INTRODUCTIONSalivary glands are compound tubuloacinar, exocrine gland and the ducts opens in the oral cavity. Salivary glands secretes a fluid called saliva that coats the teeth and the mucosa. Saliva is a complex fluid, produced by the salivary glands, the most important function of which is to maintain the well- being of mouth. Individuals with a deficiency of salivary secretion experience difficulty in eating, speaking, and swallowing and become prone to mucosal infections and dental caries.

1. SALIVARY GLANDS
Dr ANUDARSH PK
FIRST YEAR MDS
DEPT: OF PUBLIC HEALTH DENTISTRY

2. INTRODUCTION
• Salivary glands are compound tubuloacinar, exocrine gland and the
ducts opens in the oral cavity.
• Salivary glands secretes a fluid called saliva that coats the teeth and
the mucosa.
• Saliva is a complex fluid, produced by the salivary glands, the most
important function of which is to maintain the well- being of mouth.
• Individuals with a deficiency of salivary secretion experience
difficulty in eating, speaking, and swallowing and become prone to
mucosal infections and dental caries.

3.  Development of salivary glands occurs in six stages:
1) Bud Formation
2) Formation And Growth Of Epithelial Cords
3) Branching Of Cords
4) Dichotomous Branching
5) Canalization
6) Cyto- differentiation.
DEVELOPMENT OF SALIVARY
GLANDS

4. STAGE 1-BUD FORMATION
 The underlying mesenchyme induces the
overlying epithelium to proliferate
 The epithelium thus forms a bud.

5. STAGE 2 -FORMATION AND
GROWTH OF EPITHELIAL CORD
• The epithelial bud proliferates to form a solid cord
of cells.
• The underlying mesenchymal condensation also
proliferates.

6. STAGE 3-BRANCHING OF CORDS
 The epithelial cords proliferates rapidly and
branches into terminal bulbs.

7. STAGE 4-DICHOTOMOUS
BRANCHING
 The terminal end branches extensively forms
numerous bulbs.
 The connective tissue below the epithelial cord
forms a capsule and surrounds the entire
glandular structure.

8. STAGE 5-CANALIZATION
 Extensive branching of the duct structure and growth of
connective tissue septa continues in this stage
 First in distal ends of main cord & in branch cords then in
proximal part of main cord & finally in central portion of
main cord.

9. STAGE 6-
CYTODIFFERENTIATION
 At last there is cytodifferentiation of the
functional acini and intercalated ducts.

10. DEVELOPMENT OF SALIVARY
GLAND IN INTRAUTERINE LIFE
• Parotid Gland- 4th Week of intrauterine life
• Submandibular Gland- 6th Week of intrauterine
life
• Sublingual Gland- 8th week of intrauterine life
• Minor glands- 12th week of intrauterinelife.

11. CLASSIFICATION OF SALIVARY
GLANDS
1) ACCORDING TO SIZE:
MAJOR
 Parotid
 Submandibular
 Sublingual
MINOR
 Glands of Lips
 Cheeks
 Hard Palate
 Soft palate
 Von Ebners
 Blandin&Nuhn.

12. 2) ACCORDING TO BRANCHING OF DUCTS:
A) Compound- Major glands
B) Simple- Minor glands

13. 3) ACCORDING TO SECRETION:
SEROUS
a)Parotid
b)Von-ebner
MUCOUS
a)Palatine
b)Post. lingual
c) Glossopalatine
MIXED
a)Submandibular
b)Sublingual
c)Buccal
d)Labial.

14. ANATOMY OF SALIVARY GLANDS
PAROTID GLAND
• Is the largest
• Weight – 15gms
• Is situated below the External acoustic meatus, b/w the
ramus of the mandible and the sternocleidomastoid.
• Secretion of parotid gland is serous.
• Anteriorly , the gland overlaps the masseter muscle. A part
of this forward extension is often detached – Accessory
Parotid which lies b/w the zygomatic arch and the parotid
duct.

16. PAROTID CAPSULE
• The investing layer of deep cervical fascia forms the capsule for the
gland.
• The fascia splits to enclose the gland.
• Superficial lamina – thick & adherent to the gland.
• Deep lamina – thin – attached to the styloid process, the
mandible and tympanic plate.
• A portion of deep lamina, extending between the styloid process and
the mandible – thickened to form Stylo mandibular Ligament –
separates the Parotid gland from the Submandibular salivary gland.

