This document discusses salivary gland anatomy, function, and disorders. It begins by outlining the objectives of understanding salivary gland anatomy, diagnosing disorders, and familiarizing with treatments. It then describes the major salivary glands - parotid, submandibular, and sublingual glands - and their secretions. Minor salivary glands are also introduced. Diagnostic modalities like imaging, biopsies, and various treatment options for obstructive disorders like sialolithiasis and mucoceles are covered in detail.

1. Salivary Glands
Disorders
DR. Wael Talaat
Assistant Professor of Oral &
Maxillofacial Surgery
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2. Objectives



To know the anatomy of major salivary glands
To properly diagnose the different salivary
glands disorders
To be familiar with the different treatment
modalities
2

3. Major glands/Secretions

Major SG are paired structures and include the
parotid, submandibular and sublingual

Parotid: serous
Submandibular: mucous & serous
Sublingual: mucous


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4. Salivary Function



Aids in mastication, deglutination
Salivary lysozyme, IgA and other antibacterial
substances protect against caries and oral cavity
infections
Saliva also aids in speech
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5. 5

6. Anatomy: Parotid Gland
The largest salivary gland
 Lies wedge-shaped between the mandible
and sternomastoid muscle and over both
 Relations:
• Above: external auditory meats and
temporomandibular joint
• Below: post belly digastric
• Anteriorly: mandible and masseter
• Medially: styloid process and its muscles

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7. Relations of the Parotid
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8. Anatomy:Parotid Gland

CN VII branches
roughly divide the PG
into superficial and deep
lobes while coursing
anteriorly from the
stylomastoid foramen to
the muscles of facial
expression.
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9. Anatomy: Parotid Duct



Small ducts coalesce at the anterosuperior aspect of the
PG to form Stensen’s duct.
Runs anteriorly from the gland and lies superficial to
the masseter muscle
At the anterior edge of the masseter muscle, Stensen’s
duct turns sharply medial and passes through the
buccinator muscle, buccal mucosa and into the oral
cavity opposite the maxillary second molar.
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10. 10

11. Anatomy: Submandibular gland


Located in the submandibular triangle of the
neck, inferior & lateral to mylohyoid muscle.
The posterior-superior portion of the gland
curves up around the posterior border of the
mylohyoid and gives rise to Wharton’s duct.
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12. 12

13. Anatomy: Submandibular Duct


Wharton’s duct passes forward along the
superior surface of the mylohyoid adjacent to
the lingual nerve.
The nerve winds around the duct, first being
lateral, then inferior, and finally medial.
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14. Anatomy: Submandibular duct



2-4mm in diameter & about 5cm in length.
It opens into the floor of the mouth thru a
punctum.
The punctum is a constricted portion of the
duct to limit retrograde flow of bacteria-oral
fluids.
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15. 15

16. Anatomy: Sublingual glands
Lie on the superior
surface of the mylohyoid
muscle and are separated
from the oral cavity by a
thin layer of mucosa.
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17. Anatomy: Sublingual glands


The ducts of the sublingual glands are called
Bartholin’s ducts.
In most cases, Bartholin’s ducts consists of 820 smaller ducts of Rivinus. These ducts are
short and small in diameter.
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18. Anatomy: Sublingual glands

The ducts of Rivinis either open…
 individually into the FOM near the punctum
of Wharton’s duct
 on a crest of sublingual mucosa called the
plica sublingualis
 open directly into Wharton’s duct
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19. Major Salivary Glands
Bartholin`s ducts (sublingual : The : they
Stensen`s duct (Parotid duct ) ducts )duct are
8-20 into the oral cavity adjacent in the
opens in number and open directlyduct ) :floor
Wharton`s duct (Submandibular to maxillary
The
of or mouth molar
Or indirectly
firstthe second (plica sublingualis)the lingual
duct opens near the junction of
through the submandibular duct
frenum and the floor of the mouth
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20. Minor Salivary Glands
Minor S.G are referred to as the labial ,
buccal , palatine , tonsillar (Weber`s
glands) , retromolar (Carmalt`s glands) ,
and lingual glands which are divided into
three groups : inferior apical (glands of
Blandin Nuhn ) , taste buds (Von Ebner`s
gland) and the posterior lubricating
glands .
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21. Physiology



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Physiologic control of the SG is almost entirely
by the autonomic nervous system;
parasympathetic effects predominate.
If parasympathetic innervation is interrupted,
glandular atrophy occurs.
Normal saliva is 99.5% water
Normal daily production is 1-1.5L
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22. DIAGNOSTIC MODALITIS
1 ) History and clinical examination
It is very important in diagnosis of S.G
disorders , the clinician will be able to
categorize the problem as reactive ,
obstructive , inflammatory ,infectious ,
neoplastic , developmental or traumatic.
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23. DIAGNOSTIC MODALITIS
2) Salivary gland radiography
 Plain film radiography
 Sialography
 C.T scan , M.R.I and Ultrasound
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25. 25

26. Sialography
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27. Sialography
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28. DIAGNOSTIC MODALITIS
3) Sialochemistry
Examination of the electrolyte composition
of the saliva (sodium & potassium) may
indicate a variety of S.G disorders
For example :
Elevated Na+ with decreased P+ may
indicate an inflammatory sialadenitis
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29. DIAGNOSTIC MODALITIS
4) Fine needle aspiration biopsy
Fine needle aspiration biopsy is well
documented in differentiation between
benign & malignant S.G neoplasms
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30. 30

31. DIAGNOSTIC MODALITIS
5) Salivary gland biopsy
Either incisional or excisional can be used
to diagnose a tumor of one of the major
S.G
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32. Obstructive
Salivary Gland Disorders
Sialolithiasis
 Mucous retention/extravasation

32

33. Obstructive SG Disorders:
Sialolithiasis


Sialolithiasis results in a mechanical
obstuction of the salivary duct
Is the major cause of unilateral diffuse
parotid or submandibular gland swelling
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34. Sialolithiasis Incidence
Sialolithiasis remains the most frequent reason
for submandibular gland resection
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35. Sialolithiasis


The exact pathogenesis of sialolithiasis
remains unknown.
Thought to form via….
an initial organic nidus that progressively
grows by deposition of layers of inorganic
and organic substances.

