Salivary glands- Dr. Barkha.S.Tiwari. PG student. Dept of Public Health Dentistry

1
Good morning
22/08/2016Salivary glands - Dr.Barkha.S.Tiwari

2
SALIVARY GLANDS

 INTRODUCTION
 CLASSIFICATION
 BRIEF HISTOLOGY
 DEVELOPMENT
 ANATOMY


22/08/2016
Salivary glands - Dr.Barkha.S.Tiwari 3

MAJOR SALIVARY GLANDS
PAROTID GLAND
 SUBMANDIBULAR GLAND
 SUBLINGUAL GLAND
 MINOR SALIVARY GLANDS
 EXAMINATION OF SALIVARY GLANDS
22/08/2016Salivary glands - Dr.Barkha.S.Tiwari 4

 CLASSIFICATION OF SALIVARY GLAND DISORDERS
 DENTAL IMPLICATIONS
 SUMMARY
 CONCLUSION
 REFERENCES.

• One in which the secretory
cells maintain their integrity
throughout the secretory
cycle
• One whose discharged
secretion contains part of the
secretory cells
• One whose discharged
secretion contains the entire
secreting cells

Compoundtubuloacinar
merocrine exocrine glands which
secretes saliva
SALIVARY
GLANDS

 Stimulation of the continous flow of saliva clears the mouth
from bacteria and food particles.
 Buffering ions, particularly bicarbonate, aid in acid
neutralization, thus protecting enamel against
demineralization.

 Lubricating properties saliva reduces friction and diminishes
mechanical wear
 Digestive functions of saliva include the moistening of food,
formation of food bolus which thus facilitates swallowing and
assist taste perception.
 Salivary enzymes, amylase and lipase initiates digestion of food
by breaking down starch into soluble maltose and dextrin.

22/08/2016 Salivary glands - Dr.Barkha.S.Tiwari 12
Submandibular
gland

Serous
• Parotid Gland
• Von Ebner’s
Glands
Mucous
• Labial Glands
• Palatine
Glands
• Glossopalatine
Glands
Mixed
• Submandibular
gland
• Sublingual gland
• Anterior lingual
and Buccal minor
glands

SECRETORY UNIT
1.Serous cells
2.Mucous cells
3.Myoepithelial cells
TRANSPORT UNIT
1.Intercalated duct
2.Straited duct
3.Excretory duct

Grapes - Secretory Acini
Stalk – Ductal System
Structure of salivary gland

ARCHITECTURE OF SALIVARY GLANDS
SOURCE: ORAL ANATOMY, HISTOLOGY & EMBRYOLOGY B.K.B BERKOVITZ IV EDITION

SALIVARY GLAND PARENCHYMA
 Composed of secretory end piece. The shape of this end
piece may be tubular, acinar or tubuloacinar. The
secretory end piece may be serous or mucous.
 Intercalated, striated
and excretory ducts.
 Myoepithelial cells.
SOURCE: ORAL ANATOMY, HISTOLOGY & EMBRYOLOGY B.K.B BERKOVITZ IV EDITION

Serous Acini Mucous Acini
Forms thin watery secretion
containing salivary
amylase.
Forms viscous secretion
containing mucin

Serous Mucous
Acinar shape Spherical Tubular
Cell-
Shape Pyramidal Tubular
Nucleus Spherical basally placed Flattened basally placed
Secretory granules Apically placed and stain
darkly in routine histological
preparations
They appear unstained in
routine histological
preparations
Intercellular canaliculi Present Absent but seen in the
cells with serous
demilunes.
Cytoplasmic organelles Golgi compex, Mitochondria,
lysosomes, peroxisomes, RER
Golgi complex,
Mitochondria, lysosomes,
peroxisomes, RER
Intercellular junctions Present Present
Appearance in H&E Darkly stained Stain lightly, empty
looking cells. Periodic acid
Schiff, alcian blue.

 The most prominent feature of mucous cell is the
accumulation of mucus in the apical cytoplasm which
compresses the nucleus and endoplasmic reticulum against the
basal cell membrane.

Demilunes
Mucous cells are covered by group
of serous cells

Stellate or spider like cells which are present
between the basement membrane and the ductal
cells

-Usually one myoepithelial
cell per secretory end
piece
-Found between
basement membrane and
basal plasma membrane
Contain cytokeratin
intermediate filaments
and actin filaments
Similar to smooth muscle
cells
Also called basket cells.
Closely related to
secretory and intercalated
duct cells.
Stellate or spider like cells
with flattened nucleus,
scanty perinuclear
cytoplasm and long
branching processes

Proteins that have tumour
suppressor activity
,antiangiogenesis factors,
which act as barriers against
invasive epithelial neoplasms.
Contribute to
secretory pressure in
acini or duct
Support the secretory cells
preventing over distention
as secretory products
accumulate in cytoplasm.
Accelerate the initial
outflow of saliva
from the acini
Contracts and widens
the diameter of the
lumen
FUNCTIONS OF MYOEPITHELIAL CELLS