17. SURFACES & BORDERS
• The glands has four surfaces
a) Superior
b) Superficial
c) Antero-medial
d) Postero-medial
• The surfaces are separated by three borders.
a) Anterior
b) Posterior
c) Medial

18. 1. Superior surface related to
 Cartilaginous part of External acoustic meatus
 Superficial temporal vessels
 Posterior surface of TMJ
 Auriculotemporal nerve

19. 2. Superficial surface (largest)
A. Skin
B. Superficial fascia
C. Great auricular nerve
D. Pre-auricular lymph node
E. Posterior fibers of platysma
F. Parotid fascia
G. Deep parotid lymph nodes

20. 3. Anteromedial surface related to
 Masseter
 Lateral surface of TMJ
 Posterior border of the mandible
 Medial pterygoid
 Terminal branches of facial nerve

22. 4 Posteromedial surface
 Mastoid process
 Sternocleidomastoid
 Posterior belly of the digastric
 Styloid process

23. BORDERS
 ANTERIOR BORDER :
– Separates the superficial surface
from the Anteromedial surface
– Extends from –anterior part of the superior
surface to the apex
– Structures emerging:
 Parotid duct
 Terminal branches of the facial nerve
 Transverse facial vessels

25. POSTERIOR BORDER :
– Separated the superficial surface from the
posteromedial surface
– Overlaps the sternomastoid.
MEDIAL BORDER :
– Separates the Anteromedial surface from the
posteromedial surface.
– Related to the lateral wall of pharynx

26. STRUCTURES WITHIN THE
PAROTID GLAND
1) Arteries
 ECA-external carotid artery
 Maxillary artery
 Superficial temporal vessels
 Posterior auricular artery

27. 2) VEINS
 Retromandibular vein divides into:
1. Posterior division drains into external jugular
vein
2. Anterior division drains into common facial vein

28. 3) Nerves
• Terminal branches of facial nerve
a) Temporal
b) Zygomatic
c) Buccal
d) Mandibular
e) cervical
4) Parotid lymph nodes

29. NERVE SUPPLY TO PAROTID
INFERIOR SALIVATORY NUCLEUS
AURICULOTEMPORAL NERVE
TYMPANIC BRANCH
LESSER PETROSAL NERVE
RELAY IN OTIC GANGLION
POST GANGLIONIC FIBRES THROUGH
AURICULOTEMPORAL NERVE
PAROTID

32. PAROTID DUCT
• Stensen’s duct-5cm long
• Emerges from the substance of the gland to course
anteriorly until it reaches the anterior border of
the masseter muscle at a point of the upper and
middle third.
• When it crosses the masseter muscle it receives
the duct of the accessory lobe.

33. • Around the border of the masseter muscle-turns sharply
medially, often embedded in the furrow of the
protruding buccal fat pad.
• In its medial course ,the duct reaches the outer surface
of the buccinator muscle, where it perforates in the
oblique direction anteriorly and medially.
• Then runs for a short distance obliquely forward,
between the buccinator and the mucous membrane –
opens on the oral surface of the cheek

34. SUBMANDIBULAR GLAND
• Situated in the anterior part of the Digastric triangle
• Size that of a walnut
• Is J-shaped
• Secretion of submandibular gland is both serous and mucous.
• Divided by the posterior border of the Mylohyoid Muscle into
1. Larger part superficial to the muscle
• Covers the inferior surface of the gland
• Attached to the base of the mandible

35. 2. Small part lying deep to the muscle
• Covers the medial surface of the gland
• Attached to the mylohyoid line of the mandible

36.  Superficial part:
– Fills the digastric triangle
– It has
a ) Inferior surface-covered by-
 Skin
 Platysma
 Cervical branch of facial nerve
 Deep fascia
 Facial vein
 Submandibular lymph nodes.

