INTRODUCTION DEFINITION EMBRYOLOGY/DEVEOLPMENT HISTOLOGY OF SALIVARY GLANDS CLASSIFICATION OF SALIVARY GALNDS ANATOMY OF SALIVARY GLANDS AGE CHANGES CLINICAL CONSIDERATION CONCLUSION

1. SALIVARY GLANDS

2. CONTENTS
 INTRODUCTION
 DEFINITION
 EMBRYOLOGY/DEVEOLPMENT
 HISTOLOGY OF SALIVARY GLANDS
 CLASSIFICATION OF SALIVARY GALNDS
 ANATOMY OF SALIVARY GLANDS
 AGE CHANGES
 CLINICAL CONSIDERATION
 CONCLUSION

3. INTRODUCTION
What are Glands ?
A gland is an organ which produces and releases substances
that perform a specific function in the body.
Classification of glands:
Exocrine glands
 (Gr. Exo, outside,+ krinein, to separate) release their products
onto an epithelial surface, either directly or through a duct
e.g; the salivary glands.

4.  Endocrine glands:
(Gr, endon, within,+ krinein) release their products into the
blood stream, e.g; thyroid gland.
 Mixed glands
some glands possess both exocrine and endocrine function
e.g; pancreas.
 Paracrine glands
acts locally
Secrete its products in to local extra cellular environment
Ex: Entero endocrine cells of GIT

5. Baesd on the No. of cells.
UNI CELLULAR
MULTI
CELLULAR
I. Morphology of the duct/duct system.
a. Simple
b. Compound
II. Shape of the secreting portion/portions.
a. tubular
b. alveolar or acinar gland.
c. tubulo-alveolar (tubulo-acinar) glands.
EXOCRINE

6. III. Basis of nature of secretory product:
a. Mucous glands
b. Serous glands
c. Mixed (seromucous) glands
IV. Basis of the mode of secretion:
a. Holocrine glands
b. Merocrine glands
c. Apocrine glands
d. Cytogenic glands

7. DEFINITION
 Salivary glands are compound tubuloacinar , merocrine ,
exocrine glands the ducts of which open into the oral
cavity.
- BERKOVITZ 3rd edition
EMBRYOLOGY/DEVEOLPMENT
Time of origin
Gland Location Intra uterine life
Parotid gland Corners of the stomodeum as placode 6th
week I.U
Submandibular gland Floor of the mouth End of 6th
week I.U
Sublingual gland Lateral to S.m.primordium 8th
week I.U
Minor salivary glands Buccal Epithelium 12th
week I.U
Maturity of secretory end piece: During last 2 months of gestation.

8. Stage I(Bud formation).
 Develops as proliferation of oral epithelium Into underlying
ectomesenchyme (condensing around bud).
 A thin basal lamina separates the bud from underlying
mesenchyme.
 Interaction of the epithelium with underlying condensing
mesenchyme associated with salivary glands provide optimum
environment for gland formation.
DEVELOPMENT

9. Stage II (Formation and growth of epithelial chord.)
 The mesenchyme (MES) around the
developing glandular epithelium also
proliferates.
 Proliferation of the epithelial bud into the underlying
mesenchyme results in long epithelial cords.
 Basal lamina is believed to play a role in influencing the
morphogenesis & differentiation of the salivary glands.

10. Stage III (Initiation of branching in terminal parts of
epithelial chord).
 Epithelial chord proliferates & its end
branch into bulbs.
Stage IV (Branching of epithelial chord and lobule
formation):
 Terminal ends branch extensively forming numerous bulbs -
cleft formation.

11.  ECM component deposition within clefts apparently serve to
stablise them.
 Connective tissue component below epithelial chord forms
capsule & surrounds entire gland.

12. Stage V (Canalization):
 Lumen forms within the ducts before they
develop within the terminal buds.
 Apoptosis of centrally located cells.
 Different rates of proliferation of outer
and inner layers of epithelial chord.
 Lumen formation takes place at distal ends of chord, then in
proximal and at last in central part.
 Secretion of fluid by ductal cells which increases the
hydrostatic pressure within to form a canal.

