2. CONTENTS
• Introduction
• Salivary glands
• Development of Salivary glands
• Classification of salivary glands
• Major Salivary glands
• Parotid gland
• Submandibular gland
• Sublingual gland
• Minor Salivary glands
• Histochemical nature of secretory product
• Stages of Development of salivary gland
• Structure of Terminal Secretory units
• Developmental Anomalies
• Diseases of Salivary Gland
• Age changes of Salivary Gland
2
3. INTRODUCTION
• The oral cavity is kept moist by a film of
fluid called saliva that coats the teeth and
the mucosa.
• Saliva is a complex fluid, produced by the
salivary glands.
• Salivary glands are a subtype of exocrine
glands, which are glandular structures that
involve a duct system to release their
products onto an epithelial surface.
• This differs from endocrine glands (like
the adrenal and thyroid glands) that release
their products directly into the
bloodstream. 3
5. SALIVARY GLANDS
• Function : salivary glands is to produce saliva, which aids in lubrication
• digestion of food
• taste
• immunity
• oral homeostasis
• Development : begins at 6th week of IU life.
5
8. MAJOR SALIVARY GLANDS
• The largest of the
glands are the three
bilaterally paired
major salivary glands.
They are all located
extra orally, and their
secretions reach the
mouth by variably
long ducts.
8
9. PAROTID GLAND
• Development:
• Begins at 6th week of IU life.
• They are the first salivary gland to form.
• They start off as little epithelial buds near the lips of the primitive
mouth.
• These buds will move toward the back, closer to the otic placodes of
the ears.
• The ducts that channel through the parotid glands will form at the
10th week.
• The ends of the ducts will become populated with the secretory acini
cells, which only 18th of IU life will begin to secrete into the parotic
duct.
9
10. ANATOMY
• The parotid is the largest major salivary gland.
• Location: This gland situated in the pyramidal fossa,
posterior to the ramus of the mandible which is called
the retromandibular fossa (parotid bed).
• Subcutaneous portion lies in front of the
external ear
• Deeper portion lies behind the ramus of the
mandible, filling the retromandibular fossae.
• Weight: 14 - 28 grams.
• Appearance: Tan-yellow
• It is purely serous secreting gland
10
11. • General outline:
Inverted pyramid, the base is the
most superior part of the gland, while
the blunted apex points inferiorly.
It also has anteromedial,
posteromedial, and superficial
surfaces.
11
12. Blood Supply & Lymphatic Drainage
Arterial supply:
• External carotid and its
branches
Venous supply:
• Retromandibular vein and
its branches
12
Parotid gland
Superficial and deep parotid lymph
nodes
Deep cervical lymph nodes
Lymphatic Drainage
15. • This occurs when both parasympathetic and
sympathetic axons of the auriculotemporal nerve are
damaged in trauma or surgical procedures like
parotidectomy.
• Aberrant nerve regeneration can occur, resulting in the
postganglionic parasympathetic fibers growing along the
sympathetic pathways to cross-innervate the vessels and
sweat glands of the face.
• This causes vessel dilation and sweat production in
response to gustatory stimulation.
• Because aberrant nerve regeneration takes time to produce
gustatory sweating, the presentation of Frey syndrome is
generally delayed by 6 to 18 months after surgery.
FREY SYNDROME/AURICULOTEMPORAL NERVE
SYNDROME
16. • Clinical features:
(a) When a person eats, the ipsilateral cheek (parotid region) becomes red, hot, and
painful. It is associated with beads of perspiration (gustatory sweating).
(b) When a person shaves, there is cutaneous hyperesthesia in front of the ear.
• Evaluation:
Minor starch-iodine test
• Management:
• Preventive techniques:
• Thick skin flap
• Acellular dermal matrix
• Autologous fat implantation
• Superficial muscular aponeurotic system flap
• Temporoparietal fascia flap
• Sternocleidomastoid flap
17. • Medical treatment:
• Topical antiperspirants
• Injection of alcohol to the otic
ganglion
• Botulinum toxin for local injection
• Surgical treatment:
• Jacobson’s neurectomy, which
involves resectioning the tympanic
nerve (a branch of the
glossopharyngeal nerve), and
identifying Jacobson’s nerve. The
nerve is sectioned, and the
canaliculus is obliterated to prevent
the regeneration of the nerve fibers.