37. b) Lateral surface
Submandibular fossa on the mandible
Facial artery
c) Medial surface divided into
1. Anterior part – related to the
– Mylohyoid muscle
– Nerve
– Vessels

38. 2. Middle part-
• Hyoglossus
• Styloglossus
• Lingual nerve
• Hypoglossal nerve
3. Posterior part-
• Styloglossus
• Stylohyoid ligament
• Glossopharengeal nerve
• Wall of pharynx

39. SUBMANDIBULAR DUCT

40. • Called “WHARTONS” duct
• 5 cm long
• Emerges at the anterior end of deep part of the
gland
• Runs forwards on the hyoglossus ,between the
lingual and the hypoglossal nerves
• Opens in the floor of the mouth on the summit
of the sublingual papilla, at the side of the
frenum of the tongue

41.  BLOOD SUPPLYAND LYMPHATIC
DRAINAGE :
• Facial artery
• Veins drain into common facial vein or lingual
vein
• Lymph passes into the Submandibular lymph
nodes
 NERVE SUPPLY :
• Supplied by branches from
Submandibular ganglion
• These convey
– Secretomotor fibers
– Sensory fibers from lingual nerve
– Vasomotor sympathetic fibers from facial
nerve.

42. SUBLINGUAL GLAND

43. • Is the smallest
• Almond shaped
• 3-4gm weight
• Secretion of sublingual gland is both serous and
mucous.
• Lies above the mylohyoid, below the mucosa of
the floor of the mouth
• Medial to the sublingual fossa

44. • Lateral to genioglossus
• About 15 ducts emerge from
 the gland –
 Called ducts of rivinus
 BLOOD SUPPLY:
• Lingual and submental arteries

45. Minor Salivary Glands

46. • Present under epithelium of lips & cheeks
• Mixed in nature
• Intercalated duct are variable in length
LABIAL & BUCCAL GLANDS

47. • Present at glandular region of hard palate i.e.
posterolateral part of hard palate.
• Pure mucous gland
PALATINE GLANDS

48. GLANDS OF TONGUE
 Anterior Gland:
• Near apex of tongue anterior lingual gland are
present. These are glands of Blandin & Nuhn.
• Mucous in nature
• Ducts of these gland open on ventral surface of
tongue near lingual frenum.

49.  Posterior Glands:
• Present on posterior part of tongue near suclcus
terminalis
• Mucous in nature
• Ducts open at dorsal surface of tongue
 von Ebner’sgland:
• Serous gland
• Opening through vallate papilla.

50. COMMON SALIVARY GLAND
DISORDERS
 SIALOLITHIASIS
(salivary gland stones).Tiny, calcium-rich stones
sometimes form inside the salivary glands with
prevalence of 1.2%. The exact cause of these stones is
unknown. Some stones may be related to:
• Dehydration, which thickens the saliva
• Decreased food intake, which lowers the demand for
saliva
• Medications that decrease saliva production, including
certain antihistamines, blood pressure drugs and
psychiatric medications
 Some stones sit inside the gland without causing any
symptoms. In other cases, a stone blocks the gland's
duct, either partially or completely. When this happens,
the gland typically is painful and swollen, and saliva
flow is partially or completely blocked.

51.  The majority of calculi are found within the
submandibular gland (80%–92%), likely due to
the fact that the submandibular gland produces
highly viscous saliva that needs to travel upward
against gravity as it traverses Wharton’s duct.
 The remaining calculi are found in the parotid
gland (6%–20%) and sublingual/minor salivary
glands (1%–2%)

52.  SIALADENITIS
Sialadenitis is a general term used to denote an
infectious or inflammatory process of the salivary
glands. Sialadenitis can be due to a variety of causes
including viral, bacterial, fungal, and granulomatous
processes ,immunologically mediated disease, and,
parasitic.

