either side of the lingual frenulum.
• Relationship with Nerves

• Both the submandibular gland and duct share an intimate anatomical

relationship with three principal nerves; the lingual nerve, hypoglossal
nerve and facial nerve (marginal mandibular branch). The courses of these
nerves are briefly outlined:

• Lingual nerve:
• Beginning lateral to the submandibular duct
• the nerve courses anteromedially by looping beneath the duct and then
terminating as several medial branches. The terminal branches ascend on
the external and superior surface of hyoglossus to provide general
somatic afferent innervation to the mucus membrane of the anterior two-
thirds of the tongue.
• Relationship with Nerves

• Hypoglossal nerve:
• Lies deep to the submandibular gland and
runs superficial to hyoglossus and deep to
digastric muscle.
• Facial nerve (marginal mandibular branch):
• Exits the anterior-inferior portion of the
parotid gland at the angle of the jaw and
traverses the margin of the mandible in the
plane between platysma and the investing
layer of deep cervical fascia curving down
inferior to the submandibular gland.
Submandibular gland
• Blood supply
• The facial and lingual arteries contribute to
the blood supply of the submandibular gland
and in turn their venous drainage is provided
by the corresponding veins.
• Innervation
• presynaptic fibers from the facial nerve (CN VII) via
the chorda tympani to the submandibular ganglion
and postsynaptic fibers from cells in the
submandibular ganglion that together make up the
parasympathetic secretomotor fibers.
• The vasoconstrictive sympathetic fibers from the
superior cervical ganglion.
Sublingual gland

• is the smallest of the major salivary glands

• is unique in the fact that it has several ductal openings that run along
the sublingual folds.
Sublingual gland
• The major glands are entire masses of secretory tissue with a single
duct that connects the exocrine glands with the oral cavity, while the
minor glands are individual exocrine glands that secrete directly into
the oral cavity via their own individual ducts.
• This is where the sublingual glands, although classed as major glands,
fall into both categories. They are collectives exocrine tissue masses,
but they have many ducts that open in the area in which they are
situated.
Sublingual gland
• Borders
• The sublingual glands lie bilaterally in the floor of the mouth
• The glands form a shallow groove on the medial surface of the
mandible known as the sublingual fossa.
• The submandibular duct and lingual nerve pass alongside the medial
aspect of the sublingual gland.
• situated underneath the tongue, bordered laterally by the mandible
and medially by genioglossus muscle of the tongue
• Numerous ducts can be seen secreting saliva along the margin of the
sublingual folds.
• Innervation
• The sublingual glands receive autonomic innervation through
parasympathetic and sympathetic fibres, which directly and indirectly
regulate salivary secretions respectively. Their innervation is the same as that
of the submandibular glands.

• Parasympathetic
• Parasympathetic innervation originates from the superior salivatory nucleus
through pre-synaptic fibres via the chorda tympani branch of the facial nerve
(CNVII). The chorda tympani then unifies with the lingual branch of the
mandibular nerve (CNViii) before synapsing at the submandibular ganglion
and suspending it by two nerve filaments.

• Post-ganglionic innervation consists of secretomotor fibres which directly

induce the gland to produce secretions, and vasodilator fibres which
accompany arteries to increase blood supply to the gland. Increased
parasympathetic drive promotes saliva secretion.
Sympathetic
Sympathetic innervation originates from the superior
cervical ganglion, where post-synaptic vasoconstrictive
fibres travel as a plexus on the internal and external
carotid arteries, facial artery and finally the sublingual
and submental arteries to enter each gland.

Increased sympathetic drive reduces glandular blood

flow through vasoconstriction and decreases the
volume of salivary secretions.
• Blood supply is via the sublingual and
submental arteries which arise from the
lingual and facial arteries respectively; both
of the external carotid artery.

• Venous drainage is through the sublingual

and submental veins which drain into the
lingual and facial veins respectively; both
then draining into the internal jugular vein.
• Clinical aspects
• There are several pathological disorders that can occur in both the
minor and the major salivary glands. Since the sublingual glands have
traits from both categories, they are most likely to be affected by a
bacterial or viral infection. This can cause pain and a hard swelling in
the gland that is infected.
The minor salivary glands
• They can be found in patches around the
oral cavity such as the cheek, the labia,
the lingual mucosa, the soft palate, the
lateral parts of the hard palate, the floor
of the mouth and between the muscle
fibers of the tongue.
• Clinical aspects
• Salivary gland cysts can develop due to injuries, tumours, infections or
salivary stones that can block the flow of saliva. Since it cannot
escape into the ducts it remains within the tissues which start to swell
as the saliva builds up.