17
18. STENSON’S DUCT
• Length – 5 cm and width – 3 cm
• comes out from the middle of the anterior border of
the parotid gland and which opens into the vestibule
of the mouth opposite side of the crown part of the
upper second molar tooth.
18
Stenson’s duct
19. ANATOMY:
• This large salivary gland, about the
size of a walnut.
• Location: Partly below and partly
deep to the posterior half of the
mandible.
• Size: It is half the size of the parotid
gland weight: 10–20 g.
• It is a mixed type of gland (that is
both mucus and serous in nature)
but predominantly serous.
19
SUBMANDIBULAR GLAND
20. • Floor of mouth: Clinically this region
is very important because it is the
common site for swellings due to
enlargement of submandibular
lymph nodes and submandibular
salivary gland.
• The inflammatory edema of the
floor of the mouth (called Ludwig’s
angina) spreads in this region to
cause generalized swelling of the
region.
20
21. Ludwing’s Angina
• Ludwig's angina is a rapidly progressive bilateral
cellulitis of the submandibular space associated
with elevation and posterior displacement of
the tongue usually occurring in adults with
concomitant dental infections.
• Site: second mandibular molar is the most
common site ,but the third mandibular molar is
also commonly involved.
• The inflammatory response leads to edema of
the neck and tissues of the submandibular,
submaxillary, and sublingual spaces.
• Significant edema may cause trismus and an
inability to swallow saliva.
• Pain, especially with tongue movement, is
common with Ludwig's angina.
21
22. MANAGEMENT
• There are four principles that guide the treatment of
Ludwig's Angina:
1. Sufficient airway management
2. Early and aggressive antibiotic therapy
3. Incision and drainage for any who fail medical
management or form localized abscesses
4. Adequate nutrition and hydration support.
22
24. Facial artery loops downwards and
forwards between the bone and the
gland
winds around the lower border of the
body of the mandible at the
anteroinferior angle of the mandible
to reach the face
24
25. Bi-manual palpation of submandibular salivary
gland
• Part of the gland lies in the oral cavity above
the floor of the mouth and part outside the
oral cavity below the floor of the mouth.
• The submandibular lymph nodes lying on
the surface of the gland cannot be palpated
bimanually as they lie below the floor of the
mouth.
• Thus an enlarged submandibular gland can
be differentiated from a mass of the
submandibular lymph nodes by bimanual
palpation.
25
26. WHARTON’S DUCT
• Length : 5 cm
• Emergers at the anterior end of the
deep part of the submandibular
gland
crossed by the lingual nerve
runs forward with lingual nerve and
vein and hypoglossal nerve
opens into the sublingual papilla at the
side of the frenulum of the tongue.
26
27. BLOOD SUPPLY & LYMPHATIC DRIANAGE
• The gland is supplied by sublingual and submental
arteries and drained by common facial and lingual
veins.
27
Submandibular gland
submandibular lymph nodes
jugulodigastric lymph nod
Lymphatics
Blood Supply
Lymphatic Drainage
28. NERVE SUPPLY
Parasympathetic Sympathetic Sensory Supply
Preganglionic fibers
Arises from superior
salivatory nucleus
pass successively through
facial, chorda tympani &
lingual nerves;
terminate in the submandibular ganglion
which serves as a relay station.
28
Postganglionic fibers
Arise from submandibular
ganglion
Supply to the
Submandibular gland
Preganglionic
fibers
Arise from T1
spinal segment
Relay in its superior
cervical sympathetic
ganglion
Postganglionic
fibers
Arise from
superior cervical
sympathetic
ganglion
Form plexus &
reach the gland
through facial
artery
Lingual nerve
29. • Shape: oval shape when sectioned
transversely, however, the gland shape is
longitudinal and lentiform when sectioned
parallel to the body of the mandible.
• Location: Inferolateral to the tongue, below the
mucosa of the floor of the mouth, and above
the mylohyoid muscle.
• Sublingual tissue is palpable behind the
mandibular canines.
• This is seromucous ,predominantly mucous.
ANATOMY:
29
SUBLINGUAL GLAND
30. • Saliva secretes directly through
the ducts of Rivinus.
• The sublingual duct of Bartholin
joins Wharton’s duct to form the
draining orifice on each side of
the lingual frenulum.
