This document discusses the anatomy, histology, functions, common diseases, and surgical landmarks of the major and minor salivary glands. It describes the parotid, submandibular, and sublingual glands in detail, including their location, structure, duct system, blood supply, innervation, and clinical relations. Common salivary gland disorders like sialadenitis, sialolithiasis, and Sjogren's syndrome are summarized with regards to their etiology, clinical features, diagnosis, and treatment.

2.  Major glands – parotid, submandibular and
sublingual
 Minor glands – upper aerodigestive tract
 Development – pharyngeal ectoderm
 Structure –
 It has cells which are arranged into acini and
drained by duct
 Parotid – serous cells, submandibular – serous
+ mucinous cells, sublingual/minor salivary –
mucinous cells

4.  Para – around, otic – ear/situated in the
surrounding region of EAC lateral to ramus of
mandible
 Largest salivary gland (15-25g)
 Shape – inverted 3 sided pyramid
 Well encapsulated
 Uppermost – just below zygoma, lowermost (tail
of parotid) – related to SCM, extend forward to
masseter
 Lobes – larger superficial lobe (80%), deep
smaller lobe (20%) divided by buccal branch of
facial nerve, superficial and transverse temporal
arteries. Can be a third accessory lobe
superficial to parotid duct

6.  Lymph nodes – superficial to gland – 6-8
 Within superficial lobe – 15-20
 Deep lobe – 1-2
 Finally drain into JD ln
 Duct – stensen’s duct (excretory duct), opens
into vestibule of oral cavity opposite upper 2nd
molar
 Facial nerve after exiting stylomastoid foramen
enters parotid gland and is divided into
 Upper temporozygomatic division – temporal
branch and zygomatic branch
 Lower cervicofacial division – cervical branch
and mandibular branch . Buccal br common in
both divisions

8.  Surgical landmarks for identification of
facial nerve
 Tragal cartilage point – 1-1.5 cm medial and
inferior to it
 Tympano mastoid suture – 6-8 mm deep to it
 Styloid process
 Post belly of digastric
 Mastoid process
 Between stylomastoid foramen and parotid –
ideal location to identify

9.  Submaxillary salivary gland
 Paired, lie below lateral part of body of
mandible and fills the submandibular (digastric)
triangle
 Size of walnut
 Lobes - larger superficial in submandibular
triangle, lie on myelohyoid muscle. Relations –
facial nerve and vein.
 Deep smaller – in floor of mouth, lie on
hyoglossus muscle, closely related to lingual and
hypoglossal nerve, terminates into duct
 Marginal mandibular br of facial n lies near to
lower lobe and at risk during excision

10.  Encapsulated
 Duct – excretory duct known – wharton’s
duct, emerges from deep lobe of gland,
drains into floor of mouth at sublingual
papillae lateral to frenulum of tongue........
 LN – near gland, within superficial lobe

12.  Paired
 3-4 g
 Almond/Ovoid shape.............
 Ant part of floor of mouth
 Ducts – 8-20 multiple excretory ducts, opens half
into floor of mouth and remaining half drain into
wharton’s duct
 LN – drain into submental and submandibular ln
 Common disorder - ranula

13.  450
 Hard palate – 250, soft palate – 100, uvula –
10
 Others – mucosa of nose, cheeks,
nasopharynx, supraglottis, lips, floor of
mouth, RMT
 Common lesions – mucous retention cysts of
lower lip, hard palate tumours (90%
malignant)

14.  Functions
 - Lubricating agent (mucin)- lubrication of
ingested food. Facilitates speech, mastication,
swallowing and articulation
 - Protective – contain Ig A, against hydrolytic and
proteolytic enzymes, against chemical agents
 - Essential for perception of taste sensation
 - Maintains orodental hygiene and protects teeth
 - Regulate body hydration
 - Maintenance of water balance in adults

15.  1.5 L produced / day / person
 63% submandibular gland, 30% parotid gland, 5%
sublingual and other salivary gland
 Calculus more in submandibular gland (mucinous
secretions)
 Composition
 Water – 99%
 Inorganic – sodium, potassium, calcium, magnesium,
chloride, iodide, fluoride
 Organic – mucoprotein, enzymes, amylase, lysozyme,
urea, aminoacid, glucose, galactose