13.  Following lumen formation in the terminal buds, epithelium
consists of two layers of cells.
 Inner cells differentiate into mucous or serous cells depending
upon type of specific gland.
 Some of the outer cells of epithelium differentiate into
myopithelial cells that are present around secretory end piece
and intercalated ducts.
 Portion of epithelial bud close to the oral cavity forms main
excretory duct, distal portion forms secretory end piece.
Stage VI (Cytodifferentiation):

14. HISTOLOGY OF SALIVARY GLANDS
SECRETORY
UNITS(ACINI)
-SEROUS
-MUCOUS
MYOEPITHELIA
L CELLS
DUCTAL UNITS
INTERCALATED
DUCTS
-STRIATED
DUCTS
-EXCRETORY
DUCTS
CONNECTIVE
TISSUE:
Surrounding
capsule
Tissue septae
Tissue
elements

15. Serous cells:
 Pyramidal with a broad base on the basement membrane, apex
facing the lumen
 Secretory granules – Zymogen granules present in the apical
cytoplasm
 Abundance of RER
 Mature zymogen granules expelled from the cell surface by
exocytosis

16. Mucous cells:
 Typically have a tubular configuration
 Mucous end pieces in some cases have serous cells associated with
them in the form of a demilune
 The most prominent feature of mucous cells is the accumulation in
the apical cytoplasm of their secretory product –mucus
 Have a large Golgi complex, located basal to the mass of secretory
granules

17.  Contractile elements associated with the secretory end pieces
and intercalated ducts
 Stellate shaped, numerous branching processes which envelop
the secretory end piece
 Contraction of these processes provides support to the end
pieces during active secretion of saliva
Myoepithelial cells:

18. Ductal Elements:
Acini
Intercalated ducts
Striated ducts
Excretory ducts
Stenson’s/whartons duct

19. • Single layer of cuboidal cells
• Secretory units may also secrete lysozyme and lactoferrin
Intercalated
ducts
• Constitute largest portion of ductal system; Columnar cells
• Modification of primary saliva by reabsorbtion and secretion
of electrolytes
Striated
ducts
• Pseudostratified columnar epithelium
• Other types of cells viz. Tuft cells, lymphocytes and
macrophages may be present within
Terminal
excretory
ducts

20. CONNECTIVE TISSUE:
 Capsule –demarcate gland from adjacent
structures.
 Septa –divide gland into lobes and
lobules
-Carry the nerves and blood
vessels and excretory ducts.
 Fibroblast, Macrophages, Dendritic cells,
Mast cells,Plasma Cells, Adipose tissue.
 Collagen fibers and elastic fibers along
with glycoprotein and proteoglycans of
the Ground substances

21. CLASSIFICATION OF SALIVARY GALNDS
SALIVARY GLANDS
BASED ON
ANATOMY
•MAJOR SALIVARY
GLANDS
•PAROTID GLAND
•SUBLINGUAL GLAND
•SUBMANDIBULAR GLAND
•MINOR SALIVARY
GLANDS
•LABIAL AND BUCCAL
GLANDS
•GLOSSOPALATINE
GLANDS
•PALATINE GLANDS
•LINGUAL GLANDS
•-BLANDIN &NUHN
•-VON EBNER’S GLAND
•CARMALT’S GLANDS
SALIVARY GLANDS
BASED ON
SECRETION
SEROUS
MUCOUS
MIXED

22. SEROUS
GLANDS
•PAROTIDGLAND
•VON EBNER’S GLAND’S
MUCOUS
GLANDS
GLOSSOPALATINE & PALATINE GLANDS
MIXED
GLANDS
• SUB LINGUAL GLANDS
• SUB MANDIBULAR GLANDS
• LABIAL & BUCCAL GLANDS
• LINGUAL GLANDS

23. ANATOMY OF SALIVARY GLANDS
PAROTID GLAND:
 Largest salivary gland
 60 to 65% of total saliva.
 Pyramidal in shape.
 Weights between 14-28g.
 It is situated below external acoustic meatus ,b/w ramus of
mandible and sternocleido mastoid muscle.
 Anteriorly the gland overlaps the masseter muscle.

24. Parotid Capsule
• The investing layer of deep cervical fascia forms the capsule for
the gland.
• The fascia splits to enclose the gland.
• Superficial lamina – thick & adherent to the gland.
•Deep lamina – thin , attached to the styloid process, the
mandible and tympanic plate.
• A portion of deep lamina, extending between the styloid process
and the mandible – thickened to form Stylomandibular
Ligament, separates the Parotid gland from the Submandibular
salivary gland.