Bartholin’s Duct
30
31. NERVE SUPPLY
• The postganglionic fibers reach the sublingual gland, and release
acetylcholine and substance P. Acetylcholine, the primary
neurotransmitter, and the muscarinic receptors work to increase
salivation .
31
32. MINOR SALIVARY GLANDS
• The minor salivary glands account for
approximately 1% or less of the total
daily salivary output.
• They can be found in patches around the
oral cavity such as the buccal, the labial,
the lingual mucosa, the soft palate, the
lateral parts of the hard palate, the floor
of the mouth and between the muscle
fibers of the tongue.
• They amount to approximately 800-1000
individual glands in total.
32
33. WEBER’S GLAND/RETROMOLAR GLAND
• Muciparous glands on the side of the tongue.
• They are a minor salivary gland in the
peritonsillar space.
• They clear the peritonsillar space of debris.
• Peritonsillar abscess is an infection of
the Weber's gland resulting in tissue
necrosis and pus formation.
• Cause: Klebsiella pneumoniae
peritonsillar abscess followed by liver
abscess in an immunocompetent adult
33
35. PALANTINE GLANDS
• Aggregates in the lamina propria
postero-lateral region of the hard
palate and in the submucosa of the
soft palate and the uvula.
• Opening of the palatine ducts are
large.
35
36. BLANDIN-NUHN GLAND
The anterior lingual salivary glands (glands of
Blandin and Nuhn) are mixed- mucous and serous
glands that are embedded within the musculature of
the anterior tongue.
The glands drain by means of five to six
small ducts that open near the lingual
frenum in the location of the fringed fold
known as the plica fimbriata.
36
BLANDIN-NUHN GLAND
37. Von – Ebner's Gland
• Location: In tongue and open into
the troughs surrounding
circumvallate papillae on the dorsum
of the tongue and at the foliate
papillae on the side of the tongue.
• Secrete digestive enzymes & proteins
that are thought to play role in taste
process.
• Fluid of their secretion cleanse the
trough & prepare the taste receptors
for a new stimuli.
37
39. Histochemical nature of the secretory product
39
MUCOUS : LABIAL & BUCCAL GLANDS
GLOSSOPALATINE
PALATINE
SEROUS: PAROTID
VON – EBNER’S GLAND
MIXED: SUBMANDIBULAR &
SUBLINGUAL
40. TUBARIAL GLAND
• The tubarial salivary glands, are a pair of
salivary glands found in humans between
the nasal cavity and throat.
• The tubarial glands are found in the lateral
walls of the nasopharynx
• PSMA PET/CT also depicted an unknown
bilateral structure posterior in the
nasopharynx, with ligand uptake similar to
the known major salivary glands.
• It is believed to lubricate & moisten the
upper throat.
40
41. DEVELOPMENT OF SALIVARY GLANDS
Embryologic development of salivary gland is the result of a highly
orchestrated complex interaction between two distinctive tissues, the
oral epithelium and underlying mesenchyme.
41
42. STAGES OF DEVELOPMENT OF
SALIVARY GLAND:
• BUD FORMATION
• CORD FORMATION
• BRANCHING OF CORDS
• LOBULE FORMATION
• CANALIZATION
• CYTODIFFERENTIATION
42
43. DEVELOPMENT
Individual salivary glands
Proliferation of oral epithelial cells
Forming a focal thickening
Grows into the underlying ectomesenchyme
Formation of a small bud [stage 1] - 6th week of IU Life
connected to the surface by a trailing cord of epithelial
cells [stage 2] with mesenchymal cells condensing
around the bud
Clefts develop in the bud, forming two or more new
buds
Branching morphogenesis [stage 3]
43
44. • Signaling molecules: Includes
members of fibroblastic growth
,protein family, sonic hedgehog,
transforming growth factor β, and
their receptors, play a major role
in the development of branches.
• Finally, the specific mesenchyme
associated with the salivary glands
has been shown to provide the
optimum environment for gland
development.
44
45. • The epithelial parenchymal components
increase in size and number.
• The associated mesenchyme (connective
tissue) is diminished, although a thin layer
of connective tissue remains, surrounding
each secretory end piece and duct of the
adult gland.