53. INFECTIOUS SIALADENITIS
 Worldwide, viral sialadenitis is most commonly
due to mumps virus
 other viruses including parainfluenza, influenza,
coxsackie, Epstein–Barr virus, herpes simplex
virus, and HIV
 mumps sialadenitis begins with a prodromal
period followed by acute bilateral salivary gland
swelling typically affecting the parotid glands

54.  In HIV patients it is most commonly due to the
same viral/bacterial pathogens as non-HIV
patients, they can develop a separate entity
referred to as HIV-associated salivary gland
disease. This is characterized by progressive,
painless swelling of the bilateral salivary glands
due to the formation of benign lymphoepithelial
cysts (BLECs)

55.  Bacterial sialadenitis presents with acute unilateral
salivary gland swelling without a preceding
prodromal period.
 The most common bacterial pathogens are
Staphylococcus aureus and anaerobes

56.  INFLAMMATORY SIALADENITIS
 Autoimmune sialadenitis refers to a group of
noninfectious disorders that result in chronic
inflammation and fibrosis of the salivary glands.
 Sjogren’s sialadenitis is a female predominant
disorder (>90%) most commonly seen in the
postmenopausal age group (50–70 years of age).
 Sarcoid sialadenitis refers to chronic inflammation
of the salivary glands in patients with sarcoidosis.
It is seen in 10%–30% of patients with sarcoidosis
and patients typically present with painless
bilateral parotid swelling.

57. POSTRADIATION SIALADENITIS
 Radiation-induced sialadenitis is frequently seen
in patients who receive radiation treatment for
oropharyngeal cancer.
 The first clinical signs of sialadenitis manifest as
decreased saliva flow and have been reported to
occur with radiation dose thresholds as low as 15
Gy.

58. SALIVARY GLAND NEOPLASMS
 In the parotid gland, approximately 80% of
neoplasms are benign while 20% are malignant.
 The most common benign parotid gland
neoplasms are pleomorphic adenoma and
Warthin’s tumor ,while the most common
malignant neoplasm is mucoepidermoid
carcinoma.

59.  In the submandibular gland, 50% of neoplasms
are benign while 50% are malignant. the most
common benign neoplasm is the pleomorphic
adenoma, constituting 85% of all benign
submandibular gland neoplasms. The most
common malignant neoplasms include adenoid
cystic carcinoma (ACC), mucoepidermoid
carcinoma

60.  In the sublingual and minor salivary glands, 80%–
90% of neoplasms are malignant
 ACC is the most common, while mucoepidermoid
carcinoma is the second most common

61. PLEOMORPHIC ADENOMA
 Pleomorphic adenoma (benign mixed tumor) is a
neoplasm comprised a combination of glandular
epithelium and myoepithelial components.
 It is the most common benign salivary gland
neoplasm and has a female predominance (2:1),
typically affecting patients aged 30–60 years.
 Nearly 80% of these lesions arise in the parotid
gland, and of these, 80%–90% arise in the
superficial portion of the gland

62. Carcinoma Ex Pleomorphic
Adenoma
 Carcinoma ex pleomorphic adenoma refers to
malignant transformation of a preexisting
pleomorphic adenoma. Although rare, it has been
reported to occur in 0.15% of lesions

63. WARTHIN’S TUMOR
 Warthin’s tumor (papillary cystadenoma
lymphomatosum) is a benign neoplasm comprised
both epithelial and lymphoid tissue that forms
papillary projections
 It is the second most common benign salivary
neoplasm and has a strong association with
smoking.

64. MUCOEPIDERMOID CARCINOMA
 Mucoepidermoid carcinoma is a malignant
neoplasm comprised of epidermoid and mucus-
secreting epithelial cells.
 It is the most common malignant neoplasm of the
salivary glands
 60% of lesions arise in the parotid gland

65. ADENOID CYSTIC CARCINOMA
 ACC is a malignant neoplasm derived from both
ductal and myoepithelial cells.
 Clinically, these patients tend to present at an
older age (5th–7th decades)
 ACC has the greatest propensity for perineural
spread and local invasion
 ACC tends to be very aggressive and it is reported
that 90% of cases will have cervical lymph node
metastases at the time of diagnosis.

66. ACINIC CELL CARCINOMA
 Acinic cell carcinoma is a malignant neoplasm
derived from the glandular epithelium and is
considered a variant of adenocarcinoma.
 Nearly 90% of lesions arise in the parotid, most
commonly located in the parotid tail.

67. ONCOCYTOMA
 Oncocytoma is a benign neoplasm derived from
mitochondria-rich epithelial cells
LIPOMA
 Lipomas are benign neoplasms composed of mature
adipose tissue surrounded by a fibrous capsule
 Salivary gland lipomas(sialo lipoma) are much rarer and
most commonly involve the parotid gland

68. RANULA
 Ranula is defined as a mucus retention cyst or
mucocele in the sublingual space arising from
either the sublingual gland or the minor salivary
gland tissue.

