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Salivary Glands Anatomy and Pathology

• The human body has three major pairs of large salivary glands: the parotid, submandibular, and sublingual glands.
• There are also numerous small salivary glands (600-1000) distributed throughout the upper respiratory and digestive tracts, including the mouth, nose, pharynx, sinuses, and larynx.
• The major salivary glands are responsible for 80-90% of saliva production.

Parotid Gland

• The largest salivary gland, shaped like a pyramid with its base facing upward.
• Located in front of the ear and the styloid process, behind the mandible.
• It covers the masseter and temporalis muscles.
• It has a thick capsule, causing pain during rapid swelling from acute infections and malignant tumors.
• Its excretory duct is called Stensen's duct, opening into the inner surface of the cheek opposite the second upper molars.
• Lymph drainage: to the parotid and upper deep cervical nodes.
• Important surgical anatomical structures within the parotid gland include:
  • Facial nerve: branching within the gland into superficial and deep branches.
  • External carotid artery.
  • Retro-mandibular vein.

Submandibular Gland

• A mixed (seromucous) salivary gland.
• Located in the submandibular triangle.
• Its excretory duct is called Wharton's duct, about 5 cm long, originating from the deep portion, and emptying into the floor of the mouth on either side of the lingual frenulum.
• Lymph drainage: to the submandibular and upper deep cervical nodes.
• Anatomical relationships with important nerves and structures:
  • Marginal branch of the facial nerve.
  • Hypoglossal nerve (motor nerve for tongue movements).
  • Lingual nerve (sensory nerve to the tongue) deep to and parallel to its duct.
  • Facial artery, passing through its posterior pole and giving off the mental branch

Sublingual Gland

• The smallest salivary gland, purely mucous-secreting.
• Located on the floor of the anterior mouth under the mucous membrane.
• Its excretory duct is called Rivinus' ducts.
• Small salivary glands: 600-1000 scattered in the submucosa of the mouth, pharynx, sinuses, and larynx. They can be a source of tumors in these areas.
• Highest density of small salivary glands is found on the hard palate and inside the lips and cheeks.

Saliva Production and Functions

• Daily saliva production is 1-1.5 liters.
• More than 90% of saliva is produced by the parotid and submandibular glands.
• Each gland has a specific secretory pattern:
  • Parotid: serous, highest rate with stimulation.
  • Submandibular: mixed seromucous, highest rate at rest.
  • Sublingual: mucous.
• Salivary functions:
  • Moistening mucous membranes and the mouth.
  • Facilitating food breakdown and taste.
  • Moistening food bolus.
  • Contains amylase for starch and sugar digestion.
  • Contains bicarbonate to buffer acids from microbes.
  • Contains enzymes, IgA and other substances to combat microbes.
  • Contains proteins aiding the growth of healthy oral flora, preventing dental caries and gum disease

Salivary Gland Diseases

• Functional disorders: hypersalivation, xerostomia (dry mouth).
• Congenital diseases (rare): vascular tumors, lymphangiomas, ranula
• Acquired diseases: Inflammatory, Infectious, Traumatic, Autoimmune (Sjögren's syndrome), Neoplastic.
• Tumors (Benign and Malignant): Types, symptoms, diagnosis, and treatment.
• Salivary stones: Formation and clinical manifestations.
• Mumps (epidemic parotitis): Viral infection. Symptoms, diagnosis, and treatment.

Salivary Gland Examination

• Visual and palpation of gland regions to check consistency and pain.
• Palpation of Wharton's and Stensen's ducts.
• Oral cavity examination for abnormalities in the floor of the mouth, tonsils, or hard palate.
• Evaluation of the ears, face, and facial nerves.
• Neck examination for lymph node enlargements.

Additional Topics (from further pages)

• Sjögren's syndrome: autoimmune disease affecting salivary and lacrimal glands.

• Mikulski's syndrome: bilateral parotid and lacrimal gland swelling.

• Inflammatory and infectious diseases (acute and chronic).

• Specific salivary gland pathologies like acute and chronic sialadenitis.

• Detailed description of various salivary gland tumors (benign and malignant).

• Detailed process for diagnosis.

• Various treatment options (conservative and surgical) for common and less common conditions.