• Thicker partitions of connective tissue
(septa), continuous with the capsule and
within which run the nerves and blood
vessels supplying the gland, invest the
excretory ducts and divide the gland into
lobes and lobules. [stage 4]- 10th week of
IU Life
45
46. • Development of a lumen: within the
branched epithelium generally occurs in
this order:
1) in the distal end of the main cord and in
branch cords
2) in the proximal end of the main cord
3) in the central portion of the main cord
• The cells of the inner layer eventually
differentiate into the secretory cells of the
mature gland, mucous or serous,
depending on the specific gland [stage 5]-
18th week of IU Life.
• Some cells of the outer layer form the
contractile myoepithelial cells that are
present around the secretory end pieces
and intercalated ducts [stage 6] -28th week
of IU Life.
46
47. Structure of Terminal secretory units
• The basic functional unit of a salivary
gland is the terminal secretory unit
called acini.
• An acinus refers to any cluster
of cells that resembles a many-lobed
"berry," such as
a raspberry (acinus is Latin for
"berry").
• The serous, mucous along with
myoepithelial cells are arranged in an
acinus or acini (multiple) with a roughly
spherical or tubular shape and a central
lumen.
47
48. TYPES OF ACINI
• Cubiodal/columnar
• Oval nuclei pressed
towards base
• Most often organized as
tubules, consisting of
cylindrical arrays of
secretory cells
surrounding a lumen
• Pyramidal
• Broad base resting
on the basal lamina
• Narrow apical
surface
• Mucous acini which
is capped by serous
cells forming a
Serous demilune
called Crescent of
Gianuzzi .
• Secretion of
demilune passes to
the lumen through
canaliculi between
the mucous cells.
Mucoserous
/
48
49. It has been shown that demilunes areas a result of artifact during tissue
preparation.
Recent methods like rapidfreezing,freeze substitution andthree-dimensional
reconstruction techniques have shown that serous cells align with mucous
cells to surround a common lumen.
49
50. SEROUS CELL MUCOUS CELL
On the basis of secretion :
• Little or no enzymatic activity
• Produce more carbohydrate components than
proteins
• Enzymatic activity – Acid phosphatase, esterases,
Glucuronidase
• Produce secretory proteins, carbohydrate content
less Secretory glycoproteins
On the basis of functions:
• Solubilizing the dry food, maintaining oral hygiene,
and initiating starch digestion
• Lubricating the oral cavity and making food into the
slippery bolus
On the basis of light microscopy:
• Apical portion contains zymogen granules
• Apical portion stains strongly with H&E
• Apical portion shows numerous eosinophilic
secretory granules which stains with toluidine blue
• Secretion of granules as string of pearls – No loss of
cytoplasm
• Apical portion of cell appears empty
• Apical portion stains weakly with H&E
• Apical portion stains strongly with carbohydrate
stains like PAS, Alcian blue
• Apical cytoplasm not sealed – Mucus spilled into
lumen
50
51. MYOEPITHELIAL CELLS
• Myoepithelial cells are contractile cells associated with the secretory end
pieces and intercalated ducts of the salivary glands.
• Location: between the basal lamina and the secretory or duct cells and are
joined to the cells by desmosomes.
• Appearance: Reminiscent of a basket cradling the secretory unit, hence the
terms ‘basket cell’.
• Derived from epithelium but are
51
52. • The myoepithelial cells are innervated through the parasympathetic motor
nerve.
Functions:
1. Accelerate the initial outflow
2. Reduce luminal volume.
3. Contribute to secretory pressure
4. Support the underlying parenchyma and reduce the back permeation of
fluid.
5. Help salivary flow to overcome increase in peripheral resistance of the
ducts.
52
53. DUCTS
• The ductal system of salivary glands is a varied
network of tubules that progressively increase
in diameter, beginning at the secretory end
pieces and extending to the oral cavity.
• Each type of duct is lined by different type of
epithelium, depending on its location in the
gland.
• The ductal system is not just a pipeline or
conduit for the passageway for the saliva; it
also actively participates in the production and
modification of saliva.
53
54. INTERCALATED DUCTS
• Lined by single layer of low cuboid cells with
relatively empty appearing cytoplasm.
• contribute to macromolecular components
like lysozymes, lactoferrin and some
unknown components to the saliva.
• Because of their small size and lack of
distinctive features, difficult to identify in
routine histologic sections.
