The document describes the major salivary glands - parotid, submandibular and sublingual glands. It details the location, structure, relations, blood supply and applied anatomy of each gland. The parotid gland is the largest salivary gland located in the preauricular region. The submandibular gland is situated in the submandibular triangle below the mandible. The sublingual gland is the smallest gland located beneath the oral mucosa.

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