69.  The annual incidence of salivary gland tumors varies
around the world from approximately 0.4–
13.5/100,000 people.
 Salivary gland tumors are reported to represent
between 1% and 5% of all head-and-neck tumors.
 75%–85% the found in the major Salivary glands
 10% to 20% in the minor salivary glands
 Ratio of 5:1
EPIDEMIOLOGY

70. APPLIED ASPECTS
FACIAL NERVE PARALYSIS AFTER IANB
 Facial paralysis caused by deposition of the anesthetic
solution in the parotid region, a problem which mainly
occurs when the needle is directed more posterior toward
the posterior border of the mandible.

71.  Symptoms of this temporary loss of the use of the
muscles of facial expression include the inability
to close the eyelid and the drooping of the labial
commissure on the affected side for a few hours.

72.  The paralysis could be either immediate or
delayed, based on the time elapsed from the
moment of the injection to the onset of the
symptoms. In the immediate type, the paralysis
occurs within minutes of injection with a recovery
period of 3 hours or less. However, in the delayed
type the symptoms appear within several hours to
several days, while recovery may expand from
24 hours to several months.

73. RADIOTHERAPY AND
SALIVARY GLANDS
 Salivary gland damage leading to hyposalivation and
xerostomia is one of the most common complications of
radiation therapy.
 Xerostomia and associated complications amplifies the
adversities faced by a patient.
 A study was conducted in rats by yitzhak marmary et al
in 2016 for assessing radiation-induced loss of salivary
gland function , driven by cellular senescence mentioned
that there is DNA damage in salivary glands after
radiotherapy
 The radiation induced cell death depends upon the radio-
sensitivity of a tissue and tissue turnover rate.

74. EFFECT OF PROTEIN DEFICIENCY
ON SALIVARY GLAND FUNCTION
 Protein deficiency results in alterations to salivary
gland structure and function.
 Studies in children have shown that the severity of
protein energy malnutrition (PEM) is related to
the extent of reduction of stimulated salivary
secretion rate.
 PEM also results in a decrease in calcium,
chloride and secretion of protein of stimulated
saliva .

75.  Also there is reduction in immunologic and
agglutinating defense factors of unstimulated
saliva.
 An increased severity of PEM is accompanied by
a decrease in salivary protein concentration and
arginase activity.

76. EFFECTS OF MINERAL AND VITAMIN
DEFICIENCIES ON SALIVARY GLAND
FUNCTION
 Animal studies have shown that
 Calcium deficiency may result in salivary secretion
dysfunction.
 Zinc deficiency in a reduction in parotid proline-rich
proteins.
 Iron deficiency in a reduction in secretion rate and
impaired peroxidase antibacterial activity.

77.  Vitamin A deficiency has been found to reduce the
activity of bacteria-agglutinating glycoproteins.
 vitamin A deficiency are also associated with salivary
gland atrophy, which subsequently reduces the defense
of the oral cavity against infection and its ability to
buffer the plaque acids.
 Vitamin D deficiency reduces parotid gland secretion.

78. MALNUTRITION AND PAROTID
ENLARGEMENT
 It is due to hypertrophy of the cells of the gland
and the condition is reversible with a return to
adequate nutrition.
 This condition is particularly common in males
and is possibly due to a work hypertrophy
following excessive stimulation of the gland by
malnutrition changes in the esophagus.

79. DIAGNOSTIC AIDS
 Conventional radiograph: conventional
radiographs such as occlusal radiograph or OPG
can be used in diagnosis of sialolithiasis

80. SIALOGRAPHY
 The technician will inject contrast material into the
duct.
 After the dye fills the salivary gland, X ray will be
taken to identify salivary gland disorder

81. SIALENDOSCOPY
 It is a minimally invasive procedure that incorporates a
small -calibre endoscope and facilitates direct
examination of the salivary ductal system.

82. ULTRASONOGRAPHY
Ultrasound examination of salivary glands with a high
resolution transducer is found to be a highly sensitive.
A non-invasive method for salivary gland evaluation
It is a cost effective imaging tool which displays high
definition images useful in evaluating the superficial
structures particularly the peripheral areas of the
affected salivary gland.