54
55. STRAITED DUCTS
• Function: The striated ducts receive
saliva from the intercalated ducts and
also modify the primary saliva received.
• The duct cells synthesize and secrete
glycoproteins such as kallikrein and
epidermal growth factor.
• They form the largest portion of the duct system.
• Lined by a layer of tall columnar epithelial cells
with large, spherical, centrally placed nuclei.
55
56. EXCRETORY DUCTS
• The striated ducts join each other to
form larger intralobular ducts.
• These ducts gradually increase in size
and are surrounded by increasing layers
of connective tissue.
• Progressively along the path, the duct
becomes nonstriated and large, to
become the excretory interlobular duct.
56
57. CONNECTIVE TISSUE
• Connective tissue of the salivary gland
consists of a surrounding capsule that
demarcates the gland from the adjacent
structures.
• The extension of the connective tissue as
septa inward from the capsule divides the
gland into lobes and lobules.
• The septa contain blood vessels and nerves
that supply the parenchymal components
(glandular components) and excretory ducts.
• Connective tissue - fibroblasts, macrophages,
dendritic cells, mast cells, plasma cells,
adipose cells, and occasionally granulocytes
and lymphocytes.
• Plasma cells located adjacent to the secretory
end pieces and intralobular ducts produce
immunoglobulins.
57
58. NERVE SUPPLY
• Innervation:
• Postganglionic nerve fibers of
the sympathetic and
parasympathetic divisions of
the autonomic nervous system.
• The axons of each nerve
bundle are invested by
cytoplasmic processes of
Schwann cells.
58
61. ABBERANT SALIVARY GLANDS
• Abberant/ectopic is a salivary gland tissue that develops at a site where it
is not found normally.
• Clinical features:
• Site – cervical region near the parotid gland or body of mandible.
• Posterior to first molar
• Site for development of retention cyst or neoplasm
61
62. APLASIA & HYPOPLASIA
• Aplasia : It is congenitally absence of salivary gland
- occurs with congenital anomalies
• Hypoplasia : occurs with Melkerson Rosentha
syndrome
• Clinical features:
• Xerostomia
• Dental caries
• Early loss of teeth
• Dry oral mucosa
• Cracking & fissuring at corner of mouth
• Management:
• Good oral Hygiene
62
63. HYPERPLASIA
• Hyperplasia of the terminal duct of salivary glands.
• Causes:
• Hormonal
• Metabolic
• Site: Minor salivary glands of palate
• Asymptomatic when surface is firm, sessile & normal in color
• Management:
• Excision for microscopic examination
63
64. ATRESIA
• Congenital occlusion or absence of one /two major salivary ducts.
• Site: Submandibular duct in floor of mouth
• Clinical feature: Xerostomia
ACCESSORY DUCTS
• Most common developmental anomaly
• Site: superior and anterior to normal stenson’s duct orifice.
64
65. DIVERTICULI
• Small pouches or out pocketing of ductal system of one the major salivary
glands.
• Cause:
• pooling of saliva and recurrent sialadenitis, especially parotitis
• sialolith
Congenital Fistula
• Sinus tract form either in crease behind the pinna or in front of the tragus.
• Management:
• Complete surgical excision of sinus tract.
65
67. PLEOMORPHIC ADEMONA/ BENIGN MIXED
TUMOR
• Most common salivary gland tumor,
because of its dual origin from epithelial
and myoepithelial elements.
• Etiology: Unknown
• Incidence: Increasing in the last 15-20 years
in relation to the exposure of radiation to the
head and neck region
• Epidemiology:
• All ages are included
• account for 70-80% of benign salivary gland
tumors and are especially common in
the parotid gland.
• predominantly affects superficial lobe of the
parotid gland.
67
68. • Management:
• Superficial (Patey's operation) or total parotidectomy with the latter being the
more frequently performed procedure due to lower incidence of recurrence.
Meticulous technique is required to preserve the facial nerve. The tumors of the
submandibular glands are treated with simple excision procedure with
preservation of adjacent nerve including the mandibular branch of the trigeminal
nerve, the hypoglossal nerve, and the lingual nerve.
• The plane between the superficial and deep lobes in which nerves and veins lie
has been designated by Patey as faciovenous plane.
• This plane helps the surgeons to remove the parotid tumor without damaging
the nerve.
68
69. WARTHINS TUMOR
• It is a benign and frequent salivary gland
neoplasm.