Ductal System
Intercalated
duct
Striated
Duct
Excertory
duct
i
Salivary
acini
Oral Cavity

Intercellular canaliculi
Secretory end piece
Intercalated duct
Striated duct
Excretory duct
Main excretory duct

 Consist of hollow tubes connected to the acinus and with the
other ducts.
 Intercalated ducts - Smallest ducts
 Striated ducts - larger ducts
 Both of which are intralobular
 Main excretory duct – largest duct –interlobular
 The ducts do not act as a simple conduit but modify the saliva
through secretory and resorptive process
DUCT SYSTEM

Single layer of low cuboidal cells
contribute macromolecule(lysozyme & lactoferrin) to saliva .
It also houses undifferentiated cells which can undergo differentiation to
replace the damaged or dying cells in the striated ducts.
Parotid Gland-numerous & long
Submandibular Gland-less numerous than parotid
Sublingual Gland-short & less
INTERCALATED DUCTS

STRIATED DUCTS• Largest portion of duct system
• Receives primary saliva from intercalated
duct
• Lined by tall columnar cells with centrally
placed spherical nucleus
• Forms secretary glycoproteins
Characteristic feature
-basal infolding & in bw these folds,
numerous mitochondria present indicating the
cell is actively involved in active transport

FUNCTIONS OF STRAITED DUCT
Secrete kallikrein
and epidermal
growth factor.
Site of electrolyte
reabsoption,mainly
sodium and
chloride &
secretion of
potassium and
bicarbonate
Modify the
organic content
of the primary
saliva
Conversion of
luminal fluid
from hypertonic
to hypotonic in
nature.

-Epithelium is pseudostratified
But becomes stratified near
the oral opening.
 Dendritic cells or antigen
presenting cells are seen,
 They are involved in immune
surveillance.

 Located in the connective tissue septa between the lobes i.e.
interlobular location.
 Larger in diameter than striated duct.
 As the size of the duct increases the number of mitochondria
and extent of infolding of the basolateral surface decrease.
 Tuft cell are present they have stiff microvilli and are thought
to be receptor cells.

 The two layers of excretory duct – mucosa and
connective tissue have collagen and elastin fibres on
the external surface which allows passive stretching of
the duct to allow and accommodate varying volumes of
saliva.
SOURCE: TEN CATE’S ORAL HISTOLOGY DEVELOPMENT, STRUCTURE AND
FUNCTION VII EDITION

Mechanism of salivary
secretion
Secretary cells and intercalated
ducts produce primary salivary
secretion-Isotonic
Striated and excretory duct they
modify primary saliva. The final
saliva secretion -Hypotonic

CONTROL OF SALIVARY SECRETIONS
 Salivary flow controlled by activity of autonomic nervous
system .If the innervations are interrupted then the gland
atrophies.
 Salivary glands receive efferent nerve fibers from both
parasympathetic & sympathetic system
 Secretomotor fibers interact with adrenergic & cholinergic
receptors

 Ground substance- proteoglycans & glycoproteins
 Cells – fibroblasts, macrophages, mast cells, occasional
leukocytes, fat cells, & plasma cells.

1. All salivary glands follow a similar development pattern.
2. Functional glandular tissues (parenchyma) develops as
epithelial outgrowth of buccal epithelium that invades the
underlying mesenchyme.
3. Connective tissue stroma (capsule and septa) and blood
vessels form from the mesenchyme.

1. Parotid glands originate near corners of
stomatodeum -6th week of prenatal life.
2. Submandibular glands arise from floor of
mouth at the end of 6th week or beginning
of 7th week.
3. The subligual glands form lateral to
submandibular primordia ,about 8th week .
All minor salivary glands form, from epithelium but develop only
after 12th prenatal week.
BUD FORMATION AND GLAND ORIGIN

6 STAGES OF DEVELOPMENT
Stage I :- Formation of bud :
Induction of oral epithelium by
underlying mesenchyme.
Thickening and formation of the
epithelial bud.

Stage II :-Formation and
growth of epithelial cord.
Condensation and proliferation
occur in surrounding mesenchyme .

Stage III :- Initiation of
branching in the terminal part
of the epithelial cord and
continuation of glandular
differentiation.
Growth in length of terminal cord ,
differentiation of berry like
terminal bulb.

Stage IV :- Repetitive
branching of the epithelial
cord and lobule formation.

Stage V :- Canalization of
presumptive ducts.
Formation of hollow tube or duct
occurs by 6th month in all major
salivary glands.

Stage VI :- Cytodifferentiation
Final stage.
Mitotic activity shifted to terminal
bulb from epithelial cord.

- Acinar development differs for serous and mucous cells
therefore, all three major glands show variation in
cytodifferentiation.
- Secretogogue stimulus –secretion coupling mechanisms and
innervation of the gland continue to mature after
cytodifferntiation.

