Major salivary gland by Dr.Hardik Rupareliya

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Oral and maxillofacial surgeon,
Surat,Gujarat

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Major salivary gland by Dr.Hardik Rupareliya

  1. 1. Anatomy of Salivary Glands
  2. 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. 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. 4. •Main function of Salivary Gland-secretion of saliva •Daily secretion -800 to 1500 ml •pH : 6-7
  5. 5. Saliva Compositon Water (99.5%) Solid (0.5%) Organic Inorganic Ptyalin Mucin Lysozyme IgA Lactoferrin Na+ K+ Ca+ Cl- HCO3 Mg
  6. 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. 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. 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. 9. Largest salivary paired gland (weighs15gms) Secretions of which is serous in nature 2 lobes 1)Superficial 2)Deep
  10. 10. Site Angle of Mandible Sternomastoid Auricle
  11. 11. Head of Mandible Middle of Masseter m. 2 cm below Angle of Mandible Mastoid Process
  12. 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. 13. RELATIONS
  14. 14. 1. Superficial Temporal vessels. Auriculotemporal nerve. 2. Cartilaginous part of External Auditory Meatus. 3. Temporal branch of Facial n. Upper Part
  15. 15. 1. Cervical branch of Facial n. 2. Retromandibular vein. 3. Posterior belly of digastric. 4. External Carotid artery. Lower Part
  16. 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. 17. 1. Great Auricular nerve. 2. Parotid lymph nodes. 3. Skin and Fascia Lateral Surface
  18. 18. 1. Ramus of the mandible. 2. Masseter muscle. 3. Medial pterygoid muscle Medial Surface-Antero
  19. 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. 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. 21. Capsule 1.False Capsule
  22. 22. Capsule 1.False Capsule 2.True Capsule
  23. 23. Accesory Part Semidetached part of the gland, which lies just above the parotid duct
  24. 24. Parotid Duct 5 cm long & emerges from the anterior border & runs superficial to masseter m.
  25. 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. 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. 27. Nerve Supply 1. Sensory: a. Gland: Auriculotemporal nerve a. Capsule: Great Auricular nerve
  28. 28. Nerve Supply 2. Sympathetic: From the sympathetic plexus around the external carotid.
  29. 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.
  30. 30. 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
  31. 31. Surgical approches Pre auricular Submandibular Combination of both
  32. 32. Submandibular Gland
  33. 33. Site Anterior part of Digastric triangle, It is roughly j-shaped Mixed secretion but predominantly serous
  34. 34. Parts 1. Superficial part 2. Deep part 3. Submandibular duct Superficial part Deep part Submandibular duct
  35. 35. 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
  36. 36. 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).
  37. 37. Deep Part Small part lying deep to mylohyoid Superficial to hyoglossus Between lingual nerve above & hypoglossal nerve below Mylohyoid Lingual n.
  38. 38. 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
  39. 39. 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
  40. 40. Nerve Supply 1.Sensory: Lingual nerve 2.Sympathetic: Plexus around the facial artery 3.Parasympathetic: Chorda tympani from Facial nerve
  41. 41. 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
  42. 42. Relations Above the mylohyoid below the mucosa of floor of mouth Medial to sublingual fossa Lateral to genioglossus
  43. 43. 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
  44. 44. 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)
  45. 45. DISORDERS OF SALIVARY GLAND
  46. 46. CLASSIFICATION OF SALIVARY GLAND DISORDERS A) Developmental disorders Aberrancy Aplasia & Hypoplasia Hyperplasia Atresia Accessory ducts Diverticuli Congenital fistula
  47. 47. B) Functional disorders Sialorrhoea Xerostomia C) Obstructive disorders Sialolithiasis Mucus plug Stricture & stenosis Foreign bodies Extra ductal causes
  48. 48. D) Cyst Mucocele Ranula E) Asymptomatic enlargement Sialosis Allergic Associated with malnutrition and alcoholism
  49. 49. F) Infection Viral Bacterial Mycotic G) Autoimmune disorders Sjogren’s syndrome Mikulicz’s disease Uveoparotid fever Recurrent non specific parotitis
  50. 50. Blue pigmented swelling Plunging RanulaRanula
  51. 51. Non-invasive investigations Radiographs Computerized Tomography Ultrasound scanning Magnetic resonance imaging Single Photon emission Computed Tomography Invasive Investigations Biopsy Fine needle Aspiration cytology Sialography
  52. 52. Thank You

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