• Causes: Epstein Barr virus infection, tobacco,
autoimmune disease, ionizing radiation, and
chronic inflammationary epithelial tumors of the
parotid gland.
• Epidemiology: Warthins tumor occasionally occurs
in young patients
• Clinical features: Warthin tumor presents as a
rounded or an ovoid nodular painless, slow-
growing, fluctuant to firm at palpation.
Warthin tumor induces little or no pain, ear
ringing, ear pain, and hearing loss in some cases.
• Management: Relies on surgical removal, which
can be easily realized due to the superficial
location of the tumor.
69
70. MYOEPITHELIOMA
• It is usually benign.
• They account for 1% of the salivary tumors with
poor prognosis.
• It consists of myoepithelial cells. Classically, they
are found in the parotid gland or palate.
• A similar tumor type may be found in the tongue,
referred to as ectomesenchymal chondromyxoid
tumor.
Management:
• Benign myoepithelioma are treated with simple
excision.
• They are less prone to recurrence than
pleomorphic adenoma.
• Malignant myoepitheliomas are excised and have
been treated in the past with dacarbazine but
are prone to both metastasis and re-occurrence. 70
71. Salivary gland stones (Sialolithiasis)
• Calculi in the salivary gland are more common in
the submandibular gland than the parotid gland.
• Its secretion is more viscid and alkaline
• Its duct takes a tortuous and upward course, which hampers
its smooth drainage (against gravity) into the floor of the mouth
• The presence of the stone obstructs the flow of
saliva from the gland leading to acute swelling
with meals.
• The swelling usually resolves about an hour after
the onset of symptoms.
• Palpation of the duct or visualization of the duct
orifice will likely reveal the offending agent.
• Plain radiography may also reveal the presence of
the stones, as the majority of them are radio-
opaque.
71
72. SUPPURATIVE PAROTITIS
• Most commonly occurs in neonates or
patients with dehydration, poor oral hygiene,
malnutrition, immunosuppression, oral
trauma, sepsis, or any medication
or disease that decreases salivary
secretions.
• Clinical features: Acute onset of pain, swelling,
warmth, and induration of the involved gland
and purulent discharge from the Stenson’s duct.
• Physical findings: fever, trismus, malaise,
and cervical adenitis.
• Bacterial infection of the parotid gland
usually in patients with decreased salivary flow.
• Cause: Staphylococcus aureus.
72
73. GRANULOMATOUS PAROTITIS
• Clinical features: painless, slowly enlarging mass without surrounding
inflammation. It may be misdiagnosed as a slow-growing tumor until the
correct diagnosis often is made by biopsy and culture.
• Cause: M. tuberculosis and M. avium–intracellulare may cause infection
in the parenchyma of the gland or in intraglandular or periglandular
lymph nodes.
• Clinical evidence of systemic tuberculous disease usually is absent.
• Parotitis has been observed as an extension of nontuberculous cervical
adenitis.
• Actinomycosis of the parotid gland causes a slowly enlarging, nodular,
nontender gland; associated oral or cervicofacial infection usually is
present.
• Fistulas draining yellow or white material with sulfur granules are 73
74. RECURRENT PAROTITIS
• Recurrent parotitis of childhood is rare, with onset
that typically occurs before the child reaches 10
years of age and a peak incidence at approximately
6 years of age.
• Underlying congenital abnormality, such as
sialectasis, is a common predisposing feature.
• Selective IgA deficiency may be a contributing
variable.
• Clinical features: Repeated episodes of fever, pain,
and unilateral swelling of the parotid gland. Purulent
material often can be expressed from the Stenson’s
duct and, when cultured, often yields streptococcal
organisms.
74
75. • Sialography and ultrasound reveal multiple areas of sialectasis
throughout the parotid glands bilaterally, even if only one side is
symptomatic.
• The frequency of attacks varies, and each episode of parotitis
may last 2 weeks, when it resolves spontaneously.
• Recurrences become less frequent with increasing age and that
the disease tends to cease at the onset of puberty or early
adulthood.
75
76. MUMPS
• Mumps is the most common form of viral parotitis
and is characterized by fever, malaise, anorexia,
and headache.
• Clinical features: Unilateral or bilateral ear ache
and parotid tenderness develop.