ANATOMY
PAROTID GLAND – para-around, otic- ear

Medial border
Posterior
border
Anterior
border
Apex
Irrregular
Lobulated
Yellowish
mass
Largest
salivary
gland

TMJ
External acoustic meatus
Superficial temporal
vessels
Auriculotemporal nerve
Superior surface - upper end of gland

Also known as ‘Stenson’s Duct’
Thick walled and about 5 cm. long.
Emerge from middle of anterior border.
Runs forward and downward on masseter

 At anterior border of masseter turns medially and pierces:- 3 ‘B’s.
 Finally it opens into vestibule of the mouth opposite the crown of the
upper second molar tooth.
22/08/2016 Salivary glands - Dr.Barkha.S.Tiwari 55
Buccal pad of fat
Buccopharyngeal
fascia
Buccinator

Stensen’s Duct - opens into oral cavity on buccal mucosa
opposite the maxillary second molar

STRUTURES WITHIN THE PAROTID GLAND

BLOOD SUPPLY OF PAROTID GLAND

NERVE SUPPLY
Facial nerve and its terminal branches

Parasympathetic ANS Sympathetic ANS
Stimulation arises from superior and
inferior salivatory nuclei of pons and
medulla
Neurotransmitter – acetylcholine,
activate the acinar cells and dilate the
blood vessels of salivary gland
Profuse and watery saliva is secreted
with less organic components
Nerve fibres to salivary glands arise from
the lateral horns of first and second
thoracic segments of spinal cord
Neurotransmitter – norepinephrine
Thick and viscous saliva is secreted
with mucoproteins
SALIVARY GLANDS

Parasympathetic
nerve supply of
parotid
Inferior salivatory
nucleus
Tymp br of
glossopharyngeal
Otic ganglion
Auriculotempora
l branch
Parotid gland
Parasympathetic
nerve supply of
submandibular
superior salivatory
nucleus
Nervous
intermedius
Geniculate
ganglion
Chorda tympani
Lingual branch
Submaxillary
ganglion
sublingual
gland
Sub mand
gland

Preganglionic
fibres
Glossopharyngeal
nerve
Tympanic branch, the typanic
plexus and the lesser petrosal
nerve
Otic ganglion
Postganglionic
fibres
Auricolutemporal
nerve
Parotid gland

Sympathetic
nerves
vasomotor
Derived from the
plexus around the
middle meningeal
artery

Side of the scalp
Lateral surface of the
auricle
External acoustic meatus
Parotid gland
Middle ear
Parts or the eyelids and
Orbit
Temple
Upper part of cheek
The parotid lymph nodes
drain into

SUBMANDIBULAR GLAND / SUBMAXILLARY
SALIVARY GLAND
 Pair of glands located beneath the floor of the mouth superior to mylohyoid
muscle
 Mixed secretion, weighs half the weight of parotid gland
 Approximately 70% of saliva is produced by submandibular gland

 Situated in the anterior part of
the digastric traingle
 Size of a walnut
 Roughly ‘J’ shaped
 Mylohyoid muscle divides the
gland into 1.Larger part-located
superficial to the muscle
 2.Smaller part- lying deep to
the muscle.

Also known as WHARTON’S duct.
Thin wall and 2-4mm In diameter.
About 5 cm In length.
It emerges at the anterior end of
deep part of the gland and runs
forwards on the hyoglossus,
between the lingual and
hypoglossal nerves.
.

At the anterior border of
hyoglossus the duct is crossed by
lingual nerve.
It opens on the floor of the mouth,
on the summit of the sublingual
papilla, at the side of the frenulum
of the tongue.

BLOOD SUPPLY, LYMPHATIC DRAINAGE AND
NERVE SUPPLY
1. Blood is supplied to the glands by facial artery which
arises from external carotid artery
2. The vein drains into the common facial or lingual vein
3. Lymph passes to submandibular lymph nodes
4. Nerve supply is from the sensory fibres of the lingual
nerve, secretomotor fibres and vasomotor sympathetic
fibres

Clinical anatomy-
During the Excision of gland
-incision-placed >2.5cm below the angle
of the mandible to preserve marginal
mandibular branch of the facial nerve

 Pair of glands located
beneath the floor of the
mouth anterior to the
submandibular gland.
 Mixed gland-but mainly
mucous
SUBLINGUAL SALIVARY GLAND

1. Smallest of the
three salivary
glands
2. Weighs about 3-4
gms
3. About 15 ducts
emerge from the
gland
4. Almond shaped

Bartholin’s Duct – opens through sublingual papilla or
joins with wharton’s duct. Duct of Rivinus
1.Bartholin’s ducts
consists of 8-10
smaller ducts of
rivinus
2.Ducts are short and
small in diameter.
3.Most of them open
directly open into the
floor the mouth.

