Anatomy and Physiology of Salivary Glands
Anatomy and Physiology of Salivary Glands
Anatomy and Physiology of Salivary Glands
Dr. Supreet Singh Nayyar, AFMC For more topics, visit www.nayyarENT.com
Layout
Anatomy of Parotid, Submandibular, Sublingual
glands
Physiology structure of glands, secretion of
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Anatomy
3 Pairs Major
salivary glands
Parotid Submandibular
Sublingual
Collection of salivary
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Contd
Engulfment of facial nerve 16th- 21st wk
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Parotid Gland
Lobulated, inverted
pyramid, extent
Superficial, deep lobes Parotid space Borders - ant, post Surfaces superficial,
Capsule
Condensed deep cervical fascia, tough, inelastic
auricular nerve
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lymph nodes
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during surgery
TM Sulcus
PBD Tragal pointer Mastoid
Retrograde
Styloid process
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Branching Patterns
Varied, Surgically important Single trunk, divides into
Zygomaticotemporal, Cervicomandibular
Temporal, upper / lower
zygomatic, buccal
Buccal, cervical, mandibular
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Contd
Type1-5 ( Katz and Catalano, 1987)
Type 1 (25%) No anastomotic links Type 2 (14%) Buccal fuses distally with Zygomatic Type 3 (44%) Major communication between Buccal &
others Type 4 (14%) Anastomosis between major divisions Type 5 (3%) More than one Facial Nv trunk
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Sympathetic
Superior cervical ganglion
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Parotid duct
Formed near the anterior
border
Lies on superficial surface of
Masseter
Opens in the mouth at
parotid papilla
Accessory Parotid tissue
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Large superficial, small deep lobe Located in Submandibular triangle Well defined capsule
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Deep Lobe
Extends for a variable distance between Mylohyoid &
Hyoglossus
Relations
Superior Lingual nerve Inferior XII Nv, Deep lingual vein, Submandibular duct
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Whartons duct
5 cm in length Middle of deep part Crosses Sublingual space Proximally b/w Mylohyoid & Hyoglossus
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Branches of Facial & Lingual arteries Lymph nodes adjacent to the superficial part
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Sympathetic
Superior Cervical Ganglion
Submandibular Ganglion
Lingual Nerve Submandibular Ganglion SUBMANDIBULAR GLAND
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Sublingual Gland
Development
8th wk
Epithelial buds present in
paralingual sulcus
Almond shaped
Located in anterior part
of floor of mouth
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Submandibular gland
Med Lingual nerve,
Mandible
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Contd
Ducts
Multiple Drain into oral cavity directly or into Submandibular duct
Blood supply
Nerve supply
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Contents
Mucin (glycoprotein) Salivary amylase Secretory Immunoglobulins Other enzymes DNase, RNase, lysozyme, lactoperoxidase, lingual lipase Kallikerin Inorganic compounds Na+, K+, HCO3-, Ca2+
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Function Of Saliva
Lubrication and protection
Buffering and clearance Maintenance of tooth integrity Antibacterial activity Taste and digestion
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Duct System
Acini Intercalated Ducts Striated Ducts Interlobular Excretory Ducts
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muscle
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Secretion Of Saliva
Active transport process under neuronal control
Composition
Hypotonic to plasma Tonicity more when rates of production are high( at max rate -
70% to that of plasma) K+,HCO3- higher than in plasma pH acidic during resting phase, basic during active phase( HCO3- secretion)
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exocrine protein
HCO3- to saliva
No addition in volume More of Na+, Cl- removed than addition of K+, HCO3- responsible
for hypotonicity
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Mechanism 1
Stimulation rise in cytosolic
Ca2+
, Na+, H2O
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Mechanism 2
Cl-/HCO3-, Na+/H+ exchanger KCl outflow
exchanger
Mechanism 3
Involves acinar HCO3-
secretion
molecule
exchanger
Na+, H2O follow into the
lumen
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exocytosis
Conc and rate varies with level and type of
stimulation
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understood
Produce final hypotonic solution
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Parasympathetic Stimulation
Primary fluid secretion
Protein secretion
Vasodilatation
Increased metabolism and growth Myoepithelial cell contraction
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Sympathetic Stimulation
High protein secretion
Vasoconstriction decreased blood flow
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Parasympathetic
Ach binds to M3
Receptors
Activation of G protein
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Phospholipase C IP3 & DAG Intracellular Ca2+ release, Protein www.nayyarENT.com exocytosis
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Contd
Sympathetic
Noradrenaline binds to
1, 1 receptors
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Adenylate Cyclase activation cAMP dependant Protein Kinase protein www.nayyarENT.com exocytosis
Activation of G protein
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Contd
Psychic factors
Circadian rhythm Diurnal variation
Age
Drugs
Tricyclic antidepressants Phenothiazines
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Contd
Salivary Gland diseases
Radiation sialadenitis Autoimmune sialadenitis HIV infection Iron overload Sarcoidosis Amyloidosis Cystic fibrosis
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Diurnal variation
Diet Drugs flow dependant components
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Contd
Disease states
Sialadenitis Radiation damage Sjorgens syndrome Cystic fibrosis HTN DM Alcoholic cirrhosis Aldosteronism Chronic pancreatitis
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Hormone monitoring
Unconjugated steroids Proportional to free unbound plasma levels Useful in field studies Estradiol, progesterone, testosterone
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Contd
Drugs
Factors lipid solubility, protein binding, molecular size,
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concenteration, excretion
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Sialolithiasis
Concentric shells of calcareous material
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References
Scott-Browns Otolaryngology 6th ed, Vol 1, Vol
5 Otolaryngology Head & Neck Surgery Charles W Cummings, 4th ed, Vol 2 Skandalakis Surgical Anatomy Lasts Anatomy 9th ed Physiology Berne & Levy, 5th ed
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