• The gland or glands enlarge during the
subsequent 2 to 3 days, and the orifice of the
Stensen duct is erythematous and swollen, yet
secretions from the duct are clear.
• At the point of maximal swelling, the angle of the
jaw is obliterated, and the earlobe is lifted upward
and out.
• The other salivary glands are involved in 10
percent of cases.
• Rare systemic manifestations of mumps infection
include epididymo-orchitis,
meningitis, meningoencephalitis, and oophoritis.
76
77. MUCOCELE
• Mucocele, which is of minor salivary
gland origin, arises when there is a
disruption of the flow of its secretions.
Extravasation mucoceles Retention
mucoceles
trauma to the salivary duct
leading to the collection of
secretions in the connective
Tissue.
More common in young
children
MUCOCELE
obstruction of the
salivary duct
accumulation of
saliva within the
ductal system
More common in
older age
77
78. • Etiology:
• Mechanical trauma is the most common in biting one's own lip during chewing.
• Chronic inflammation/irritation (e.g., from heat and smoking), excretory duct
fibrosis, trauma from intubation, and rarely from sialolithiasis of the minor salivary
glands.
• Clinical feature: It develops suddenly and enlarge rapidly and become fluctuant.
• Dome-shaped, non-tender, fluctuant, non-blanchable on applying pressure, and
mobile swellings ranging from 0.1-4 cm in size.
• Superficial mucoceles have bluish to translucent hue, deep lesions have pinkish
mucosal color.
• Management:
• Surgical excision
• Marsupialization
• Aspiration
• Laser, Electrocautery, Cryosurgery
78
79. Mucocele of Blandin-nuhn gland:
• Clinical features: rapid onset, increase
and reduction in size, bluish color, and
fluid-filled consistency.
• During surgery, the glands that are deep
in the tongue musculature are commonly
left behind, resulting in persistence of the
lesion.
• Superficial mucoceles are more prevalent
in children and retention mucoceles are
rare in children.
79
80. RANULA
• Mucus extravasation cyst involving a sublingual gland and is a type
of mucocele found on the floor of the mouth.
• Clinical features: swelling of connective tissue consisting of
collected mucin from a ruptured salivary gland caused by local
trauma.
• Appearance : Blue-tinted .It looks like the belly of frog
• Cause: Leakage & accumulation of saliva
• Symptoms: Painless swelling, soft consistency and do not blanch on
compression.
Management:
• 1. Surgical Excision
• .2. Marsupialization: Some providers prefer it before embarking on
surgical removal. The whole pseudocyst is packed with gauze for 7-10
days. This allows re-epithelialization of the cavity and also seals off
the leakage site. Besides, it also provokes a foreign body reaction
causing fibrosis and atrophy of the offending acini. If
marsupialization fails to eliminate the disease, then surgical excision
is the next treatment of choice.
• 3. Laser Ablation, Cryosurgery, and Electrocautery
• 4. Intralesional Injection of a Sclerosant Agent
80
81. • Sjogren's syndrome is a disorder of auto
-immune system identified by its two most
common symptoms — dry eyes and a dry
mouth & dry skin SICCA
COMPLEX
• The condition often accompanies other
immune system disorders, such as
rheumatoid arthritis and lupus.
• Mucous membranes and moisture-
secreting glands of eyes and mouth are
usually affected first — resulting in
decreased tears and saliva.
81
Sjogren’s Syndrome
82. Management
Identification of the cause
Pilocarpine therapy
Salivary substitutes
Soft & nutritious diet
Sugarless gum
ARTIFICIAL SALIVA SUBSTITUTES
Commercially available products contain
Carboxy methylcellulose –Tubrication,
Animal mucins –To increase viscosity,
Parabens- Inhibit bacterial growth,
Sugar free agents- xylitol, sorbitol- sweetners, mineral salts- simulate
electrolyte content,
Fluoride- Remineralisation
83. Age changes of salivary gland
• The lobule structure becomes less ordered.
• The acini vary more in size and eventually atrophy occurs.
• Intralobular ducts become more prominent and the percentage of
fribro-adipose tissue increases.
83
84. CONCLUSION
84
• The development and anatomy of the salivary glands is important to
know the location of salivary gland and its pathway, nature of
secretion to better diagnose and understand the disorder for having a
better picture of treatment plan for the underlying disease.
