. Severe reduction of salivary output not only results in a rapiddeterioration in oral health but also has a detrimental impact on the quality of life for. It has been used to indicate an individual’s caries susceptibility; it has also been used to reflect systemic physiological and pathological changes which are mirrored in saliva.
Systemic diseases where salivary glands are involved.Clinical situations in which salivary flow and chemistry are helpful in diagnosis or monitoring patient progress.
since they may compromise the assay by lowering saliva pH and increasing bacterial growth. (13,14)
the levels of many analytes are higher in the general circulation than in saliva..
Instruction for collection of saliva........means method.
The SOS is made of a non-toxic, inert polymer shaped into a 30 x 10 mm cylinder . Not recommended for children under the age of six, due to the possibility of choking
Instructions for UseRemove SOS from outer packaging and place into proper mouth location as directed (see placement diagram on next page). Keep SOS in place for 1-2 minutes to ensure that it is saturated. (If collecting from the parotid glands in the cheek, saliva flow will be low, and collection time should be extended for up to 5 minutes to ensure adequate volume.) Due to location effects for certain analytes, we recommend that the SOS should not be moved around in the mouth.Place SOS into the swab storage basket insert (upper portion of the tube).Replace cap and snap securely onto tube. For samples being sent to Salimetrics, label the exterior of the tube using pre-printed, bar-coded labels provided, or write the ID number with a waterproof pen.
Wen the stimulated whole saliva flow rate is and stimulated wole saliva is flow rate is ,it is abnormally low and Indicative of marked salivary hypofunction.
Since the salivary gland are located superficially ,radiographic images may be obtained with standard dental radiographic techniques.for visualization of parotid gland plain filn radiography such oblique-lateral or rotated AP VIEW MAY BE USED.standardocclusal film may be placed intra orally adcent to the paroid duct to visualzea stone close to the orifice.
One of the oldest method .most remmendedmehod as it provides the cleares visualization of the branching ducts.
But sialography has got limitations…..
Flow phase represents the phase immediately after the injection when isotope is equilibrating in the blood and accumulaing in the salivary gland through active ransport.second phase that concentration phase starts after 1 min of administration of tracer.after 15 min of administration tracer begins to increase the oral cavity and decrease in the salivary gland.activity remaining in the salivary gland after stimulation is suggestive of obstruction,certainumors,and inflammation.
Transverse gray scale sonogram of the submandibular gland showing an echogenic focus (arrow) with posterior acoustic shadowing, diagnostic of a intraglandular ductal calculus.2- Transverse gray scale sonogram showing a welldefined, round, homogeneous, hypoechoic lesion in the left submandibular gland. These features suggest a benign salivary gland lesion. Note the posterior acoustic enhancement commonly seen with pleomorphic adenoma.
Due to there superficial locations, the parotid and sucmandibular gland are easily visualozed by the ultrasonography.
Soft Tissue Window The short arrow shows the compressed submandibular gland adjacent to the sialolith and the long arrow shows the normal gland for comparison.Abscesses have hypervascular walls evident with CT imaging. MRI usually preferred because:No radiation exposureContrast media is not always neededMinimal distortion caused by dental restoration
Absence of salivary gland unilaterally or bilaterally.L-LACRIMINAL GLAND aplasia,orlacriminal sac inflammaion,auricles are deformed with ear having a cup shaped appearnce,hearloss.D-peg shappedteeth,hypodontia, digital deformitites manifested by deviation of fingers medially or laterally.treacherscollins syndrome will include features of craniofacial deformities,micrognathia,conducing hearing loss,zygoma,slantingeys.
Small localised swelling, the cause of focal enlagement is usallyhormmonal and metabolic.1.these also said to be benign adenoma of these glands.
No clinical significance attached to it other than they may be site of development of a retention cyst or neoplasm.
In exceedingly rare conditions,Wen it does occurs causes severe xerostomia,
It causes drooling, which produces social embarrassment ,rejection and severe impairement in the quality of a life. most of the cases of hyper salivation are secret ion clearance issue. a swallowing study should study should be obtained. saliva flow rate should be determined. unstimulated saliva flow rate is 2.0to 3.5 ml permin.where as collection of saliva using drooling technique into a pre weighed container will result in more den 5ml.0 in 5 min.in post menopausal woman or male androngen level should be determined.
ZYBAN which aids in smoking cessation.
