This document discusses the anatomy and applied aspects of the major salivary glands - the parotid, submandibular, and sublingual glands. It describes the location, structure, blood supply, nerve supply, duct system, development, and common pathologies of each gland. The parotid gland is the largest salivary gland and is located below and in front of the ear. The submandibular gland is located beneath the jawbone and the sublingual glands are found under the tongue. Surgical procedures for each gland aim to preserve their ducts and nerve supply to minimize postoperative complications.

1. SALIVARY GLANDS
ANATOMY & APPLIED
ASPECTS
Joel D’silva
Department of Oral & Maxillofacial Surgery

2. INTRODUCTION
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

3. DEVELOPMENT

5. STAGES OF
DEVELOPMENT

6. STAGE 1
Bud formation:
Introduction of the oral epithelium by
underlying mesenchyme

7. STAGE 2
Formation and growth of epithelial cord

8. STAGE 3
Initiation of branching in terminal parts of
epithelial cord and continuation of glandular
differentiation

9. STAGE 4
Dichromatous branching of epithelial cord and
lobule formation

10. STAGE 5
Canalization of presumptive ducts

11. STAGE 6
Cytodifferentiation

12. UNDERSTANDING THE HISTOLOGY

14. PAROTID GLAND
Largest
Average Wt - 25gm
Irregular lobulated mass lying mainly below the
external acoustic meatus between mandible and
sternomastoid.
On the surface of the masseter, small detached
part lies b/w zygomatic arch and parotid duct-
accessory parotid gland or ‘socia parotidis’

16. Parotid Capsule
• Derived from investing layer of deep cervical
fascia.
• Superficial lamina-thick, closely adherent-sends
fibrous septa into the gland.
• Deep lamina-thin- attached to styloid process,
mandible and tympanic plate.
• Stylomandibular ligament.

17. External Features
•Resembles an inverted 3 sided
pyramid
•Four surfaces
• Superior(Base of the Pyramid)
• Superficial
• Anteromedial
• Posteromedial

18. •Separated by three borders
• Anterior
• Posterior
• Medial

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

20. • Apex
• Overlaps posterior belly of digastric and
adjoining part of carotid triangle
• Superficial Surface
• Covered by
• Skin
• Superficial fascia containing facial
branches of great auricular N
• Superficial parotid lymph nodes and
post fibers of platysma

22. • Anteromedial Surface
• Grooved by posterior border of ramus
of mandible
• Related to
• Masseter
• Lateral Surface of
temperomandibular joint
• Medial pterygoid muscles
• Emerging branches of Facial N

23. • 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

25. BORDERS

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

27. • Posterior Border
• Separates superficial surface from
posteromedial surface
• Overlaps sternomastoid

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

29. Structures within the
parotid gland

30. ARTERIES

31. VEINS

32. NERVES

34. • Facial Nerve trunk lies approximately 1
cm inferior and 1 cm medial to tragal
cartilage pointer of external acoustic
meatus.

35. 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.

36. • At the anterior border of masseter it
pierces
• Buccal pad of fat
• Buccopharyngeal fascia
• Buccinator Muscle
• It opens into the vestibule of mouth
opposite to the 2nd upper molar

38. 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

39. Blood supply
• Arterial
• Branches of Ext.
Carotid A
• Venous
• Into Ext. Jugular Vein
Lymphatic Drainage
Upper Deep cervical nodes
via Parotid nodes

40. NERVE SUPPLY

41. •Parasymapthetic N
• Secretomotor via
auriculotemporal N
•Symapathetic N
• Vasomotor
• Delivered from plexus around
the external carotid artery
•Sensory N
• Reach through the Great
auricular and auriculotemporal N

42. Applied aspects
• Parotid swellings are very painful due to the
underlying nature of the parotid fascia.
• Mumps is infection of salivary gland caused by
paromyxovirus which will cause severe pain

43. Incision
• Lazy ‘S’ incision
• Pre-auricular—mastoid-cervical incision

45. • 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.

