The major salivary glands are the parotid, submandibular, and sublingual glands. The parotid gland is the largest and is located below and in front of the ear. The submandibular gland is beneath the jawbone and the sublingual gland is beneath the floor of the mouth. Each gland has specific blood supply, nerve innervation and ducts through which saliva passes. Imaging modalities like ultrasound and CT are useful for evaluating salivary gland disorders. Surgical procedures like gland excision require careful dissection to preserve structures like nerves and ducts.

1. Surgical Anatomy of
Salivary Glands
Presented by-
Dr Shibani Sarangi
Oral & Maxillofacial Surgery

2. Introduction
The salivary glands are the exocrine glands, glands with ducts,
that produce saliva and pour their secretion in the oral cavity
.They are classified as:
1) Major (Paired) -Parotid
Submandibular
Sublingual
2) Minor -Those in the Tongue, Palatine Tonsil, Palate
Lips & Cheek

4. Development of Salivary glands
• They originate from oral epithelium buds invading the
underlying ectomesenchyme.
• Origin of epithelial buds:
Ectodermal –Parotid gland,Minor salivary glands
Endodermal-Submandibular gland
Sublingual gland

7. Functions of Saliva
• The functions of saliva are:
• Chemical digestion: breaks down starch by the function of
“salivary amylase”
• Helps chewing and swallowing.
• Lubricating effect: moisturizes the inside of the mouth and
creates smoother speech.
• Solvent effect: dissolves food and allows the tongue to taste
food.

8. MAJOR SALIVARY
GLANDS

9. PAROTID GLAND
• Largest major Salivary gland
• 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’

10. • 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

11. External Features
-It resembles an inverted 3 sided pyramid having four surfaces –
• Superior(Base of the Pyramid)
• Superficial
• Anteromedial
• Posteromedial
-Separated by three borders :-
• Anterior
• Posterior
• Medial

12. Relations-
• Superior Surface –
• Concave
• Related to :
1) Cartilaginous part of external acoustic meatus
2) Post. Aspect of temperomandibular joint
3) Auriculotemporal Nerve
4) Sup. Temporal vessels

13. • 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 nerve
Superficial parotid lymph nodes and post fibers
of Platysma

14. Anteromedial Surface –
• Grooved by posterior border of ramus of mandible
• Related to -
1)Masseter
2)Lateral Surface of temporomandibular joint
3) Medial pterygoid muscles
4)Emerging branches of Facial Nerve

15. • Posteromedial Surface :
• Related to-
1) Mastoid process with sternomastoid and posterior belly of digastric.
2) Styloid process with structures attached to it.
3) External Carotid artery which enters the gland through the surface
4) Internal Carotid artery 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 sternocleidomastoid muscule
Medial Border-
• Separates anteromedial surface from posteromedial surface
• Related to lateral wall of pharynx

18. STRUCTURES WITHIN THE
PAROTID GLAND

19. ARTERIES

20. VEINS

21. NERVE

22. • To expose the trunk of the facial nerve at the stylomastoid foramen the dissection
passes down the avascular plane between the parotid gland and the external
acoustic canal
• The nerve lies about 9 mm from the posterior belly of the digastric muscle and 11
mm from the bony external meatus
• The facial nerve then passes downward and forward over the styloid process and
associated muscles for about 1.3 cm

23. Facial nerve branching

24. 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 nerve.

25. • 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.

26. Blood supply
• Arterial-
Branch of External Carotid artery
• Venous-
Into the External Juglar vein
• Lymphatic drainage-
Upper deep Cervical nodes via Parotid nodes
Nerve supply
Parasympathetic –Auriculotemporal nerve
Sympathetic- plexus around middle meningeal

27. Identifying Facial nerve
• Tragus pointer :1.0cm-1.5cm deep and slightly anterior and inferior to the tip
of the external auditory canal cartilage.
• The nerve bisects the angle made by the diagastric and tympanic plate.
• 1.0cm deep to attachment of the posterior belly of the diagastric groove of
the mastoid bone.
• The CN VII lies 6-8mm distal to the end point of the tympano mastoid
fissure.
• Nerve stimulator
• Magnifying loops

28. Approaches
• Pre auricular
• Submandibular
• Combination of both

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.
• Retrograde approach to the trunk from either Mandibular
branch,where it passes over Retromandibular vein.
• Supravital staining of Parotid gland.
Preventing injury to Facial nerve

30. Complications
• Facial Nerve injury
• Frey's syndrome-(Gustatory sweating)-
It is a condition where sweating & sometimes flushing of skin
in the area of distribution of Auriculotemporal nerve that
occures;which is caused by stimulation to saliva secretion.
• It is caused due to damage to postganglionic parasympathetic
fibres from the otic ganglion,that became united to
sympathetic fibres arising from Superior cervical ganglion.