Sialoliths are the calcified and organic matter that are formed within the secretory system of the major salivary gland.
.bacterial infection of the salivary gland are most commonly seen in patients with reduced salivary gland fucntion.It might not be occurring in submandibular gland more frequently as high level of mucin. Anatomically tongue movement.also referred as surgical parotitis because post surgical patients often experienced gland enlargement from ascending bacterial infection.occrs less frequetly today beccause of the prophylactic anibiotics and perioperative hydration.
Rapid onset,.it is a self ,limiting last approx 6 weeks and heals by secondary intention. No specific treatment is required.but debridement and saline rinses may help he healing process.
Lesion results from the obstruction of duct of minor salivary gland. two type extravasation n retention type.extravasation is far more common den retention type.various studies have been conducted but no predilection have been found for any age group or gender predilection.
It is an acute contagious viral infection characterized by the unilateral or bilateral swelling of the salivary gland usually parotid.submandibular or sub ingual salivary gland are occasionally involved.usallypreced by the feverheadache,malaise vomiting pain below the year.followed by the rubbery swelling of the salivary gland.itusally remains peak during 2-3 days and then grduallysubsides.complications of this disease include affect of other organ of body such as testes,ovaries,pancreases,mammary gland.
Mixed in origin because it contains both epithelial and mesenchymal elements both.most common neoplasm of children as well.stroma consist of chondroid,myoxid,fibroid.so the name given.presence of myoepithelial cells.
Due to its microscopic projection a wide resection is needed to be done to avoid re-occurrence.one of the characterictic of pleomorphic adenoma is that it has microscopic projections.if these projection are not removed , the lesion will re-occur.
Large tumours usually invloves significant amount of superficial lobe of parotid gland.
Is a tumour that is composed predominantly of one type of cell.tratment is same that of pleomorphic adenoma.
Treatment- conservative surgical excision
Salivary gland diseases
1st year post graduate
Department of oral medicine and radiology
Evaluation of salivary gland
Classification of salivary gland diseases
-staging of salivary gland tumour
Description of salivary gland diseases
Salivary glands and saliva plays a very important role in maintaining oral
and systemic health.
Saliva is constituted by the secretions of the three paired major salivary
glands. It also contains the secretions of the minor salivary glands, of
which there are hundreds contained within the submucosa of the oral
mucosa and some gingival crevicular fluid.
Saliva aids in speech and deglutition and serves as a diagnostic fluid
History : Symptoms indicative of salivary gland disorders are
limited in number and generally nonspecific. Patients usually
complain of swelling, pain, xerostomia, foul taste, and sometimes
Gender : sjogrens syndrome common in menopausal women
Age group : paramyxoviral infection is most common occurring in
the children between age group of 4-10 yrs.
Medical profile :-diabetes mellitus, arteriosclerosis, hormonal
imbalances and neurologic disturbances.
Drug history: xerostomia is often caused by the diuretics and antihypertensive drugs....
A careful dietary and nutrition history should be obtained. Patients who
are dehydrated chronically from bulimia or anorexia or during
chemotherapy are at risk for parotitis.
Swelling and pain during meals followed by a reduction in symptoms
after meals may indicate partial ductal stenosis.
Current medications …..
signs of mucosal dryness
Lips-cracked, peeling and atrophic
Buccal mucosa-pale and corrugated in appearance
Tongue-smooth and reddened
Marked increase in erosion and caries.
Erythematous form of candidiasis commonly occurs
Viscous,scant saliva suggest chronically reduced function
Visual examination by standing behind the Pt
Palpate the gland
Stand in front of pt
2-3 fingers over the posterior border of ascending ramus
Back word & inward movement with light pressure
Slightly rubbery Painless unless infected/inflamed
Check motor function of facial nerve
Intraoral examination to check papilla if inflamed
Compress the gland to see saliva flow
•Palpate below angle & body of mandible
•Intraoral examination to
check papilla if inflamed
•Compress the gland to see saliva
To measure salivary flow rate (resting / stimulated)
provide essential information for diagnostic and research purposes
Calculated from the individual major salivary gland or from a mixed
sample of the oral fluids, termed “whole saliva”.
Avoid having alchol,caffenine,prescribed medication 12 hours
before collection of saliva.
Avoid eating major meal within 60 min of sample collection
Avoid dairy products for 20 min before sample collection .