25. External Features
 The glands has four surfaces
a) Superior
b) Superficial
c) Antero-medial
d) Postero-medial
 The surfaces are separated by three borders.
a) Anterior
b) Posterior
c) Medial

26. Relations
1.Superior surface related to
 External acoustic meatus
 Superficial temporal vessels
 Posterior surface of TMJ
 Auriculotemporal nerve
2.Superficial surface (largest)
a) Skin
b) b) Superficial fascia
i. Great auricular nerve
ii) Pre-auricular lymph node
iii) Posterior fibers of platysma
c) Parotid fascia
d) Deep parotid lymph nodes

27. 3. Anteromedial surface
 Masseter
 Lateral surface of TMJ
 Posterior border of the mandible
 Medial pterygoid
 Terminal branches of facial nerve
4. Posteromedial surface
 Mastoid process
 Sternocleidomastoid
 Posterior belly of the digastric
 Styloid process.

28. 6 . Anterior border :
 Separates the superficial surface from the Anteromedial
surface
 Extends from –anterior part of the superior surface to the apex
 Structures emerging:
a. Parotid duct
b. Terminal branches of the facial nerve
c. Transverse facial vessels

29. 7. Posterior border
 Separated the superficial surface from the
posteromedial surface
 Overlaps the sternomastoid.
8.Medial border :
 Separates the Anteromedial surface from the
posteromedial surface.
 Related to the lateral wall of pharynx

30. Parotid duct:
 Runs forward across masseter muscle, turns inwards at the
anterior border of masseter & opens at a pappilla in oral
cavity just opposite second maxillary molar crown.
 5cm long.

31.  Terminal branches of facial nerve
a) Temporal
b) Zygomatic
c) Buccal
d) Mandibular
e) cervical
Parasympathetic nerves are secretomotor.
Reach the gland through the auriculotemporal nerve.
NERVE SUPPLY:

32.  Sensory – auriculotemporal nerve.
 Sympathetic nerves are vasomotor –Derived from the plexus
around the external carotid artery.

33. VASCULAR SUPPLY
 ECA-external carotid artery
 Maxillary artery
 Superficial temporal vessels
 Posterior auricular artery

34. Veins
 Retromandibular vein divides into:
1. Posterior division drains into external jugular vein
2. Anterior division drains into common facial vein
Lymphatic Drainage
Upper deep cervical nodes

35.  Situated in the anterior part of the Digastric triangle
 Size that of a walnut
 Is J-shaped
 Secretion of submandibular gland is both serous and
mucous.
SUBMANDIBULAR GLAND

36.  The gland is partly enclosed in 2 layers of deep cervical fascia.
1. Superficial layer of fascia
• Covers the inferior surface of the gland
• Attached to the base of the mandible
2. Deeper layer of fascia
• Covers the medial surface of the gland
• Attached to the mylohyoid line of the mandible

37. Superficial Part:
Inferiorly:
Skin
 Platysma
Cervical branch of facial nerve
Deep fascia
Facial vein
Submandibular Lymph Nodes
Laterally
• Submandibular fossa on the
mandible
• Insertion of medial pterygoid
• Facial Artery
Medially:
• Mylohyoid
• Hyoglossus
• Styloglossus
Deep part:
Laterally:
• Hypoglossal
nerve.
Inferiorly:
• Mylohyoid muscle.
Medially:
• Hyoglossus
muscle.

38. Wharton’s Duct:
 Thin walled, about 5 cm long
 Emerges at the anterior end of the deep part of the gland
Crossed by the lingual nerve at the region of anterior border of
the hyoglossus
 Opens on the floor of the mouth, on the summit of the
sublingual papilla, at the side of tongue frenulum

39. Blood and veins Supply:
 Supplied by the facial artery
 Veins drain into the common facial or lingual vein
Lymphatic drainage:
• Submandibular lymph node & deep cervical lymph nodes.

40. Submandib
ular
ganglion
Secretomotor fibres
Vasomotor
sympathetic fibres
from facial artery
plexus
Sensory fibres from
lingual nerve
Nerve Supply

41. SUB LINGUAL GLAND
 Smallest major salivary gland
 Almond shape
 wt. abt 3 to 4 gms.
 Lies above the mylohyoid muscle, below the mucosa of floor of
the mouth, medial to sub lingual fossa of mandible, lateral to
genioglossus muscle.
 Abt 15 ducts emerges from the gland.
 Most of them opens directly in to the floor of mouth on summit
of sublingual gland fold.