83.  Ultrasonography was found useful in diagnosing
salivary gland enlargement in submandibular
region
 It also helps in identifying the salivary glandular
tissue in accessory salivary gland and salivary
calculi.

84. SHOCK-WAVE LITHOTRIPSY
 Shock-wave lithotripsy is a non-invasive diagnostic tool
suggested for the management of sialolithiasis.
 Iro et al in 1989 introduced the application of
extracorporeal shock-wave lithotripsy (ESWL) in the
management of salivary gland calculi.
 Sialo lithotripsy helps in removing salivary stones into
smaller particles and thereby removal by flushing action is
possible from the salivary duct system or after salivation
induced by citric acid or other sialagogues.

85.  The shock-waves are generated extra-corporeally
by using Piezoelectric and electromagnetic
techniques or intra-corporeally using electro-
hydraulic, pneumatic or laser endoscopic devices.

86. SONOELASTOGRAPHY
 Elastography is an ultrasonography technique which
measures the tissue elasticity in vivo. This imaging
technique measures the elasticity of the glandular
parenchyma and is useful in evaluating the hypo function
of saliva especially in post radiation hypo function of
salivary glands.

87. COMPUTED TOMOGRAPHY
Computed tomography (CT) scans of the salivary glands
are useful in delineate the extent of the lesion and its relation
to adjacent structures.

88.  Multi detector CT scans help in characterizing
tumors of salivary glands like Warthin tumor
which demonstrates peak enhancement of signals
after administration of contrast agents which is not
found in other tumors of salivary glands.
 CT scans perform poorly in characterizing the
histopathologic nature of the tumors

89.  CT scans help in differentiating the benign and malignant
neoplasms of salivary glands. The irregular tumor margin and
surrounding tissue infiltration is the characteristic feature of
malignancy.
 Apart from tumor identification CT scan also aids to view
dystrophic calcifications in salivary glands

90. MAGNETIC RESONANCE IMAGING
 MRI scans are useful in assessment of salivary glands. The
wide variety of soft tissue signals differences and multi
planar image acquisition have made MRI an effective
imaging modality for assessment of salivary gland tumors.
PAROTID TUMOR

91.  This imaging modality is helpful in assessment of
tumors affecting the deep lobes of parotid glands,
skull base invasion of the tumors of salivary
glands, evaluation of recurrent pleomorphic
adenomas]. Also high resolution MRI scans
delineate the intra parotid course of facial nerve
which is an important landmark for surgeons
operating on parotid glands.

92.  Magnetic resonance sialography-Major limitations of
conventional sialography include use of iodine based
contrast agents and inability of the contrast agent in
overcoming the strictures within the ductal system of
the salivary gland which in turn prevent the
visualization. These limitations can be overcome by
switching on to MR sialography which uses patients
own saliva as a contrast medium.
 MR sialography also demonstrates the actual ductal
diameter due to non-use of contrast agents.

93.  SCINTIGRAPHY
Salivary gland scintigraphy uses Tc-99m
pertechnetate which helps in assessment of salivary
gland dysfunction in disorders like Sjogrens
syndrome.

94. NEWEST MEMBER!!?
TUBARIAL SALIVARY GLAND
Matthijs H.Valstar et al conducted a study
to to elucidate the characteristics of
previously unnoticed bilateral macroscopic
salivary gland locations in the human
nasopharynx and its potential clinical
implications for radiotherapy.They
visualized by using positron emission
tomography/computed tomography with
prostate-specific membrane antigen ligands
(PSMA PET/CT).

95.  Histology and 3D reconstruction confirmed the
presence of predominantly mucous glands with
multiple draining ducts, predominantly near the
torus tubarius.
 It was hypothesized that it could contain a large
number of seromucous acini, with a physiological
role for nasopharynx/oropharynx lubrication and
swallowing.

96.  This could have clinical relevance in oncology,
because high-dose external beam radiotherapy
(RT) to salivary glands during treatment for head
and neck cancer (HNC) or brain metastasis is
known to cause damage (toxicity, e.g. interstitial
fibrosis, acinar atrophy). This can result in
function loss with xerostomia and dysphagia

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