Participants should not brush their teeth within 45 minutes prior
to sample collection.
Rinse mouth with water to remove food residue before
sample collection. Wait at least 10 minutes after
rinsing before collecting saliva to avoid sample
Also while pipetting saliva, greater accuracy is
obtained by aspirating slowly in order to avoid
formation of bubbles.
Contamination of saliva samples with blood can also
be a concern
Blood can leak into saliva under certain conditions.
Dental work should not be performed within 24
hours prior to sample collection.
Research participants should be screened for oral
health problems or .
Saliva samples visibly contaminated with blood
should be discarded and recollected.
Passive drool - highly recommended because it is both cost
effective and approved for use with almost all analytes. To avoid
problems with analyte retention or the introduction of
contaminants, use only high quality polypropylene vials for
The vials used must seal tight and be able to withstand
temperatures down to -80ºC.
participants should allow saliva to pool in the mouth.
Some find it helpful to imagine eating their favorite
food. At this time, unwrap the Saliva Collection Aid
(SCA) and insert it into the top of the cryovial .
With head tilted forward, participants should drool
down the SCA to collect saliva in the cryovial. (It is
normal for saliva to foam, so we advise using a vial
with twice the capacity of the desired sample volume.)
an excellent alternative to passive drool .
SOS also helps filter large macro molecules and other
particulate matter from the sample.
Not recommended for children below 6 yrs of age.
Carlson-Crittenden collector method used for individual gland.
Stimulated saliva is obtained by applying sialagogue as citric acid
to the dorsal surface of tongue.
Flow rate of the saliva is also affected by the many factors such as
patient position, hydration, diurnal variations ,time stimulation
Stimulated whole saliva flow rate <1.0ml/min
Unstimulated whole saliva flow rate <0.1 ml/min
To differentiate inflammatory from neoplastic
To differentiate from diffuse and focal
To identify and localise sialoliths
To demonstrate ductal morphology
First mentioned by carpy in 1902.
Barsony and uslenghi –a diagnostic tool in 1925.
It is specialised radiographic view of salivary gland taken by
introduction of soluble contrast media into the ductal system.the
radiographs are called sialographs.
Recommended method for intrinsic & acquired abnormalities of ductal
Helps in viewing –ductal stricture
- ductal rupture
Oil & water based contrast media is available.
Demonstrate 3 phases:
C.I - allergy to contrast media
- active infection
- patient with iodine sensitive
High skill is needed to conduct the procedure
Pain with procedure
Might force bacteria throughout the ductal structure.
dynamic & minimal invasive diagnostic technique.
Technetium is a pure gamma ray-emitting radionuclide taken up
by the salivary gland, transported through the glands and then
secreted into oral cavity.
Uptake of Tc 99m indicated presence of epithelial tissue present.
Serves as a measurement of fluid movement in salivary acinar
Pass through 3 stages:
Flow phase 15-20 sec
Concentration phase up to 10-15
Symmetrical distribution in parotid,
Pt is given a lemon juice drop
Prompt, uniform & symmetric emptying
Non-invasive & cost effective imaging modality used in the
evaluation of masses occurring in superficial lobe of parotid
Indicated :intra & extra glandular masses.
solid & cystic lesion.
Recent studies have established sonographic diagnostic criteria for
Shows superficial part of gland
Hypoechoic benign tumour
Osseous erosions & sclerosis
To differentiate cysts from abscess
Retromandibular vein,carotid artery
& deep lymph nodes are identified.
Especially useful in inflammatory
condtions associated with sialoliths.
excellent ability to differentiate soft tissue .
Provide multiplanar imaging.
No exposure to radiation
No intravenous contrast media required.
Minimal artifact from dental restorations.
Biopsy guidance; mass
limited visibility of deeper
portions of gland; no
Stone, stricture; R/O
autoimmune orradiationinduced sialadenitis
Invasive; requires iodine
dye; no quantification
Quantification of function
Radiation exposure; no
R/O calcified structure;
structures from soft tissue
contrast dye injection;
R/O soft-tissue lesion
excellent, with ability to
differentiate osseousstructures from soft tissue;
contraindicated with por
metal implant; no
Saliva and salivary flow
Non inflammatory condition
Hyperplasia of minor salivary glands
Congenital absence of salivary gland
Aplasia occurs in combination with congnital anomalies such as
LADD SYNDROME,TREACHERS COLLINS
Hypoplasia in patient with melkerson rosenthal syndrome.
one or group of gland missing unilaterally or bilaterally
Dry n smooth oral mucosa
hormonal & metabolic
Usually occurs at minor salivary gland of he
surface firm, sessile & normal in colour.
aberrant salivary gland
an aberrant or ectopic salivary gland is a
salivary gland tissue that develops at a site
where it is not normally found.
