Anatomy of the Salivary Glands PDF

to Ana 4my 43 Anatomy of the Salivary Glands G N T Block Color Index Main Text Female Slides Male Slides Drs' Notes Important Extra info The Editing File Objectives Describe the anatomy of the Parotid gland: position, shape, structures within it, innervation and parotid duct. Describe the ana...

to Ana 4my 43 Anatomy of the Salivary Glands G N T Block Color Index Main Text Female Slides Male Slides Drs' Notes Important Extra info The Editing File Objectives Describe the anatomy of the Parotid gland: position, shape, structures within it, innervation and parotid duct. Describe the anatomy of the Submandibular and sublingual salivary glands: location, shape, parts, ducts and innervation of the glands. This lecture was presented by : Dr. Zahid Kaimkhani Dr. Amal Al-Rabiah You can find more quizzes by Clicking HERE! Special Thanks to Saleh Aljanah and Abdulaziz Alqarni! You can find Atlas by Clicking HERE! Introduction Salivary Glands Salivary glands are paired exocrine glands, that produce saliva. There are 3 large named pairs of salivary glands and multiple minute unnamed glands in the submucosa of the oral cavity (lips, palate & under surface of the tongue). Salivary glands Produces a serous, watery secretion. Parotid Sublingual Submandibular Secrets saliva that is predominantly mucous in character. Produces a mixed serous & mucous secretion. Parotid Gland Parotid Gland Largest salivary gland. Formed entirely of serous acini. Position Shape: Triangular Wedged between: Anteriorly Mandibular ramus & Masseter muscle Posteriorly Mastoid process & Sternocleid omastoid muscle (SCM) Apex Base behind angle of the mandible directed upward just below the: Zygomatic arch, External auditory meatus & Temporomand ibular joint (TMJ). Ramus Mastoid process Angle of the mandible Zygomatic arch Masseter muscle Sternocleidomastoid muscle External auditory meatus Temporomandibular joint Accessory part A small part that is separated from the main gland. Capsule The capsule is tight and derived from deep cervical fascia of the neck. ❖ The gland is divided into superficial & deep parts, by the facial nerve fibers Surfaces 1- Superficial 2- Anteromedial 3- Posteromedial Parotid Gland Parotid duct (of Stensen) ❖ ❖ ❖ Opens into the vestibule of the mouth on a small papilla, opposite the upper second molar (maxillary) tooth. 5 cm long. Runs on the masseter muscle then passes thru buccal pad of fat, then pierces the buccinators muscle. MCQ Structures in parotid gland From superficial to deep 1 Facial nerve 1- Facial nerve 2 Retromandibular vein 3 - It’s the most superficial Structure. It divides the gland into superficial & deep parts. It gives 2 Branches before it enters the gland and 5 branches within the parotid: 1-Temporal 2-Zygomatic 3-Buccal 4-Mandibular 5-Cervical 2- Retromandibular vein - (post. facial vein): ‫اﺳﻢ ﺛﺎﻧﻲ ﻟﮫ‬ Intermediate in position Formed by the union of maxillary & superficial temporal veins. Within the gland/Before it leaves the gland it’s divided into anterior & posterior branches. Females’ dr’s note: Retromandibular vein is special that it divides into 2 branches, Anterior and posterior (Special because usually veins unite and not divide): 1-Anterior branch => joins the anterior facial vein => form common facial vein => drains into IJV 2-Posterior branch => joins posterior auricular vein => drains into EJV 3- External carotid artery - Most deep. It’s divided into maxillary & superficial temporal arteries. External carotid artery Parotid Gland Blood supply Arterial supply External carotid artery & its branches. Venous drainage Retromandibular vein. Lymphatic drainage Parotid (preauricular) & thence to upper group of deep cervical lymph nodes. Nerve supply Parasympathetic (secretomotor): A- Preganglionic From Inferior salivary nucleus it enters IX CN tympanic nerve through the glossopharyngeal nerve, then to tympanic plexus then enters the lesser petrosal nerve going to otic ganglion. Remember the secretomotor pathway of the parotid gland with the mnemonic "IT has Lesser Options Anywhere", which stands for: 1. Inferior salivatory nucleus 2. Tympanic branch