42. Blood supply:
 Sublingual & submental arteries.
Lymphatic drainage:
 Submental lymph nodes
Nerve supply:
 Parasympathetic supply: Facial nerve reaching gland
through the lingual nerve & submandibular ganglion.
 Sympathetic Supply: -Postganglionic fibers from plexus on
facial artery.

43.  They are located beneath the oral epithelium in almost all
parts of the oral cavity except in the gingiva, ant. Hard
palate and ant. 2/3rd of tongue dorsum
 600 – 1000 in number present in small clusters of secretory
units
 Rich in mucin, antibacterial proteins and secretory
immunoglobulin.
MINOR SALIVARY GLANDS

44. MINOR SALIVARY GLANDS
 Continuous slow secreting glands, thus have a important role
in protecting and moistening oral mucosa, especially when
major salivary glands are mostly inactive.

45.  “Saliva is clean, tasteless, odourless, slightly acidic viscous
fluid, consisting of secretions from the parotid, sublingual,
submandibular salivary glands and the mucous glands of the
oral cavity.” - Stedmans medical dictionary 26th edition.
PROPERTIES OF SALIVA
 VOLUME:- 1000 to 1500 ml of saliva is secreted per day and
it is approximately about 1ml/minute .
 Specific Gravity : 1.002 to 1.008
 pH: 6.2 to 7.6 (6.7)
 TONICITY :- saliva is hypotonic to plasma.
SALIVA

46. Saliva
Organic substance
Inorganic
substance
Water-99.5% solids 0.5%
Enzymes
Other org.
substance
1.amylase
2.maltase
3.lingual
lipase
4.lysozyme
5.phosphatas
e 6.carbonic
anhydrase
7.kalikrein
1.Proteins- mucin &
albumin
2.Blood group
antigen 3.Free amino
acids 4.Non protein
nitrogenous
substances-urea,uric
acid,creatinine,xanthi
ne hypoxanthine
1.Sodium
2.Calcium
3.Potassium
4.Biocarbonate
5.Bromide
6.Chlorine
7.Fluoride
8.phosphate
1.Oxygen
2.Carbon
dioxide
3.Nitrogen

48. AGE CHANGES
 Acinar Atrophy
 Peri Acinar Callus formation
 Ductal Dilatation
 Fatty infilteration
 Fibrosis
 Inflammatory Infiltration
 Oncocytes

49.  Ptyalism is an abnormal condition characterized by increased
secretion of saliva in the mouth.
PTYALISM
CLINICAL CONSIDERATION

50. APTYALISM (XEROSTOMIA)
 Aptyalism is the pathological condition characterized by a
decrease or complete cessation of secretion of saliva, causing
dryness of mouth.

51.  Soreness, burning or pain sensations in the mouth.
 Due to dry, sticky oral mucosa, tongue always sticks to the
palate and there is difficulty in swallowing.
 Taste disorder (dysgeusia) and burning tongue (glossodynia).
 Whatever saliva is present, it looks stringy, ropy or foamy.
 ‘Lipstick sign’ is positive for women (lipstick always sticks to
the upper front teeth)
 Difficulty in wearing artificial prosthesis.
 Candidiasis is the most common oral infection, which is
persistently present.
CLINICAL FEATURES

52.  Removal of local or systemic causes.
 Chewing xylitol containing gums
 Regular use of artificial saliva (carboxymethyl cellulose
containing saliva)
 Antifungal drugs
 Administration of pilocarpine and use of transmucosal
neurostimulatory devices to stimulate the salivary secretion
in patients, who still retain some degree of salivary function.
 Avoidance of antihistaminic and decongestant drugs.
TREATMENT

53.  Cystic lesion developing from the salivary glands are
commonly known as “mucoceles”
Mucocele-(MUCUS EXTRAVASATION PHENOMENON).
 It results from the rupture of a salivary gland duct and spillage
of mucin into the surrounding soft tissues.
 Mucocele is not a true cyst as it lacks epithelial lining
Mucocele

54. Clinical Features
 75 % of mucoceles occur in the lower lip.
 Mucoceles are dome shaped mucosal swellings measuring
from 1-2 mm to several centimeters in size.
 They are mostly fluctuant and exhibit a bluish translucent
hue as a result of the spilled mucin.