Site- cervical region near parotid gland or he
body of mandible
No clinical signifiance
Usually its site for development of retention
cyst or neoplasm.
Congenital occlusion or absence of one or two
major salivary gland
Site-submandibular duct in the floor of the
Causes severe xerostomia
Increase in salivary secretion.
Stimulation of parasympathetic causes profuse
secretion of saliva.
Drooling from mouth
Occurs with various neurologic disorder
Heavy metal poisiong.
Drug induced as anti-pshycotic.
Medications that can cause overproduction of saliva include:
Metals that can cause hypersalivation include:
External beam irradiation to the head and neck and internal
radionuclides (eg, 131I)
Sjögren syndrome, primary and secondary
Granulomatous diseases (sarcoidosis, tuberculosis)
Human immunodeficiency virus infection
Thyroid disease (hypo- and hyperthyroidism)
Late-stage liver disease
Salivary gland disease (tumors)
Psychologic factors (anxiety,depression)
Malnutrition (anorexia, bulemia, dehydration)
Dryness of the mouth .
Not associated with salivary hypofunction
Sensory or cognitive disorders
Pt usually complains of bad taste, abnormal
sensation, burning mouth
Associated with salivary hypofunction
Need to investigate causes of hypofunction
Does the amount of saliva in your mouth feel too
little? Too much? Not notice it?
Does your mouth feel dry while eating?
Do you frequently sip liquids while eating?
Do you have difficulties swallowing food?
Difficulty eating, speaking, wearing denture
Need sips of water while eating
Soreness and Burning sensation of mouth
Abnormal taste & halitosis
Cracked lips and soreness of corners of mouth
Dry, atrophic, pale and translucent mucosa
Submandibular salivary gland is common site of calculus
formation mainly because of the saliva flowing against
Inorganic - Calcium carbonate,
calcium phosphates in the
form of hydroxyapatite
cellular debris .
The exact mechanism of stone formation is unclear, but it
appears to be related to the following conditions:
Salivary stagnation-inflammation,irregularities in the duct
system,local irritants and anticholinergic medications
Epithelial injury along the duct- sialolith formation, which
acts as a nidus for further stone formation
Precipitation of calcium salts, altered salivary hydrogen
sialolithiasis more often in submandibular gland saliva
b.Higher concentration of calcium and phosphate in the
c.Higher mucous content
e.Anti gravity flow
Acute infections-antibiotics. Stones in the distal
portion of duct can often be removed manually.
Deeper stones require surgery. Lithotripsy has been
described as a non-invasive method of disintegrating
Reduced salivary gland function.
Also referred as surgical parotitis.
More frequently occurrence involving parotid
Unilateral or bilateral salivary gland
Indurated, painful and tender to palpation.
Purulent discharge may be expressed from
Antibiotics after culture and sensitivity,
Milk the gland several times a day (not during acute
Increase hydration & use of Sialogogue
Improve oral hygiene
Remove predisposing factor if possible (calculus)
Excision of severely damaged gland (chronic/
Painless non-inflammatory, non-neoplastic
swelling of salivary glands
Parotid is most commonly affected and
Histologically presented as hypertrophy of
Detailed drug history
Liver function test
Blood glucose level
Growth hormone level
CBC and full blood investigation
Non neoplastic inflammatory self healing reaction of salivary gland
tissue, which both clinically and histologically mimics a salivary
C/F: The lesion generally presents as an ulcer
Seen- Posterior hardpalate, is due to necrosis of
minor saliary glands.
Chronic granulomatous disorder affecting
Severity and duration of disease varies
Saliva flow would be affected
Mild improvement noticed with steroid
Swelling caused by the pooling of saliva at the site of
injuries salivary gland.
Mucus extravasation cyst-spillage of mucin into the
Site inner aspect of lower lip,floor of the mouth,tongue
Painless swelling which frequently reoccurs.