31. SUBMANDIBULAR SALIVARY GLANDS
• Irregular in shape
• Weigh about 15 grams and contribute
some 60–67% of unstimulated saliva
secretion.
• Large superficial and small deeper part continous with each
other around the posterior border of mylohyoid.

32. Superficial part-
• Situated in the digastric triangle
• Wedged b/w body of mandible and mylohyoid
• 3 surfaces –
Inferior, Medial, Lateral

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

34. Relations
• Inferior- Covered by :
- Skin
- Superficial fascia containing Platysma and cervical
branches of Facial nerve
- Deep Fascia
- Facial Vein
- Submandibular Nodes

35. • Lateral surface -
-Related to submandibluar fossa on the mandible
-Mandibular attachment of Medial pterygoid
-Facial Artery

37. • Medial surface-
• Anterior part is related to mylohyoid 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

38. • 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

39. • 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 nerve
-At the Anterior border of Hyoglossus it is crossed
by lingual nerve.
-Opens in the floor of mouth at the side of frenulum of
tongue.

41. •SUBMANDIBULAR GANGLION (LANGLEY’S GANGLION)
-It’s a parasympathetic ganglion, which acts as a relay station for
secretomotor fibres supplying the submandibular and sublingual salivary
glands.
-Topographically, it’s linked to the trigeminal nerve (lingual nerve) but
functionally it’s related to the facial nerve (via its chorda tympani branch).

42. NERVE SUPPLY
• The submandibular ganglion has 3 roots, viz.:
parasympathetic, sympathetic and sensory.
• Parasympathetic root: From Chorda Tympani
• Sympathetic root:It’s originated from sympathetic plexus
around the facial artery.
• Sensory root: It’s originated from lingual nerve.
• BLOOD SUPPLY
• ARTERIAL: Branches of Facial & Lingual arteries
• VENOUS : Facial & Lingual Veins

43. Applied aspect
- 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 . Since the marginal mandibular branch of facial nerve
enters 1 inch posteroinferior to the angle of the mandible before crossing
its lower border, the incision so ought to be given 4 cm below the angle to
prevent injury to this nerve.
- 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.

44. Submandibular gland excision
• Indications :
- Chronic sialoadenitis
- Stone in submandbular gland
- Submandibular gland tumors
• Incision :-
Placed 2-4 cm below the mandible, parallel to it •
Preserve :
- Marginal mandibular nerve
-Lingual nerve
- Hypoglossal nerve

45. Approaches
• Extraoral approach-
1)Lateral Transcervical -Incision of 4-5cm in length ,is taken in the
skin in Submandibular region.Incision to be placed parallel to skin
crease ,about 2cm below the Submandibular border.The wound is
then deepened through Platysma and deep fascia.
2) Submental approach
• The submental approach provides access to the submandibular
triangle via a midline horizontal incision just superior to the
submental-cervical crease at the level of the hyoid bone,
(4.5 ± 1.9 cm).
• Intraoral approach

48. Complications:-
• Hemorrhage
• Infection
• Injury to Mandibular nerve, Lingual nerve
& Hypoglossal nerve
• Injury to Wharton’s duct

49. SUBLINGUAL GLAND
• 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.

50. RELATIONS
Above
Mucosa of oral floor,
Below -
- Mylohyoid Infront
- Anterior end of its fellow
Behind -
-Deep part of Submandibular gland
Lateral - Mandible above the anterior part of mylohyoid line •
Medial - Genioglossus and separated from it by Lingual nerve
and Submandibular duct

51. DUCT OF SUBLINGUAL GLAND
• Ducts of Rivinus
• 8-20 ducts .
• Most of them open directly into the floor of mouth .
• Few of them join the Submandibular duct.

52. • BLOOD SUPPLY
• Arterial : From Sublingual and Submental
arteries.
• Veneous: Corresponding veins

53. APPLIED ASPECT
• 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.

54. Incision
• It is given in the Sublingual groove
• Structures closely associated are:-
Sublingual gland
Submandibular duct
Lingual nerve
Hypoglossal nerve
Sublingual vein

55. Diagnostic Imaging
• It plays an important role in evaluation of disorders
associated of major salivary gland.
• The modalities used for imaging are:-
• Conventional Radiography
• Sialography
• Ultrasonography
• Computed Tomography
• Radionuclide imaging

56. References
• Textbook and colour Atlas of Salivary gland
pathology; Eric Carlson
• Textbook of Oral & Maxillofacial surgery; Neelima
Malik
• Internet