Its about surgery

2.  The salivary glands are exocrine glands,
glands with ducts, that produce saliva and
pour their secretion in the oral cavity.
 Major (Paired) –Parotid
 Submandibular
 Sublingual
 Minor -Those in the Tongue, Palatine
Tonsil, Palate, Lips and Cheeks

4. PAROTID GLAND
 Largest
 Average Wt - 25gm
 Irregular lobulated mass lying mainly below the
external acoustic meatus between mandible and
sternomastoid.
 Superficial (80%) and deep part(20%).
 Deep cervical fascia splits to enclose parotid gland and
form parotid capsule.

5.  Superficial part lies over posterior part of ramus of
mandible.
 Deep part lies behind the mandible and medial
pterygoid muscle.
 These two lobes are separated by External carotid
artery, retromandibular vein and facial nerve.

7.  Resembles an inverted 3 sided pyramid
 Four surfaces
 Superior(Base of the Pyramid)
 Superficial
 Anteromedial
 Posteromedial
 Three borders- Anterior, Posterior, Medial.

9. RELATIONS
 Superior Surface
 Concave
 Related to • Cartilaginous part of ext acoustic meatus
• Post. Aspect of temperomandibular joint
. Auriculotemporal Nerve
• Sup. Temporal vessels

11.  SUPERFICIAL SURFACE
 Covered by
• Skin
• Superficial fascia containing facial branches of
great auricular N
• Superficial parotid lymph nodes and post fibers of
platysma

13.  ANTEROMEDIAL SURFACE
• Grooved by posterior border of ramus of mandible
• Related to
• Masseter
• Lateral Surface of temporomandibular joint
• Medial pterygoid muscles
• Emerging branches of Facial N

14.  Posteromedial Surface
 • RELATED TO -
 • Mastoid process with sternomastoid and posterior
belly of digastric.
 • Styloid process with structures attached to it.
 • External Carotid A. which enters the gland through
the surface
 • Internal Carotid A. which lies deep to styloid process

16.  BORDERS
 Anterior border
 • Separates superficial surface from anteromedial
surface.
 Structures which emerge at this border
• Parotid Duct
• Terminal Branches of facial nerve
• Transverse facial vessels

17.  Posterior Border
 • Separates superficial surface from posteromedial
surface
 • Overlaps sternomastoid

18.  Medial Border
 • Separates anteromedial surface from posteromedial
surface
 • Related to lateral wall of pharynx

20. Structures within the parotid
gland
 Supplied by External carotid artery.

21.  Venous drainage by External jugular vein.

22.  NERVES

23.  Parotid Duct
 • ductus parotideus; Stensen’s duct
 • 5 cm in length
 • Appears in the anterior border of the gland
 • Runs anteriorly and downwards on the masseter b/w
the upper and lower buccal branches of facial N.
 • At the anterior border of masseter it pierces Buccal
pad of fat , Buccopharyngeal fascia , Buccinator
Muscle and opens into the vestibule of mouth opposite
to the 2nd upper molar.

24.  Surface anatomy of Parotid Duct
 • Corresponds to middle third of a line drawn from
lower border of tragus to a point midway b/w nasal ala
and upperlabial margin.

25. NERVE SUPPLY
 •Parasymapthetic N - Secretomotor via
auriculotemporal N, branch of mandibular division of
trigeminal nerve.
 •Sympathetic N • Vasomotor
 • Delivered from plexus around the
external carotid artery
 •Sensory N -Reach through the Great auricular and
auriculotemporal N

26.  Incision
 • Lazy ‘S’ incision
 • Pre-auricular—mastoid-cervical incision
 • Blairs incision and modified blairs
 • Facelift incision

27.  • A modified Blair incision is planned in a preauricular
crease coursing around the ear lobule and then into an
upper neck crease.

29.  During surgical removal of parotid gland for any
tumour the facial nerve is preserved by removing the
glands in two parts superficial and deep lobe
separately.
 Temporary paralysis due to traction recovers in 6 to 8
weeks.