16.  Acute non suppurative enlargement of one or both
parotid gland
 Etiology
 Paramyxovirus (RNA virus) MC
 CoxSackie virus type A and B, Cytomegalo virus
 Spread through droplet inf – saliva, nasal, urinary
secretions
 Enters through URT then localises in gland and CNS
 Highly contagious, school age children upto 15 yrs
 Endemic disease with peak in spring
 Incubation period – 2-3 weeks

17.  C/F
 Involves parotid gland (rarely submandibular)
 Prodromal early symptoms – low grade fever, myalgia,
headache, malaise, arthralgia
 Initially U/L parotid swelling later after 3-5 days becomes
B/L (75% cases)
 Localised pain excaberated on chewing
 Otalgia/trismus/displacement of pinna
 Dysphagia
 Overlying skin stretched with glazed appearance but no
erythema
 Congestion of ductal orifice

18.  Diagnosis
 Viral serology
 Leucocyte count – leucopenia
 Increase serum amylase
 Increase IgM and IgG (recurrent infection)
 Complement fixation test
 Complications
 Orchitis/ U/l profound SNHL/ encephalitis/ aseptic
meningitis/ pancreatitis/ myocarditis/ nephritis/
oophoritis........
 Prevention
 Inj MMR after 12 yrs of age (C/I – immunocompromised)

19.  Treatment
 Isolation/complete bed rest
 Hydration – plenty of fluids
 Oral hygiene – antiseptic gargles/ dental care
 Cold/hot compression of parotid swelling
 Analgesics
 Antipyretics
 Antibiotics (if secondary infection)
 Vitamins
 Steroids (if orchitis)

20.  MC parotid gland as parotid has only serous secretions
which are deficient in lysozymes, IgA and glycoproteins
 Age gp – elderly 50-60 yrs
 M=F
 Immunocompromised state – malignancy, post op 2 weeks
after major surgery, diabetes, renal failure, severe
haemorrhage
 Calculi/strictures
 Route of infection – mouth through stensen’s duct
 Causative organism – staph aureus (MC), streptococcus
pyogenes, pneumococci, haemophilus influenzae,
bacteroides

21.  C/F
 Rapid onset of pain and swelling over affected gland
(mainly U/L) with local tenderness
 Fever/chills/malaise/bodyache
 Trismus
 Duct inflamed
 On bimanual palpation – suppurative pus from duct
orifice
 Complications
 Abscess
 Septicaemia / respiratory obstruction

22.  Diagnosis
 Leucocytosis, neutrophilia
 Normal serum amylase
 c/s of pus
 USG/CT scan – to rule out abscess if not
recovering....
 D/D
 Lymphoma
 Dental abscess
 Sebaceous cyst

23.  Treatment
 IV fluids
 Oral dental hygiene
 External massage
 Local heat
 Analgesics/anti inflammatory
 IV antibiotics – cephalosporins, clindamycin,
vancomycin, metronidazole
 Surgical – drainage if abscess

24.  Etiology
 Advanced acute suppurative parotitis
 Trauma leading to secondary infection
 Multiple small abscess coalesce to form large abscess
 Common in elderly
 C/F
 Painful swelling over parotid, tenderness,trismus,
odynophagia
 Malaise, fever, headache
 Diagnosis
 USG
 CT Scan

25.  Complications
 Suppuration of spaces of neck, face and mediastinum
 Facial N paralysis
 Septicaemia/resp obstruction
 Rupture through cheek
 Treatment
 Incision and drainage of abscess under cover of IV
antibiotics – external pre auricular incision in
direction of facial nerve
 Iodoform gauze dressing

26.  2nd MC inflammatory disorder in children
 Boys>girls
 Etiology
 Autoimmune disease
 Calculi/stricture
 Sjogren’s syndrome
 Virus – paramyxovirus, EB virus, HIV
 Bacteria – staphylococcus, streptococcus
 C/F
 Periodic episodes of U/L parotid swelling along with pain,
fever, malaise every 3-4 months and last for days to weeks

27.  Diagnosis
 USG
 Sialography............
 c/s of pus
 Prognosis – resolves spontaneously in late
adolescence
 Treatment
 IV clindamycin/vancomycin/cephalosporins
 Sialogogues
 Local heat and massage of gland
 hydration