55.  Some mucoceles are short-lived lesions that rupture and heal
by themselves.
 Many lesions, however, are chronic in nature, and local
surgical excision is necessary.
 To minimize the risk of recurrence, should remove any
adjacent minor salivary glands that may be feeding into the
lesion when the area is excised.
Treatment

56. RANULA
 Ranula is a term used for mucoceles that occur in the floor
of the mouth, arising from the sublingual gland.
 The name is derived from the Latin word rana, which means
“frog,”because the swelling may resemble a frog’s translucent
underbelly.
Causes for Ranula Formation
i. Trauma,
ii. obstructed salivary gland or ductal aneurysm.
Clinical Features
 It presents as a smooth, fluctuant, painless swelling on the
floor of the mouth, lateral to the midline.

57.  The color ranges from normal to a translucent bluish, and the
size is usually in the range of 1–3 cm, or larger.
 “Plunging or cervical ranula” is a term used to refer to deep
seated lesion that herniates through the mylohyoid muscle
and extends along the fascial planes.

58.  Intralesional injection of corticoseroids can be used for
treating small lesions and to reduce the size of larger ranulas.
 Marsupialiazation along with unroofing of the lesion is
generally helpful.
 Surgical excision of lesion and the associated salivary gland
is carried out for larger lesions
Treatment

59. SIALOLITHIASIS
 Sialolithiasis is a pathological condition, characterized by the
presence of one or more calcified stones (sialoliths) within the
salivary gland itself or within its duct.
Clinical Feature:
 Patient complains of episodic pain and swelling of the affected
gland especially with the intake of food.

60.  Sialogogues that stimulate salivary secretion can be
prescribed.
 Larger sialoliths can be removed surgically
Treatment:
 Sialoliths of smaller dimension can be milked through the
duct to the ductal orifice by gentle massage of the obstructed
duct.
 Sialoliths that are presented at the terminal portion of the
duct can be palpated as a hard mass

61.  Sjogren’s syndrome is a multi-system immunemediated
chronic inflammatory disease, characterized by lymphocytic
infiltration and acinar destruction of salivary and lacrimal
glands,with a marked predilection for women.
Clinical Forms
 1. Primary Sjögren’s syndrome: (sicca syndrome)–xerostomia
and xerophthalmia
 2. Secondary Sjögren’s syndrome – sicca syndrome + presence
of an autoimmune disorder
SJOGREN’S SYNDROME

62.  Xerostomia or dryness of mouth often causes soreness of
mouth with difficulty in eating, swallowing and talking, etc.
 parotid glands are persistently enlarged, often bilaterally and
the swelling is usually painless.
CLINICAL PRESENTATION

63.  Pt may have dryness of the nasal,pharyngeal and laryngeal
mucosa.
Histologically
 the disease is characterized by lymphocytic infiltration and
acinar destruction of salivary and lacrimal glands.
INVESTIGATIONS
 Biopsy
 Sialography
 Scintigraphy
 Schirmer test

64. TREATMENT
• Use of artificial saliva
• Use of systemic steroids
• Antibiotic eye drops
• Anti fungal drugs
• Maintenance of oral hygiene, avoidance of sweets and fluoride
applications to control caries.

65. 1. Adenomas
• Pleomorphic adenoma
• Basal cell adenoma
• Warthin’s tumor (adenolymphoma)
• Oncocytoma (oncocytic adenoma)
• Sebaceous adenoma
• Cystadenoma
2. Carcinomas
• Acinic cell carcinoma
• Mucoepidermoid carcinoma
• Adenoid cystic carcinoma
• Basal cell adenocarcinoma
• Squamous cell carcinoma
• Small cell carcinoma
• Undifferentiated carcinoma
• Other carcinomas
3. Nonepithelial tumors
4. Malignant lymphomas
5. Secondary tumors
6. Unclassified tumors
7. Tumor like lesions
classification of salivary gland tumors(WHO 1991)
• Sialadenosis
• Oncocytosis
• Necrotizing sialometaplasia
• Salivary gland cysts

66. PLEOMORPHIC ADENOMA
 Pleomorphic adenoma or benign mixed tumor is the most
common neoplasm of the salivary glands, which is
histologically characterized by complex intermingling of
epithelial components and the mesenchymal areas.
ORIGIN
 According to the multicellular theory, these tumors originate
from intercalated duct cells and myoepithelial cells of the
salivary glands.