 Blood supply-sublingual and submental arteries
 Veins drain into the common facial or lingual vein
 Lymph passes through submandibular lymph nodes
 Nerve supply- secretomotor fibres and sensory fibres from
lingual nerve
BLOOD SUPPLY, LYMPHATIC DRAINAGE
AND NERVE SUPPLY

They are found in the oral cavity beneath the oral epithelium

BUCCAL GLANDS
Present between the mucous membrane and buccinator
muscle
These are called ‘Molar glands’.
Mixed but predominantly mucous.

LABIAL GLANDS:
These are situated beneath the
mucous membrane around the
orifice of the mouth.
Mixed but predominantly mucous.

LINGUAL MUCUS GLANDS:
Situated in the posterior one third of the
tongue behind the vallate pappilae and
at the tip of margins of the tongue
Also called as glands of Blandin and
Nuhn

LINGUAL SEROUS GLANDS:
These are located near the vicinity of the taste buds namely
circumvallate papillae and foliate papillae.
Also called as Von Ebners glands.

Glossopalatine glands -localized to the region of
isthmus in glossopalatine fold.

PALATINE GLANDS:
Pure mucous gland.
Posterolateral region of hard palate; & submucosa of soft palate &
uvula.

PAROTID GLAND
BIMANUAL PALPATION :
On the lateral aspect of mandible and on soft
tissues inferior and medial to the angle.
EXAMINATION OF STENSON’S DUCT
Identified adjacent to the upper molar teeth as a
soft tissue flap or a small fold .

 The mucosa in the area should be dried and the duct orifice is
observed while milking the gland with the application of firm
pressure.
 Clear ,colourless secretion ,flowing rapidly should be
observed.

1. BIMANUAL PALPATION:
 Place the 2nd finger of one hand into the floor of the mouth
beneath the tongue while the other hand is gradually moved
while exerting pressure superiorly and laterally so that all the
organs come in between the examiner’s fingers.

CAREFUL OBSERVATION OF SMALL
GLOBULES OF FLUID EMANATING FROM
THE DUCT ORIFICE SHOULD BE DONE.
BY DRYING THE LOWER LIP MUCOSA
AFTER EVERSION USING THUMB AND
INDEX FINGER.
TECHNIQUE:

GOOD MORNING

INTRODUCTION
CLASSIFICATION
BRIEF HISTOLOGY
DEVELOPMENT
ANATOMY

MAJOR SALIVARY GLANDS
PAROTID GLAND
SUBMANDIBULAR GLAND
SUBLINGUAL GLAND
MINOR SALIVARY GLANDS
EXAMINATION OF SALIVARY GLANDS

 DIAGNOSTIC METHOD FOR EXAMINATION OF
SALIVARY GLANDS
 CLASSIFICATION AND DISORDERS OF SALIVARY
GLAND
 TUMORS OF THE SALIVARY GLANDS
 CASE REPORTS
 REFERENCES.

Diagnostic imaging plays an important role in the
evaluation of various disorders of major salivary glands.
The modalities used for imaging include.
1) Conventional Radiography
2) Sialography
3) Ultrasonography
4) CT
5) Arteriography
6) Flow rate studies
7) Biopsy
8) F.N.A.B
9) MRI

 It is a method of studying
the salivary gland and the
alveoli radiographically.
 It is done by injecting a
radiopaque contrast
medium into the duct
system of the salivary
gland

 Scintigraphy- it is used for studying the salivary gland
parenchyma
 Biopsy- it is the most significant advancement in diagnosis
 Flow rate studies- comparative study of flow rate from major
salivary gland is done over a time period
 MRI- used in discrete swelling of salivary glands

CLASSIFICATION:
 Developmental disorders
 Functional disorders
 Obstructive disorders
 Cyst
 Asymptomatic enlargement
 Infection
 Autoimmune disorders

Developmental disorders:
Aberrancy
Aplasia and hypoplasia
Hyperplasia
Atresia
Accessory ducts
Diverticuli
Congenital fistula

10
0
Cysts:
Mucocele
Ranula
Asymptomatic enlargement:
Sialosis /sialadenosis
Allergic Sialadenitis
Associated with malnutrition and alcoholism

10
1
Functional disorders:
Sialorrhea
Xerostomia
Obstructive disorders:
Sialolithiasis
Mucus plug
Stricture and Stenosis
Extra ductal causes

10
2
Infections:
Viral infection
Bacterial infection
Mycotic infection
Autoimmune disorders:
Sjogrens syndrome
Mikuliczs disease
Uveparotid fever
Recurrent non specific parotitis

 Situation in which the salivary gland tissue develops at a site
where it is not normally found.
 Also called ectopic salivary gland.
 C/F – most frequently found near the parotid gland or the body
of the mandible
It can lead to the developmental lingual salivary gland
depression (STAFNE’S CYST), Gingival salivary gland
choristoma, development of retention cyst.
10
3

 Described by GRUBER in 1885
 Congenital absence of the salivary gland
CAUSES
Ectodermal in origin
10
4