May eventually obstruct flow of saliva from
the gland to the oral cavity.
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36. Sialolithiasis
Acute ductal obstruction may occur at
meal time when saliva producing is at its
maximum, the resultant swelling is sudden
and can be painful.
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37. Gradual reduction of the swelling can
result but it recurs repeatedly when flow
is stimulated.
This process may continue until
complete obstruction and/or infection
occurs.
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38. Etiology



Hypercalcemia
Xerostomic meds
Tobacco smoking
Smoking has an increased cytotoxic effect on
saliva, decreases PMNL phagocytic ability and
reduces salivary proteins
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39. Etiology
Gout is the only systemic disease known
to cause salivary calculi and these are
composed of uric acid.
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40. Stone Composition

Organic; often predominate in the center
Glycoproteins
 Mucopolysaccarides
 Bacteria
 Cellular debris


Inorganic; often in the periphery

Calcium carbonates & calcium phosphates in the
form of hydroxyapatite
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41. Parotid vs. Submandibular
Gland ….

Most authorities agree obstructive
phenomemnon such as mucous plugs and
sialoliths are most commonly found in the
SMG
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42. Reasons sialolithiasis may occur
more often in the SMG





Saliva more alkaline
Higher concentration of calcium and
phosphate in the saliva
Higher mucus content
Longer duct
Anti-gravity flow
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43. Clinical presentation



Painful swelling (60%)
Painless swelling (30%)
Pain only (12%)
Sometimes described as recurrent salivary
colic and spasmodic pain upon eating

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44. Clinical History

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History of swellings / change over time?
Trismus?
Pain?
Variation with meals?
Dry mouth? Dry eyes?
Recent exposure to sick contacts (mumps)?
Radiation history?
Current medications?
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45. Diagnostics: Plain occlusal film


Effective for
intraductal stones,
while….
intraglandular,
radiolucent or
small stones may be
missed.
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46. Diagnostic approaches
1- CT Scan
2- Ultrasound
3- Sialography
4- Diagnostic Sialendoscopy
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47. Sialolithiasis Treatment


None: antibiotics and anti-inflammatories,
hoping for spontaneous stone passage.
Stone excision:
Interventional sialendoscopy
 Simple removal (20% recurrence)


Gland excision
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48. Gland excision
indicated
Very posterior stones
Intra-glandular stones
Significantly symptomatic patients
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49. 49

50. Mucocele

Can be classified as a cystic salivary gland lesion
and as an obstructive salivary gland disorder.
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51. Mucocele


Mucus is the exclusive secretory product of the
accessory minor salivary glands and the most
prominent product of the sublingual gland.
The mechanism for mucus cavity development
is extravasation or retention
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52. Mucocele

Mucoceles, exclusive of the irritation
fibroma, are most common of the
benign soft tissue masses in the oral
cavity.

Muco: mucus , coele: cavity. When in the
oral floor, they are called ranula.
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53. Mucocele
Extravasation is the leakage of fluid from the ducts or
acini into the surrounding tissue.
Extra: outside, vasa: vessel
Retention: narrowed ductal opening that cannot
adequately accommodate the exit of saliva produced,
leading to ductal dilation and surface swelling. Less
common phenomenon
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54. 

Which of the two is a pseudo cyst ??
Would the mucocele of the lower lip be an
extravasation or retention cyst ??
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55. Mucocele
Consist of a circumscribed cavity in the
connective tissue and submucosa producing
an obvious elevation in the mucosa

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56. Mucocele

The majority of the mucoceles result from an
extravasation of fluid into the surrounding tissue
after traumatic break in the continuity of their
ducts.

Lacks a true epithelial lining.
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57. Ranula


Is a term used for
mucoceles that occur in
the floor of the mouth.
The name is derived
form the word rana,
because the swelling
may resemble the
translucent underbelly
of the frog.
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58. Ranula

Although the source is usually the sublingual
gland,
may also arise from the submandibular duct
 or possibly the minor salivary glands in the floor
of the mouth.

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59. Ranula



Presents as a blue dome shaped swelling in the floor
of mouth (FOM).
They tend to be larger than mucoceles & can fill the
FOM & elevate tongue.
Located lateral to the midline, helping to distinguish
it from a midline dermoid cyst.
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61. Cervical Ranula


Occurs when spilled mucin dissects through the
mylohyoid muscle and produces swelling in the
neck.
Concomitant FOM swelling may or may not be
visible.
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62. Treatment of Mucoceles in Lip
or Buccal mucosa


Excision with strict removal of any projecting
peripheral salivary glands
Avoid injury to other glands during primary
wound closure
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63. Ranula Treatment


Marsupialization has fallen into disfavor due to
the excessive recurrence rate of 60-90%
Sublingual gland removal via intraoral approach
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64. Thank You
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