67. Clinical Features
 slow growing, painless, well-delineated, nodular exophytic
growth.
 It is usually solitary but sometimes there can be multiple
lesions (multinodular) .
 smooth surfaced, soft or slightly firm, dome-shaped nodular
swellings on the hard or soft palate.
 Facial nerve palsy is a rare feature.

68.  The neoplasm exhibits proliferation of glandular, basophilic
epithelial cells in the form of diffuse sheets or clusters.
 These neoplastic have a tendency to form duct like structures,
which are often filled with eosinophilic mucins.
 The connective tissue stroma of pleomorphic adenoma often
characteristically exhibits metaplastic changes, which results
in the formation of mucoid, myxoid, chondroid and osseous
tissues within the tumor.
HISTOPATHOLOGY

69. CONSERVATIVE SUPERFICIAL PAROTIDECTOMY
Treatment
 Tumour along with the normal lobe is removed
 Preserve the facial nerve, even in malignant tumours unless
grossly involved
 Avoid rupture of the gland
 Enucleation should not be done as it causes recurrence

70.  Adenolymphoma is a benign salivary gland neoplasm with
limited growth potential.
 It is primarily occurring in the parotid and is composed of
cystic spaces with intraluminar projections lined by double
layer of cells.
CLINICAL FEATURES
 Middle aged or elderly males are commonly affected—usually
they are smokers.
 Can be bilateral, in some cases (10%).
 May be multicentric
ADENOLYMPHOMA (WARTHIN’S TUMOR)

71.  It has smooth surface, round border with soft, cystic
consistency.
 This tumour affects only parotid gland.

72. Histology
 This tumor is made up of two histologic components:
epithelial and lymphoid tissue.
 As the name would indicate, the lesion is essentially an
adenoma exhibiting cyst formation, with papillary
projections into the cystic spaces and a lymphoid matrix
showing germinal centers

73.  Partial superficial parotidectomy.
TREATMENT

74. ADENOID CYSTIC CARCINOMA (CYLINDROMA)
 Adenoid cystic carcinoma is a malignant neoplasm arising
from the glandular epithelium of either major or minor
salivary glands.
 It has profound tendency to invade into the perineural
lymphatic spaces.
 Freq. occurs at the age of 50 to 70 years.
 more prevalent among females.
 most common sites for development in minor glands are the
palate and tongue, In the major gland , it is the most
Common submandibular salivary gland
CLINICAL FEATURES

75.  The lesion often produces a relatively slow enlarging growth,
with frequent surface ulcerations.
 It frequently invade the facial nerve sheath, lingual and the
hypoglossal nerves.
 Pain is very common feature in this tumor and severe
neurological signs like anesthesia, paresthesia or palsy
frequently develop.

76.  Adenoid cystic carcinoma is composed of myoepithelial cells
and ductal cells which have a varied arrangement.
 Histologically, adenoid cystic carcinomas have three subtypes:
A. Cribriform pattern (classic).
B. Tubular pattern.
C. Solid pattern (basaloid).
Cribriform pattern (classic).
 The cribriform pattern shows basaloid epithelial cell nests that
form multiple cylindrical cyst like patterns resembling a Swiss
cheese or honey comb pattern, which is the most classic
and best recognized pattern
HISTOPATHOLOGY

77. Tubular pattern.
 The tubular pattern reveals tubular structures that are lined
by stratified cuboidal epithelium.
Solid pattern (basaloid).
 The solid pattern shows solid groups of cuboidal cells with
little tendency towards duct or cyst formation.

78.  By wide surgical excision.
 Post surgical radiotherapy is effective since the tumor cells are
radiosensitive.
 Short-term prognosis is good but long-term prognosis is
grave.
TREATMENT

79. MUCOEPIDERMOID TUMOR
 Mucoepidermoid tumor is an unusual type of malignant
salivary gland neoplasm with varying degree of aggressiveness.
 The tumors arise from the excretory duct cells of the
salivary gland
 It predominantly affects parotid and minor salivary glands, it
also frequently affects the jawbone.
 Clinically, the tumor presents slow growing, painless
swelling that often has a cystic feeling.

80.  Some lesions cause fast enlarging swelling, with pain,
ulceration, paresthesia and hemorrhage, etc.
Nodular mass on the left posterior lateral hard palate.