30.  Frey's 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 due todamage 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.  The iodine test administered by applying an alcohol–
iodine–castor oil solution.
 • The solution was applied on the lateral portion of the
face that had been surgically treated and the upper
region of the neck.
 • The solution was allowed to dry and was covered
lightly with starch powder.
 • The patients received lemon candy for a gustatory
stimuli for 10 minutes.
 • Discoloration of the starch iodine mixture was
interpreted as a positive finding for Frey’s syndrome

32.  There is no effective treatment, but various options
are described:
 i. Injection of Botulinum Toxin to local part
 ii. Surgical transection of the nerve fibers
 iii. Application of an ointment containing an
anticholinergic drug such as scopolamine

33. submandibular salivary gland
 Submandibular Glands are….
 • Irregular in shape
 • Large superficial and small deeper part continous
with each other around the post. Border of mylohyoid

35.  Superficial Part
 • Situated in the digastric triangle
 • Wedged b/w body of mandible and mylohyoid
 • 3 surfaces - Inferior, Medial, Lateral

37.  Capsule
 • Derived from deep cervical fascia
 • Superficial Layer is attached to base of mandible
 • Deep layer attached to mylohyoid line of mandible

38. Relations
 Inferior- covered by
 • Skin
 • Superficial fascia containing platysma and cervical
branches of facial N
 • Deep Fascia
 • Facial Vein
 • Submandibular Nodes

40.  Lateral surface
 • Related to submandibluar fossa on the mandible
 • Mandibular attachment of Medial pterygoid
 • Facial Artery

41.  Medial surface
 • Anterior part- is related to myelohyoid muscle, nerve
and vessels
 • Middle part - Hyoglossus, styloglossus, lingual
nerve, submandibular ganglion, hypoglossal nerve and
deep lingual vein.
 • Posterior Part - Styloglossus, stylohyoid ligament,9th
nerve and wall of pharynx

43.  Deep part
 • Small in size
 • Lies deep to mylohyoid and superficial to hyoglossus
and styloglossus
 • Posteriorly continuous with superficial part around
the posterior border of mylohyoid

44.  Submandibular 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

46. Blood supply and lymphatics
 Arteries - Branches of facial and lingual arteries,
branches of external carotid.
 Veins - Drains to the corresponding arteries.
 Lymphatics - Deep Cervical Nodes via
submandibular nodes

47. Nerve supply
 Parasymapthetic fibers from chorda tympani, a
branch of facial nerve.
 Sensory fibers from lingual branch of mandibular
nerve
 Sympathetic fibers from plexus on facial A

48. Applied aspects
 The formation of calculus is more common in the
submandibular gland than in the parotid.
 For excision of the submandibular salivary gland( for
calculus or tumour), a skin crease incision is as a rule,
given more than 1 inch( 2.5cm) below the angle of the
jaw
 A stone in the submandibular duct(wharton’s duct)
can be palpated bimanually in the floor of the mouth
and can even be seen if sufficiently large.

49.  Incision
 • Placed 2-4 cm below the mandible, parallel to it
 • Preserve :
 • Marginal mandibular nerve
 • Lingual nerve
 • Hypoglossal nerve

50. 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.

51.  RELATIONS
 Above - Mucosa of oral floor, raised as sublingual
fold
 Below - Myelohyoid
 Behind - Deep part of Submandibular gland
 Lateral - Mandible above myelohyoid line.
 Medial - Genioglossus muscle,lingual nerve and
submandibular duct.

53.  DUCT
 • Ducts of Rivinus
 • 8-20 ducts
 • Most of them open directly into the floor of mouth
 • Few of them join the submandibular duct

54.  Blood supply
 • Arterial from sublingual and submental
arteries,branches of ECA.
 • Venous drainage corresponds to the arteries
 Nerve Supply
 • Similar to that of submandibular glands( via lingual
nerve , chorda tympani and sympathetic fibers)

55.  Sublingual and minor salivary gland diseases
 • Mucous cyst (retention cyst) : Ranula, sailoliths
 • Inflammatory salivary gland diseases
 • Tumors rarely effects sublingual glands

56. Applied aspects
 The structures at risk during dissection of the gland
are the submandibular duct and the lingual nerve.
 The duct lies superficially in the floor of the mouth
medial to the sublingual fold, and is crossed inferiorly
by the nerve which then enters the tongue
 The sublingual artery and vein also lie on the medial
aspect of the gland close to the submandibular duct
and lingual nerve.

57.  APPROACH TO SUBLINGUAL GLAND:- •
INTRAORAL APPROACH:- -
 - linear incision is made parellel and lateral to
submandibular duct
 - incision shouldn’t extend more posteriorly to 1st
molar tooth to avoid damage to lingual nerve
 - the submandibular duct is carefully identified and
retracted medially - stay sutures-passeing through
margins of mucosa to aid in retention