28.  Recurrent salivary gland enlargement associated with
pain, tenderness, frank pus from duct leading to
parenchymatous degeneration and fibrosis of gland
 MC – Parotid
 Etiology
 Sialolithiasis/stricture duct/ stenosis due to
scar/FB/congenital/tumour
 Pathology
 Salivary gland obstruction -> salivary stasis ->
infection and inflammation

29.  C/F
 Firm, mild painful and enlargement of gland (mostly
B/L)
 Recurrent swelling associated with eating
 Purulent discharge from duct
 Diagnosis
 Sialography
 CT/MRI
 Treatment
 Conservative – sialogogues, massage of gland, good
hydration , antibiotics

30.  Surgery
 Surgical resection of gland – superficial
parotidectomy/ submandibular gland
excision
 Irradiation
 Ductal dilatation
 Sialendoscopy
 Treat the cause – calculi, stricture

31.  Formation of stones in the salivary ductal system
 Etiology
 Age gp 4th – 6th decade
 Males MC
 Submandibular gland - duct (wharton’s duct) MC –
70-80% - longer, large calibre, torturous course, more
thicker viscous mucus secretions with high calcium
and phosphorus concentration
 Parotid gland – parenchyma and hilum – 10-20%
 Sublingual ducts – 1%
 Duct inflammation/injury/salivary stasis/ Gout

32.  Composition
 Calcium phosphate, calcium carbonate,
glycoproteins, mucopolysaccharides, magnesium,
potassium, ammonia
 C/F
 Recurrent episodes of salivary swelling with colic pain
while swallowing during meals
 h/o recurrent acute suppurative sialadenitis
 Tenderness
 Bimanual palpation – presence of stone
 Purulent material can be squeezed out

33.  Diagnosis
 X Ray
 Parotid – lateral view. But most (90%) radiolucent
 Submandibular – occlusal view/ occlusive bite
 Identify radio opaque stones - 90% radio opaque in
submandibular gland
 OPG
 USG – detect stones > 2 mm
 CT Scan – detect radiolucent stones
 Sialography – Digital substraction sialography/ MR
sialography – radiolucent stones

34.  Treatment
 Non surgical – sialogogues/ local heat/ hydration
 Massaging of gland
 Manual milking out of stone if near duct
 Surgical
 Intra oral – incision of duct (if stones < 2cm away
from duct orifice
 Sialadenectomy – excision of involved gland – for
stones deep inside through trans cervical approach
 Sialendoscopy – rigid endoscopy to visualise and
remove
 Extra corporeal shock wave lithotripsy – reduce
stones to small fragments, flushed out by
secretogogues, salivation

35.  Dryness of mouth due to diminished or arrested
salivary secretions
 Etiology
 Medications – sedatives/ anti depressants/ anti
psychotics/ anti histaminics/ diuretics
 Therapeutic irradiation
 Diabetes
 Cystic fibrosis
 Sjogren’s syndrome
 C/F
 Difficulty in chewing, swallowing, phonation,
articulation
 Dental caries

36.  Chronic auto immune disorder of exocrine glands
affecting salivary and lacrimal glands leading to
b/l enlargement of salivary glands, enlargement
of lacrimal glands, dryness mouth and eyes
 Types
 Primary – MC 80% – confined to exocrine glands –
xerostomia, xerophthalmia (mikulicz syndrome),
recurrent with renal involvement
 Secondary – 20% - xerostomia, keratoconjuctivitis
sicca, rheumatoid arthritis
 Epidemiology – 1-3%, 4th – 5th decade of life,
women (90%)
 Etiology – genetic/ auto immune/ enviromental

37.  C/F
 Dryness of mouth and eyes
 Salivary gland enlargement (mc – parotid)....
 U/L or B/L
 Recurrent or chronic......
 Difficulty in swallowing, phonation, chewing
 Dental caries
 Intolerance to acidic and spicy food
 Dry and sticky oral mucosa
 Intraoral candidiasis
 Eye – FB sensation, chronic irritation, dilatation of
bulbar conjuctiva
 Systemic – low grade fever, malaise, arthralgia,
myalgia