81. mucoepidermoid tumor consists of three distinct types of
cells:
(A) large pale mucous secreting cells.
(B) epidermoid cells.
(C) intermediate type of cells.
Mucoepidermoid carcinomas are graded as
a)low-grade.
b)intermediate-grade.
c)high-grade.
HISTOLOGICALLY

82.  Low-grade tumors show well formed glandular structures
and prominent mucin filled cystic spaces, minimal cellular
atypia and a high proportion of mucous cells
(Low grade a and b) Large cystic spaces with mucous secretion lined by mucous and epidermoid cells
and intermediate cells (a, 400 μ m; b, 200 μ m)

83.  Intermediate-grade tumors have solid areas of epidermoid
cells or squamous cells with intermediate basaloid cells.
 Cyst formation is seen but is less prominent than that
observed in low-grade tumors.
 All cell types are present, but intermediate cells predominate.
(Intermediate grade c and d) c - Well circumscribed lesion with fewer cystic spaces and more solid areas
d - Intermediate grade, predominantly clear, and epidermoid cells (c, 4 mm; d, 200 μ m).

84.  High-grade tumors consist of cells present as solid nests
and cords of intermediate basaloid cells and epidermoid cells.
 Prominent nuclear pleomorphism and mitotic activity is noted.
 Cystic component is usually very less (<20%).
 Necrosis and perineural invasion may be present.
High grade e and f) Solid tumors with the squamoid elements exhibiting anaplasia: Nuclear
hyperchromatism, prominent nucleoli, and pleomorphism. Very rare mucous cells seen (e, 50 μ m; f, 70 μ
m)

85.  The treatment of mucoepidermoid carcinoma is predicated by
the location, histopathologic grade, and clinical stage of
the tumor.
 Early-stage tumors of the parotid often can be treated by
subtotal parotidectomy with preservation of the facial nerve
 Advanced tumors may necessitate total removal of the
parotid gland, with sacrifice of the facial nerve.
 For lowgrade neoplasms, only a modest margin of
surrounding normal tissue may need to be removed.
TREATMENT

86.  High-grade or large tumors warrant wider resection, Neck
dissection is indicated for patients with clinical evidence of
metastatic disease .
 Postoperative radiation therapy also may be used for more
aggressive tumors.

87. CONCLUSION
 Knowledge of anatomy and physiology of salivary glands is
essential to distinctly identify various associated conditions and
salivary gland pathologies.
 Precise anatomical knowledge is also essential to plan out our
treatment strategies and alter the patient’s lifestyle for the
better.

88. References:
 Clinical Periodontology By Carranza, 13th Edition.
 ESSENTIALS OF ORAL HISTOLOGY AND EMBRYOLOGY A
Clinical Approach 3rd EDITION.
 Fundamentals of Oral Histology and Physiology.
 Orban's Oral Histology & Embryology (14th Edition).
 Shafers Textbook of Oral Pathology by Arya Rajendran,
Shivapatha Sundaram 7th Edition.
 Salivary Glands Development, Adaptations and Disease.
 Essentials of Oral Pathology Swapan Kumar Purkait.
 Junqueira's Basic Histology Text and Atlas, 14th Edition.

89.  Salivary Gland Tumours Monographs in Clinical Cytology by
Jerzy Klijanienko, Philippe Vielh.
 Salivary Gland Disorders by Eugene N. Myers , Robert L.
 Salivary Gland Diseases Surgical and Medical Management
Robert L. Witt, M.D.
 Glandular Epithelium Hanan Jafar.
 Netter’s Essential Histology. Part 1 by Ovalle Willam K.,
Nahirney Patrick C.
 Oral Anatomy, Histology and Embryology 5th Edition B. K. B.
Berkovitz.

90.  Alexander T Kessler and Alok A Bhatt:Review of the Major and
Minor Salivary Glands, Part 1: Anatomy, Infectious, and
Inflammatory Processes J Clin Imaging Sci. 2018; 8: 47.
 Salivary Diagnostics David T. Wong.
 Victor Shing Howe To, Jimmy Yu Wai Chan, Raymond K. Y.
Tsang, and William I. Wei.Review of Salivary Gland Neoplasms:
2012,872982,6.
 A.S. Tucker. / Seminars in Cell & Developmental Biology 18
(2007) 237–244.