 C/F – Xerostomia, Rampant dental caries and early loss of
deciduous teeth due to lack of saliva, dry oral mucosa pebbly
in appearance and cracking of lips and fissuring of corners of
mouth
10
5

 It is the increase in the size of salivary gland
CAUSES
1. Hormonal disorders
2. Metabolic disorders
3. Autoimmune
10
6

C/F: Asymptomatic
More common in minor salivary glands of the palate and usually
present at the junction of hard and soft palate which leads to
palatal gland hyperplasia.
10
7

 Congenital occlusion or absence of one or two major salivary
gland ducts.
 It occurs in newborn as the submandibular duct fails to
cannulate during embryological development
 Usually the submandibular duct is involved.
10
8
Plug of fibrotic tissue is seen at the
distal end of wharton’s duct

10
9

 Accessory parotid lobe is the most common developmental
anomaly.
 It arises from the horizontal component of the parotid duct as
it crosses the masseter muscle.
 They do not require any treatment.
11
0

 Mostly present in patients with branchial cleft anomalies,
unilateral, painless swelling in the region of parotid
 Sinus tracts are formed behind the pinna or in front of tragus
 Discharge saliva intermittently
 Complete surgical excision of sinus tract is essential.
11
1

 First recognized by Stafne in 1942.
 Also called as ‘static bone cyst’, stafne’s cyst, ‘lingual
mandibular bone cavity’
 Developmental inclusion of glandular tissue within the
lingual surface of the body of mandible
C/F : Higher in males
If the cortical defect occurs in the anterior region it leads to –
sublingual gland bony defect, asymtomatic
11
2

11
3

11
4

11
5

1. Sialorrhea (Ptyalism) – increased salivary secretion.
Etiology :
Drugs – lithium and cholinergic agonists
Local factors- stomatitis, ANUG, erythema multiforme
Systemic disease- Down’s syndrome, paralysis, Parkinson’s
disease, epilepsy
11
6

 C/F –Drooling which may lead to mild embarrassment and
discomfort, cheek scarring and lip chapping due to constant
exposure of saliva, soiling of clothes, carpets and books.
 T/T- 1. Biofeedback
2. Removal of local factors
3. Drug Atropine sulphate ( Adults- 0.4mg every 4 to 6
hours)
(Children- 0.01mg every 4-6 hours)
11
7

 It is a subjective condition of less than normal
amount of saliva- dryness of mouth
Etiology
1. Ionizing radiation ( head and neck cancer patients)
2. Drug induced- anticonvulsants, antiemetics,
antihistaminics, anti-hypertensives.
11
8

3. Local factors- smoking, decreased mastication, mouth
breathing
4. Developmental anomalies of salivary glands
C/F- Difficulty in swallowing, speech, burning and tingling
sensations in the mouth, frequent oral infections
 Effect of xerostomia on normal functions
 Painful Salivary gland enlargement
 Candidiasis
11
9

12
0

 Clinical signs of Xerostomia:
1. Dryness of lining oral mucosa
2. Oral mucosa appears thin, pale and feels dry
3. Tongue blade may adhere to soft tissues
4. Fissuring, cracking, inflammation and atrophy of
papillae of tongue
5. Increased incidence of dental caries
12
1

 T/T – Local stimulation by chewing gums, mints or
paraffin.
 Systemic stimulation:1. Bromhexine- mucolytic and
mucokinetic agent
2. Pilocarpine
Symtomatic treatment: salivary substitute which contains
carboxymethylcellulose,sorbitol, potassium sodium and
calcium chloride
3. Discontinuation of drug
12
2

 Consumption of sweet and tart food
 Sucking ice cubes and sugar free candies
 To avoid dry foods such as cookies, toast or crackers
 Soft and liquid food
 Drink frequently
12
3

12
4
Is the formation of calcific
concentrations within the
parenchyma or ductal system of
the major or minor salivary
glands.
Also called salivary gland stone or
salivary gland calculus.

Composition:
 Calculus
 Crystalline structure: hydroxy apatite and octacalcium
phosphate.
 Chemical composition: calcium phosphate and carbon
PREVALENCE
Submandibular : 83%
Parotid : 10%
Sublingual: 7%
12
5

 Submandibular has greater prevalence due to following
factors:
Anatomic factors:
 Length and irregular course of Wharton’s duct.
 Greater size and position of orifice
 The oriface is much smaller than duct lumen
 The submandibular gland and ductal system lies in the
dependent position.
12
6

Physiochemical factors:
 High mucin content of saliva.
 Great degree of alkalinity with high percentage of organic
matter.
 Low content of carbon dioxide.
 Richness in the phosphate enzyme.
12
7

12
8
An initial organic nidus --deposition of
layers of inorganic and organic
substances
Obstruct flow of saliva from the gland to
the oral cavity.
Occur at meal time--the resultant
swelling is sudden and can be painful
Gradually reduction of the swelling --but
it recurs repeatedly when flow is
stimulated
Process continues-- until complete
obstruction and/or infection occurs.