of 9th nerve 3. Lesser petrosal nerve 4. Otic ganglion 5. Auriculotemporal nerve B-Postganglionic After it reaches the otic ganglion it’s running in Auriculotemporal nerve until it reaches the parotid gland. Sympathetic From plexus around external carotid artery. Submandibular Gland Site Located deep to the body of the mandible. Parts ❖ ❖ Formed of 2 parts: Both parts continuous round the mylohyoid muscle. Anterior 1Large superficial part 2 Small deep part Posterior Submandibular duct (of wharton) 1 2 The duct emerges from the deep part of the gland. It passes forward along the side of the tongue, under the mucous membrane of the floor of the mouth. 3 It is crossed laterally by the lingual nerve 4 Opens on the summit of a small sublingual papilla, which lies at the side of the frenulum of the tongue. Clinically ❖ ❖ It is important to remember that the submandibular duct can be palpated through the floor of the mouth alongside the tongue. Saliva can usually be seen emerging from the orifice of the duct. Submandibular Gland Blood supply & Lymphatic drainage 1 Arterial supply: Facial artery. 2 Venous drainage: Facial vein. 3 Lymph drainage: Submandibular lymph nodes Calculus formation The submandibular duct is a common site of calculus formation. The presence of a tense swelling below the body of the mandible, which is: Greatest before or during a meal (because this is when saliva secretion is at its greatest) and Reduced in size or absent between meals, is diagnostic of the condition. Examination of the floor of the mouth will reveal: Absence of ejection of saliva from the orifice of the duct of the affected gland. Frequently, the stone can be palpated in the duct, which lies below the mucous membrane of the floor of the mouth Small calcified stone blocking a salivary duct is visible as a yellowish mass in the centre of the floor of the mouth Sublingual Gland Site The smallest of the three salivary glands. It lies below the mucous membrane of the floor of mouth (between mylohyoid & side of the tongue), close to the midline. Almond shape. ❖ ❖ ❖ Sublingual ducts 8 to 20 in number. Most open into the summit of the sublingual fold, but a few may open into the submandibular duct. ❖ ❖ Blood supply & Lymphatic drainage 1 2 3 ❖ ❖ ❖ Arterial supply: Facial artery. Venous drainage: Facial vein. Lymph drainage: Submandibular lymph nodes. Ranula A ranula is a mucus extravasation cyst. Involved sublingual gland. Found on the floor of the mouth. Sublingual Gland Nerve supply of Sublingual & Submandibular glands Sympathetic From plexus around facial artery Preganglionic Superior salivary nucleus of facial nerve (7th CN) (nervus intermedius) The fibers pass to the submandibular ganglion via chorda tympani and lingual nerve Postganglionic Postganglionic parasympathetic fibers reach the submandibular & sublingual glands either: ➔ Directly ➔ Along the duct ➔ Running in lingual nerve. Superior salivatory nucleus Parasympathetic fibers Sensory fibers Sympathetic fibers T1 spinal segment gland MCQs Q1. Which of the following is the most superficial structure in the parotid gland? A. Facial nerve B. Facial artery C. External carotid artery D. Retromandibular vein C. External carotid artery D. Tonsillar artery Q2. What is the arterial supply of the sublingual gland? A. Internal carotid artery B. Facial artery Q3. Which of the following relations corresponds to the opening of the parotid duct? A. Lower 3rd molar B. Lower 2nd molar C. Upper 3rd molar D. Upper 2nd molar C. Parotid gland D.All are the same size Q4. Which of the following is the smallest salivary gland? A. Submandibular gland B. Sublingual gland Q5. Which of the following nerves carries the postganglionic parasympathetic fibers to the parotid gland? A. Lesser petrosal nerve B. Chorda tympani C. Auriculotemporal D. Tympanic nerve Q6. A 35-year-old female patient presents with tense swelling and tenderness below the body of the mandible. She reports pain and difficulty while eating. what duct is affected? A. Submandibular B. Sublingual C. Parotid D. None of the above A1. A A2. B A3. D A4. B A5. C A6. 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