Fluctuant,dome shaped,non ulcerated.
Latin rana means frog, and a ranula- a frog's underbelly.
Term used for mucocele for the floor of the mouth.
Associated with ducts from the submandibular or sublingul
Spherical or dome shaped.
Translucent blue colour in apperance .
Can cause elevation of the tongue.
Slow enlarging swelling on the floor of the mouth can
cause difficulty in speech or eating.
When deep lesion tat herniates through mylohyoid muscle
and extend along the fascial planes it is referred plunging
Contagious viral infection caused by para myxo virus.
The more common symptoms of mumps are:Parotid
inflammation in 60–70% of infections.
The incubation period(time until symptoms begin) can be
from 14–25 days
Parotitis causes swelling and local pain, particularly when
Unilateral or bilateral parotid enlargement gland.
Fever ,headache, malaise or anorexia
Pain below the ear.
Glands are tender on percussion.
Chronic autoimmune disease affecting exocrine glands,primarily
salivary and lacrimal glands.
It can exist as a disorder in its own right (Primary Sjögren's
syndrome) or it may develop years after and associated rheumatic
disorder such as rheumatoid arthritis,SLE, scleroderma, primary
biliary cirrhosis etc (Secondary Sjögren's syndrome).
Persistent xerostomia & keratoconjunctivits sicca.
Hyposalivation or reduced salivary flow rate.
Thick or frothy saliva
Difficulty in chewing and swallowing, wearing denture
Dryness of eyes.
Revised International Classification Criteria for
I Ocular symptoms: at least one of the following
1. Daily dry eyes for >3 months
2. Persistent sensation of sand or gravel
3. Use of tear substitutes >3 times daily
II Oral symptoms: at least one of the following
1. Dry mouth daily >3 months
2. Recurrent salivary gland swellings
3. Use of liquid to aid in swallowing food
II Ocular signs: at least one of the following
I1. Schirmer‟s I test (5 mm in 5 min)
2. Rose Bengal score (4)
IV Histopathology: focal lymphocytic sialoadenitis with focus
score 1 per 4 mm2 of tissue
V Salivary gland involvement: at least one of the following
1. Unstimulated salivary flow 1.5 ml ⁄ 15 min
2. Abnormal parotid sialography
3. Abnormal salivary scintigraphy
Testing for opthalmic involvement
Schirmer‟s I 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
Patient history of opthalmic symptoms
Testing for oral involvement
Salivary sialometry: low salivary flow is defined as less than 1.5 ml
of saliva per 15 minutes
Labial minor salivary gland biopsy: showing lymphocytic
sialoadenitis with a focus score of ‡1 per 4 mm2 of tissue
Examination for salivary gland enlargement: parotid and ⁄ or
Patient history of oral symptoms
Presence of auto antibodies.
Presence of rheumatoid factor in patients serum
BK ayetto, RM Logan,Sjogren‟s syndrome: a review of aetiology,
pathogenesis,diagnosis and management, Australian Dental Journal 2010;
55:(1 Suppl): 39–47
- Treat recurrent infection
- Salivary substitutes/sprays
- cholinergic drugs (Pilocarpine)
- Avoid alcohol, tobacco.
- Immunosuppressive therapy; corticosteroids or
cytotoxic drug have been proven effective.
uveitis, parotid swelling, and facial nerve paralysis.
It usually begins with a prodrome of constitutional
symptoms and involvement of the submandibular,
sublingual, and lacrimal glands may occur. last
months to years and resolves spontaneously.
Treatment is usually symptomatic with steroids being
most beneficial when administered in the acute phase
of the illness
Benign tumors with low propensity for recurrence
Papillary cystadenoma lymphomatosum
Basal cell adenoma
Benign tumors with a propensity for recurrence
Pleomorphic adenoma (major glands)
Malignant tumors with high-grade behavior
Adenoid cystic carcinoma
Salivary duct carcinoma
Epithelial-myoepithelial carcinoma of intercalated ducts
High-grade mucoepidermoid carcinoma
Squamous cell carcinoma of salivary origin
Malignant tumors with low-grade behavior
Polymorphous low-grade adenocarcinomas
Low- and intermediate-grade mucoepidermoid carcinoma
Primary tumor can not be assessed
No evidence of primary tumor
Tumor < 2 cm in greatest dimension
Tumor 2–4 cm in greatest dimension
Tumor 4–6 cm in greatest dimension
Tumor >6 cm in greatest dimension
tumour size well as
extension into adjacent tissue
Nx Regional nodes cannot be assessed
N0 No regional lymph node metastases
N1 Single ipsilateral node < 3 cm in diameter
N2a Single ipsilateral node 3–6 cm in diameter
N2b Multiple ipsilateral node, none > 6 cm
N2C Bilateral or contralateral nodes, none > 6 cm
N3 Metastasis in a lymph node > 6 cm
Presence of distant metastases cannot be assessed
M0 No distant metastases
Any T (except T4b) Nl
Adapted from the American Joint Committee for Cancer
Staging and End Results
Also called benign mixed tumour
Most common salivary neoplasm. can involve any major or minor
Seen 4th-6th decade of life.