38.  Associated conditions – pneumonitis,
hepatosplenomegaly, lymphadenopathy
 Diagnosis
 Increased ESR
 Increased Rheumatoid factor
 Positive Anti Nuclear Antibiotics
 Increased SS Antigen A
 Increased SS Antigen B
 Sialography
 Biopsy – minor sublabial gland of lower lip

39.  Treatment
 Salivary substitutes
 Artificial tears
 Sialogogue – pilocarpine 5 mg TDS, chewing gum,
raw apples, candies
 Fluoride – dental caries
 Treat fungal infection
 Eye lubricants
 Systemic steroids – if severe complications like
glomerulonephritis, necrotizing vasculitis
 Immunosuppressants – methotrexate, cyclosporin

40.  Auriculotemporal nerve syndrome
 Etiology
 Post parotid surgery (35-60%)
 RND
 Due to injury to auriculotemporal nerve
 Leads to aberrant cross innervation between
postganglionic secretomotor ps fibres to parotid
gland and postganglionic sympathetic fibres to
sweat glands and skin
 So ps fibres innervate sweat gland instead of
parotid gland and instead of causing salivation
during mastication cause secretions of sweat
gland

41.  C/F
 Sweating
 Flushing of preauricular skin and face during
mastication
 Treatment
 Reassurance
 Tympanic neurectomy of Jacobson’s nerve
(carries preganglionic ps secretomotor fibres
from inf salivary nucleus
 Inj Botulinum

42.  3-4% head and neck malignancies
 80% parotid
 Parotid – 80% benign, submandibular 50-60%, minor
salivary 20%
 Classification
 Benign
 Epithelial – pleomorphic adenoma (80%) MC, warthin’s
tumour, oncocytoma
 Mesenchymal – haemangioma, lymphangioma,
lipoma, neurofibroma
 Malignant
 Epithelial – mucoepidermoid ca (2nd MC), adenoid
cystic ca (3rd MC), adeno ca, scc
 Mesenchymal – lymphoma, sarcoma

43.  Etiology
 Radiation – warthin’s tumour, mucoepidermoid ca
 Viral – EBV, HPV
 Smoking – warthin’s tumour
 Occupational - Exposure to asbestos, silica dust,
nickel, wood industry......
 Hormonal
 Genetic
 Dietary
 Alcohol abuse
 Prophylaxis
 Dark yellow veg – carrot, sweet potato
 Vitamin A and C
 Poly unsaturated fats

44.  Theories
 Multicellular – each neoplasm arise from a
particular cell
 Acinic cell ca – acinar cells, SCC – excretory
duct cells, warthin’s tumour – striated duct
cells
 Bicellular reserve theory – there are two
types of reserve cells
 1 – intercalated duct – pleomorphic
adenoma, warthin’s tumour, adenoid cystic
ca
 2 – excretory duct – mucoepidermoid ca, SCC

45.  C/F
 Benign
 Slow growing painless swelling in the region
of gland
 Facial nerve not involved
 Malignant
 Rapid growth/enlargement of swelling.......
 Restricted mobility
 Fixity of overlying skin
 Pain
 Facial nerve paralysis........

46.  T (primary tumour)
 Tx – cant be assessed
 T0 – no evidence of primary tumour
 T1 – upto 2 cm in greater dimension without
extraparenchymal extension
 T2 - >2 upto 4 cm in greatest dimension without
extraparenchymal extension
 T3 - >4 cm in greatest dimension and/or
extraparenchymal extension
 T4a – involves skin, ear canal, facial n, mandible
 T4b – involves skull base, pterygoid plates,
encasses ICA

47.  N – Regional lymph node size in greatest
diameter
 Nx – cant be assessed
 N0 – no regional ln metastasis
 N1 – single I/L LN upto 3 cm
 N2a – single I/L LN >3 cm upto 6 cm
 N2b – multiple I/L LN upto 6 cm
 N2c – B/L or C/L LN upto 6 cm
 N3 – LN>6 cm
 M – Distant Metastasis – Mx – cant be assessed/
M0 – no distant metastasis/ M1 – distant
metastasis