Types:
 Ductal sialoliths – located in the duct of the gland.
 Glandular sialoliths
C/F:
Age and sex: middle aged patients with greater prevalence in
men.
12
9

13
0

Symptoms:
 Moderately severe pain.
 Patient complains of intermittent transient swelling during
meals, swelling resolves after meals.
 Systemic symptoms – if no treatment is instituted ,it appears
as a pronounced exacerbation characterized by an acute
suppurative process with attendant systemic manifestations
such as fever and malaise.
13
1

Signs:
 Pus – may exudate from the duct orifice.
 Surrounding tissue – severe inflammatory reaction.
 Palpation – stones in the more peripheral portion of the
duct may often be palpated ,if they are of sufficient size.
 Ulceration – overlying mucosa.
 Absence of saliva – no saliva is seen to be coming from duct
orifice.
13
2

13
3

13
4
Radiography:
 Standard mandibular occlusal view – for submandibular
duct stone.
 Periapical view in the buccal vestibule- for parotid gland.
 Sialography – indicated when sialoliths are radiolucent.

13
5
Radiodensity – almost radio-opaque.
 Shape – oval shaped and is cylindrical with multiple
layers of calcification.
 Borders – smooth borders.
 Size – it varies from little more than a pinhead up to a
length of an inch.
 CT –dense radio-opaque area.

13
6

13
7
Diagnosis:
 Palpation – digital manipulation.
 Metallic duct probe – careful probing of the duct with a
metallic probe will indicate the existence as well as location of
calculus.
 Radiographic examination.
 Sialography.

Manual manipulation:
 Small stone – gentle massage of the gland.
 Sialogogues , moist heat and increased fluid intake will
also promote the passage from the gland.
Stone in submandibular duct:
 Palpated near the near the orifice- removed by an
incision.
13
8

13
9

14
0

14
1

14
2
Stone in the submandibular gland:
Excision of the gland.
Antibiotics : in acute infection
Salivary gland endoscopy:
Lithotripsy: fragmentation of stone in the gland by
ultrasound shock waves.

1.Mucocele: It is the swelling
caused by pooling of saliva
at the site of injured minor
salivary gland.
It is not a true cyst and lacks
an epithelial lining.
14
3

 Etiology- It is caused by laceration of a minor salivary gland
duct by trauma.
Two types :
1.Mucus extravasation type
2. Mucus retention type
14
4
Extravasation type:
Results from rupture of salivary gland duct and
spillage of mucin into the surrounding soft tissues due
to trauma.
Has no epithelial lining

14
5
Clinical features:
Appears as a dome shaped mucosal swellings
1-2 mm in size.
Mostly in younger patients
Site: Inner aspect of the lower lip is the most common site
Also seen on the palate, cheek, tongue and floor of the
mouth

14
6
Symptoms: painless recurrent swelling that periodically may
rupture and release its fluid contents.
Consistency: soft or hard depending upon the tension in the
fluid. It cannot be emptied by digital pressure.
Aspiration: it yields sticky viscous clear fluid

14
7
Superficial mucocele: is present as a single or multiple tense
vesicles that measures 1-4mm in diameter.
The lesion burst leaving shallow painful ulcer that heals within
a few days.
Site – soft palate , posterior buccal mucosa.
- Patient may also give a history of reccurence.

Diagnosis:
 Clinical – dome shaped soft swelling on the lower lip which
is lateral to midline (typical feature).
 Laboratory diagnosis – in biopsy, it shows vacuolated
macrophages which are sometimes called as muciphage.
14
8

14
9

15
0
Management:
Surgical excision – along with the involved gland.
Cryosurgery – surgery with cryoprobe is also helpful in
managing the mucocele

 Mucocele that occur in the
floor of the mouth, in
association with the ducts of
submandibular or sublingual
glands.
15
1

 TYPES
1. Superficial- may develop as a
retention or extravasation
phenomenon associated with
trauma to one or more
excretory ducts of sublingual
salivary gland
2. Plunging or cervical- it
ramifies deeply into the neck
15
2

15
3
Clinical features:
Age – children and young adults
Site – floor of the mouth and below the tongue.
Lateral to the midline.
Slow enlarging painless masss
Blue dome shaped swelling
Soft and fluctuant.
Management:
Surgical excision.
Partial excision with marsupialization.