Slight female predilection.
Slow- growing, painless, firm n non –tender
Mobile in early stages. with increases in size irregular n nodular
Intermittent growth period.
Histologically epithelial cells make up a
Trabecular patterncalled stroma
The treatment for salivary gland tumor is
Benign tumors of the parotid gland are treated
with superficial or total parotidectomy
Type of benign tumor of the parotid gland.
etiology is unknown, but there is a strong association with
(age 50–70years), male predilection.
slow growing, painless, and usually appears in the tail of the
parotid gland near the angle of the mandible.
Painless until superinfected.
Visible on Tc 99m scintiscans.
Most of these tumors are treated with surgical
Superficial parotidectomy in case of large
Differentiated from mixed tumour:
composed of cells of one type.
absence of connective tissue changes.
But in cases where background stroma contains myxoid,
chondroid, or mesenchymal derivatives, the term
„monomorphic‟ should not be applied rather „mixed
tumor‟ should be used.
primarily in major salivary gland –
painless, slow growing, firm
swelling which may be cystic and
Upper lip -the most common site
Neoplasm of uniform population
of basaloid epithelial cells arranged
in soild, tubular,or trabecular
Cannot be distinguished from mixed tumor. Although,
BCA may be found in all salivary gland preferably
parotid, and minor salivary glands of upper lip
Consist of island or sheets of basaloid sheets.
Excision. Recurrence is seldom seen.
most common type of malignant salivary gland tumour.
painful and ulceration of overlying tissue.
Extra orally – parotid gland is affected.
Intra orally - palate
Presents as painless, slow-growing mass that is firm or
Metastasis is seen in high grade tumour.
Tumour is composed of mucus – secreting cells and
epidermoid type of cells in varying proportions
Malignant salivary tumors
usually require wide local
resection of the primary
radiotherapy should be added
to improve local control.
Second most common malignant salivary gland tumor o occur in
90-95%locted in parotid gland
Superficial lobe and inferior lobe of parotid gland are common site
Slow growing, mobile / fixed mass, asymptomatic.
Facial muscle weakness reported.
Characterized by the late distant metastasis and local
Cells – acinar differentiation ie, duct formation.
Rare type of CANCER that can exist in many different body sites.
It most often occurs in the areas of the head and neck, in particular the
Patients may survive for years with metastases because this tumor is
generally well-differentiated and slow growing.
It is the second most common malignant salivary gland tumor overall
(after mucoepidermoid carcinoma)
Primary treatment -surgical removal with clean margins.
Paliative radiotherapy is commonly given following
Malignant epithelial neoplasm of major salivary gland, composed of
Mostly occurs in parotid gland.
Previous exposure to ionizing radiation, increases the risk
present as a firm enlarging mass that is not uncommonly fixed to the
Pain , facial weakness present.
Tumor most commonly seen in plummer vision syn.
presence of neoplastic squamous cells.
Metaplastic changes, with varying degree of nuclear a typia.
General anatomy of head and neck Chaurasia
Oral medicine Burkits
Oral medicine ravikiran ongole
Oral pathology shafers
ANATOMY AND PHYSIOLOGY OF THE SALIVARY GLANDS Resident
Physician: Frederick S. Rosen, MD Faculty Physician: Byron J. Bailey, MD ,
January 24, 2001
The Pathology of the Salivary GlandsR. A. Cawson, M. J. Gleeson, J. W. Eveson
The Journal of Contemporary Dental Practice, Volume 9, No. 3, March 1, 2008
The anatomy and physiology of salivary glands by Helen Whelton