48.  0 – Tis N0 M0
 I – T1 N0 M0
 II – T2 N0 M0
 III – T3 N0 M0/T1-3 N1 M0
 IV a – T4a N0-1 M0/T1-4a N2 M0
 IV b – T4b N0-2 M0/T1-4b N3 M0
 IV c – T1-4 N0-3 M1

49.  MC
 Benign, Parotid gland (mc)
 Sites – tail of parotid (mc)
 Age gp 30-50yrs
 Females
 C/F
 Painless slow growing swelling
 FB sensation, dysphagia (if deep lobe involved)
 Smooth, firm, lobulated, non tender with normal
skin and facial nerve
 Diagnosis
 FNAC, CT Scan, sialogram

50.  Pathology
 Mixed tumour – both epithelial and
mesenchymal (myoepithelial) component
 Encapsulated
 Sends pseudopods into surrounding tissues
 Treatment
 Superficial parotidectomy
 If deep lobe involved – Total parotidectomy
 Never enucleate as recurrence due to
pesudopods

51.  2nd MC benign tumour
 Age 50-70 yrs
 Males, elderly, obese
 Exclusively in parotid gland
 10% B/L, can be multiple
 Site – tail of parotid (mc)
 C/F
 Painless slow growing swelling which can be soft,
cystic, firm
 Facial N – normal
 Pathology
 Rounded encapsulated tumour which can be cystic
with mucoid or brownish fluid
 Has both epithelial and lymphoid elements

52.  Diagnosis
 FNAC
 Technetium Scan – for hot nodules
 Treatment
 Superficial parotidectomy

53.  MC malignant (variably malignant) salivary gland
tumour
 Parotid MC 50%
 Minor salivary glands (Palate) – more aggressive
 MC – children
 Types
 Low grade tumours
 Common in children,good prognosis, rare
recurrence, 80-90% 5yr survival rate
 C/F – slow growing tumour, rare metastasis
 Treatment – superficial parotidectomy/total
conservative parotidectomy with preservation of
Facial N

54.  High grade tumours – more aggressive, poor
prognosis, 30% 5yr survival rate
 High recurrence rate 60%, high nodal
metastasis 40%, high distant metastasis 30%,
 Facial N involved
 Treatment
 Total radical parotidectomy with facial nerve
grafting, RND followed by post op RT
 Advanced – Palliative CT-RT
 Diagnosis – CT Scan, Chest X Ray (for
secondaries), Sialogram, FNAC, Technetium
Scan

55.  CYLINDROMA
 2nd MC Malignant tumour
 MC in Submandibular gland, Sublingual gland,
Minor Salivary gland
 Perineural spread and lymphatic spread
 C/F
 Slow growing tumour associated with pain
 40% regional metastasis to lymph nodes, 40%
distant metastasis to lung, brain, bone
 Early involvement of Facial N

56.  Treatment
 Wide excision with normal areas/ Radical
parotidectomy
 RND
 Post op RT
 Recurrence – high rate as tendency to grow
along nerves

57.  Common congenital deformity
 1 in 700 births
 Males
 U/L 80%, left 70%
 Etiology – failure of fusion of median nasal
process, maxillary process, alveolar process
 Teratogenic – rubella, methotrexate, retinoic
acid
 Syndromic
 Increase parental age

58.  C/F
 Difficulty in feeding
 ET dysfunction
 CSOM
 CHL
 Speech defect
 Hypernasality
 Regurgitation
 Aesthetic – facial disfigurement
 Swallowing difficulty...............
 Submucous cleft – musculature of palate is
deficient with intact mucosal coat

59.  Treatment
 Conservative
 Feeding assistance with special nipples and bulb
syringe
 Counselling of parents
 Palatal prosthesis
 Surgery
 Age of repair 1-2 yrs
 Cleft Lip repair
 Millard’s repair – rotation advancement flap
 Rotation of superiorly displaced medial lip segment
and advancement of lateral lip segment
 Triangular flap repair – single flap from lateral side is
raised

60.  Cleft Palate
 Oxford method (V Y Push back)
 Two flap technique
 Four flap technique
 Von lagenback’s palatoplasty
 Post operative complications
 Hypernasality (50%)
 Oronasal fistula (10-20%)
 Velopharyngeal incompetence
 Aesthetic problems of lips