 It is characterized by non-neoplastic, non-inflammatory
enlargement of the salivary gland.
Etiopathogenesis:
1. In association with systemic diseases- eg. Diabetes,
malnutrition, cirrhosis, alcoholism etc.
2. Antihypertensives or psychotropic drugs for treatment of
neurogenic medication.
15
4

 C/F: Found more in females
- Bilateral enlargement of the salivary
gland
- Parotid gland is frequently affected
which leads to preauricular swelling.
Radiological features:
Leafless tree appearance on
sialography- it is due to compression of
finer duct by hypertrophic aciner cells
15
5

 Management
1. Control of underlying cause
2. Partial parotidectomy
15
6

15
7
Also called epidemic parotitis.
Is an acute contagious viral infection,
characterized chiefly by unilateral or
bilateral swelling of the salivary glands.
Mainly effects the major salivary glands.
Paramyxovirus.
Transmission: it is an airborne infection
transmitted through saliva and urine

CLINICAL FEATURES:
 Age – 5 TO 15 yrs
 Sex – boys than in girls
 Incubation period – 2-3wks
 Site – parotid gland most commonly involved and bilateral.
15
8

 Prodromal symptoms – onset of headache, chills, moderate
fever, vomiting and pain below the ear which lasts for
about 1 week.
 Sudden onset of salivary gland swelling.
 Symptoms – pain on mastication.
 Signs – swelling of the ear lobe.
15
9

 Complications :
1. Orchitis- great danger in adult males (ensues 20% of the
cases)
2. Pancreatitis
3. Meningitis
16
0

16
1
Management:
Vaccination – prevention with live attenuated vaccine.
Given in 12 to 15 months of age.
Repeated at the age of 4 to 5 yrs
Symptomatic treatment – to control pain and swelling-
analgesic and antipyretic.
Rest
Diet restriction – avoid sour foods and drinks to decrease
salivary gland discomfort

Etiology :
-Microorganisms: most commonly caused by penicillin
resistant Staphylococcus aureus or Streptococci viridans.
-Decreased host resistance and salivary secretion
-Dehydration, malnutrition and poor oral hygiene.
16
2

16
3
Retrograde contamination of the
salivary ducts and parenchymal
tissues by bacteria inhabiting the oral
cavity.
Stasis of salivary flow through the
ducts and parenchyma promotes
acute suppurative infection.

 C/F: unilateral involvement of parotid gland
 Prodromal symptoms- elevation of body temperature and
sudden onset of pain
 Signs – parotid gland is tender, enlarged and the overlying
skin is warm and red. The swelling usually causes elevation
of ear lobule.
 Flecks of purulent material discharge from the salivary duct
16
4

16
5

-the infection can occur after the surgery of parotid gland .i.e.
postoperative parotitis
So the fluid and electrolyte balance should be maintained during
postoperative period.
If the infection is not eradicated, pus may penetrate the gland
and spread into the surrounding tissues
16
6

 T/T:
- Meticulous oral hygiene should be practiced
- Soft diet should be given
- Antibiotics
- Electrolyte balance
- Stimulation of saliva
- Surgical drainage
16
7

It is usually caused by Streptococcus viridans, E.coli, proteus.
Etiology:
1. Ductal obstruction
2. Sjogrens syndrome
3. Viral infection or allergy
16
8

 C/F: occurs in childhood around 3-4 yrs of age
- Minimal pain with unilateral swelling at the angle of the jaw
- T/T:
- Radiation therapy
- Surgical removal
- Antibiotics
- Ligation of stenson’s duct
16
9

 First described by Henrik Sjogren
in 1933.
 Is an autoimmune disorder
 Is a chronic inflammatory disease
that predominantly affects the
salivary, lacrimal, and other
exocrine glands.
17
0

17
1
TYPES :
PRIMARY SJOGRENS SYNDROME:
Also called sicca syndrome
Consists of – xeropthalmia
Xerostomia
SECONDARY SJOGRENS
SYNDROME:
Consists of – xerostomia
Xeropthalmia
Rheumatoid arthritis

17
2
Etiology:
Genetic
Hormonal
Infectious
Immunological
Clinical features:
Middle aged adults
Female predilection
Eyes – effect on eye is called keratoconjunctivitis sicca
Dry eyes and dryness of other organs.

17
3
Oral manifestations:
Xerostomia is the major complaint.
Unilateral or bilateral enlargement of the salivary gland.
Frothy saliva may form along the lines of contact with oral tissues.
Mucosa is dry and tends to wrinkles.
Tongue – partial or complete depapillation.
Severity of dental caries and plaque accumulation.

17
4
Radiolological features:
Sialography – sialectasia which typically produces
‘a snow storm appearance.’ , in some cases
‘cherry blossom’ or ‘fruit laden branchless tree’
Salivary Scintiscanning.

17
5
Test for Opthalmic Involvement
• Schirmer’s Test- Quantitative measure
of tear production over a specific
period of time
• Rose Bengal Eye stain- reveals breaks
in the corneal – epithelial surface to
evaluate ocular surface irritation.

17
6
Test For Oral Involvement
• Salivary Sailometry
• Labial minor salivary gland biopsy
• Examination salivary gland enlargement
• Systemic tests– Autoantibodies
Rheumatoid antibodies

Management
 Artificial tears
 Salivary substitutes
17
7

17
8
Oral hyginene maintenance
Salivary stimulants – bromhexine, pilocarpine
Surgery – if the enlargement
is discomfortable to patient.