46. Superficial parotidectomy
• Hypotensive anaesthesia
• Head up position
• Infiltration with 1:80,000 LA with adrenaline
• Long term paralytic agents should be avoided for
C VII monitoring whenever indicated

48. Facial Nerve injury

50. • A parotid abscess may be caused by the spread
of infection from the oral cavity.
• An infection may also spread due to the parotid
lymph node draining an infected area

51. • Parotid abscess is best drained by horizontal
incision according to Hiltons method of incision
and drainage.
Vertical incision on skin but transverse incision
on the parotid fascia to safeguard facial nerve
and branches

52. • Frey's syndrome

53. • The lobule of the ear is often pushed up in
parotid swelling
• For tumours of the parotid gland incision biopsy
is not indicated as it will cause the seeding of
the tumour

54. Inflamatory diseases of parotid

55. Neoplasms of the salivary gland
• 75% occur in the parotid glands.
• In parotid glands, 80% of tumors are benign.
• Of these 80% are Pleomorphic adenomas.
• 15% of salivary tumors occur in submandibular
glands.
• Of these 50% are benign and 50% and malignant.
• In carcinomas mucoepidermoid ca> adenoid
cystic ca > adenocarcinoma

56. • 10% of salivary tumors occur in sublingual
and minor salivary glands
• 60-70% of these are malignant

57. Classification

58. Epithilial tumors
• Benign
• Pleomorphic adenoma (Mixed tumor)
• Oxyphil adenoma
• Papillary cystadenoma lymphomatosum (Warthin’s
tumor)
• Basal cell adenoma

59. Epithelial tumors
• Malignant
• Mucoepidermoid carcinoma
• Adenoid cystic carcinoma
• Acinic cell ca
• Papillary adenocarcinoma
• SCC
• Undifferentiated ca
• Ca arising in pleomorphic adenoma

60. Connective tissue tumors
• Benign
• Hemangioma
• Lipoma
• Neurilemmoma
• Fibroma
• Malignant
• Malignant lymphoma
• Above mentioned benign tumors may turn malignant.

61. submandibular
salivary gland

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

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

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

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

68. • Lateral surface
• Related to submandibluar fossa on the
mandible
• Madibular attachment of Medial
pterygoid
• Facial Artery

69. • 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

70. • 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

72. 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

74. Blood supply and lymphatics

75. • Arteries
• Branches of facial and lingual arteries
• Veins
• Drains to the corresponding veins
• Lymphatics
• Deep Cervical Nodes via submandibular nodes

76. Nerve supply
• Parasymapthetic fibers from chorda tympani
• Sensory fibers from lingual branch of
mandibular nerve
• Sympathetic fibers from plexus on facial A

78. 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 1inch(
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.

79. Tumors of submandibular glands
• Tumors in this gland are uncommon
• Enlargement is more due to calculus
• Of all tumors, mixed tumor is most common
• Swelling is hard but not stony hard and should be
differentiated from submandibular lymph node

82. Submandibular gland excision
• Indications :
• Chronic sialoadenitis
• Stone in submandbular gland
• Submandibular gland tumors

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

85. Complications
• Hemorrhage
• Infection
• Injury to mandibular nerve, lingual nerve ,
hypoglossal nerve

86. Sublingual Salivary Glands

87. • 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.

88. Relations
• Above
• Mucosa of oral floor, raised as sublingual fold
• Below
• Myelohyoid Infront
• Anterior end of its fellow
• Behind
• Deep part of Submandibular gland

89. • Lateral
• Mandible above the anterior part of
mylohyoid line
• Medial
• Genioglossus and separated from it
by lingual nerve and submandibular
duct

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

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

93. Sublingual and minor salivary
gland diseases
• Mucous cyst (retention cyst) : Ranula, sailoliths
• Inflammatory salivary gland diseases
• Tumors as described before but it rarely effects
sublingual glands

94. 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.

95. Incision
Ann R Coll Surg Engl 1994; 76: 108-109

97. REFERENCES
• Anatomy – by B.D.Chaurasia
• Oral anatomy- by Sicher and DuBruls
• Gray’s anatomy
• Oral and maxillofacial surgery-by Nilima Malik
• Oral and maxillofacial surgery- Kruger
• Ann R Coll Surg Engl 1994; 76: 108-109