 First described by Mikulick’s in 1888
 Bilateral, chronic, painless enlargement of lacrimal and
salivary glands.
C/F: occurs more in women
Associated with fever, UTI infections, mild local discomfort
and pain.
T/T:
Surgical excision.
17
9

18
0

• Tumors of salivary glands - 5% of Head and Neck Cancers
• 0.3% of all cancers
• Diverse histopathology
• Proportion of malignant and benign varies with the gland of
origin
18
1

• Benign tumors (low propensity for recurrence)
 Oncocytoma
 Adenolymphoma
 Basal cell adenoma
 Canalicular adenoma
• Benign tumors( high propensity for recurrence)
 Pleomorphic adenoma (major glands)
18
2

18
3
• Malignant tumors (high grade behaviour)
Adenoid Cystic Carcinoma
Salivary duct carcinoma
Epith-myoepith carcinoma of intercalated ducts
High –grade mucoepidermoid carcinoma
Squamous cell carcinoma of salivary origin

18
4

18
5

18
6

• Most common of all salivary gland
neoplasms
• 70%-Parotid tumours
• 50%- submandibular tumours
• 45%- Minor salivary gland umours
• 6%- Sublingual tumours
18
7

 Cells differentiate to both epithelial and mesenchymal cells.
 The term ‘Pleomorphic adenoma’ was suggested by ‘Willis’
 It shows unsual histologic pattern of the lesion.
Histogenesis: it has presence of both ductal and myoepithelial
cells.
18
8

18
9
• 4th -6th decade
• F:M 6:4
• Slow growing, painless mass
• Parotid-90% superficial lobe, most in tail of gland
• Minor salivary Gland- lateral palate, submucosal mass

19
0

19
1
Complete surgical excision
• Parotidectomy with facial nerve preservation
• Submandibular gland excision
• Wide local excision of minor salivary gland
Avoid enucleation and tumor spill

19
2

19
3

 It is the second most common tumor of the salivary gland
C/F:
It is more common in men
Occurs exclusively in the parotid gland
Painless slow growing tumor
T/T:
Superficial parotidectomy
19
4

As the name suggest it consists of both mucus secreting as
well as epidermoid type of cells.
Based on the clinical and histological feature
Two types – benign and malignant
C/F: 3rd and 5th decade
Sex- equal distribution
Site- 60% of parotid gland
30% of minor salivary gland
19
5

 It appears as a slow enlarging painless mass. Pain can be
associated in few cases.
 Low grade malignancy- slow, enlarging and painless
 High grade malignancy- produces pain and infiltrate the
surrounding tissues
19
6

 T/T: Subtotal parotidectomy
Radial neck dissection
Radiotherapy
19
7

 C/F:
Age- 5th and 6th decade of life
Site- parotid, submaxillary and accessory glands in palate
and tongue.
Symptoms- local pain and facial nerve paralysis
Site- it may exhibit ulceration
T/T: Surgical excision
Adjunct radiotherapy
19
8

19
9

 It is a non-neoplastic, inflammatory self healing reaction of
the salivary gland.
Etiology:
Local ischemia
Trauma
C/F:
Sex - Higher in males
Age- 4th and 5th decade of life
Site- mostly on palate
20
0

 Symptoms- painless, pieces of tissue may fall out from the
palate.
 Signs- large ulcerated nodule, demarcated from the
surrounding normal tissue
The margins are deep, indurated, crater-like and inflamed.
T/T- It is a Self limiting condition
Debridement with saline rinses
20
1

20
2

20
3

 Salivary glands are esthetically and functionally of equal
importance .
 Minor and major salivary glands are equally involved with
diseases.
 Correct diagnosis and extent of disease aids in successful
management.
 Maintenance of anatomical limits and eradication of disease is
success of surgeon.
20
4

 Human Anatomy vol-3 Head, Neck and Brain by B.D.
Chaurasia.
 Ten Cate’s Oral Histology, Development, structures, and
function. By Antonio Nanci.
 Human Histology by Inderbeer Singh.
 Oral and Maxillofacial Pathology by Brad W. Neville
20
5

20
6
Human embryology and development by Inderbeer Singh.
Shafer’s textbook of Oral Pathology 6th edition.
Oral medicine - Burket’s 10th edition.
Text book of oral medicine by Anil G. Ghom. 2nd edition

20
7

Salivary glands- Dr. Barkha.S.Tiwari. PG student. Dept of Public Health Dentistry

Recommended

Recommended

More Related Content

What's hot

What's hot (20)

Similar to Salivary glands- Dr. Barkha.S.Tiwari. PG student. Dept of Public Health Dentistry

Similar to Salivary glands- Dr. Barkha.S.Tiwari. PG student. Dept of Public Health Dentistry (20)

Recently uploaded

Recently uploaded (20)

Salivary glands- Dr. Barkha.S.Tiwari. PG student. Dept of Public Health Dentistry