Anatomy And Physiology Of Salivary Glands
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Transcript of Anatomy And Physiology Of Salivary Glands
Anatomy And Physiology Of
Salivary Glands Dr. Supreet Singh Nayyar, AFMC
For more topics, visit www.nayyarENT.com
Anatomy of Parotid, Submandibular, Sublingual glands
Physiology – structure of glands, secretion of primary fluid, neuronal control, neurotransmitters
Factors affecting salivary flow & composition
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Layout
Anatomy 3 Pairs – Major
salivary glands
Parotid Submandibular Sublingual
Collection of salivary tissue within oral mucosa – Minor salivary glands
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Ectoderm of oral cavity
Solid bulb from oropharyngeal epithelium 6 weeks - parotid gland
Dichotomous branching of solid bulb, development of lumen, condensation of mesenchyme
Formation of primitive ducts
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Development Of Parotid Gland
Engulfment of facial nerve – 16th- 21st wk
Functional maturation after feeding is established
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Contd…
Parotid Gland Lobulated, “inverted
pyramid”, extent
Superficial, deep lobes
Parotid space
Borders - ant, post
Surfaces – superficial, superior, anteromedial, posteromedial
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Condensed deep cervical fascia, tough, inelastic surface component, thin deep layer
Stylomandibular ligament
Fibrous septa arise from capsule
Contents of fascia – superficial lymph nodes, greater auricular nerve
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Capsule
Structures Within The Gland
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• Facial nerve, division of gland
• Retromandibular vein, anterior and posterior divisions
• External carotid artery, terminal branches
Capsule – Periparotid Nodes
Mostly superficial to Facial Nerve
Part of MALT, secrete IgA
Salivary gland tissue may be present within the lymph nodes
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Lymphoid Tissue In The Gland
Intraparotid Facial Nerve Stylomastoid foramen
Methods of identification 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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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
Unpredictable preoperatively, to be precisely defined during surgery
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Contd…
Autonomic Nerve Supply Parasympathetic
Inferior salivatory nucleus
IX nerve
Lesser Petrosal nerve
Otic ganglion
Auriculotemporal nerve
PAROTID
Sympathetic Superior cervical
ganglion
Plexus around ECA
PAROTID
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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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Development 6th IU wk Ectoderm in floor of primitive oral cavity Lateral to primitive tongue Development of acini – 12th wk
Large superficial, small deep lobe Located in Submandibular triangle Well defined capsule
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Submandibular Salivary Gland
Surgical Anatomy
Medial surface – Mylohyoid, Hyoglossus, Lingual nerve, XII nv, Submandibular ganglion, Deep lingual vein
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Superficial Lobe
Inferior surface – Digastric, Deep fascia, Platysma, Skin
Lateral surface – Submandibular fossa, Facial artery
Extends for a variable distance between Mylohyoid & Hyoglossus
Relations Superior – Lingual nerve Inferior – XII Nv, Deep lingual vein, Submandibular
duct
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Deep Lobe
5 cm in length Middle of deep part Crosses Sublingual space Proximally – b/w Mylohyoid & Hyoglossus Distally – b/w Genioglossus & Sublingual gland Opening – on sides of frenulum of tongue Relation to Lingual nerve
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Wharton’s duct
Branches of Facial & Lingual arteries
Lymph nodes adjacent to the superficial part
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Blood Supply & Lymphatic Drianage
Autonomic nerve supply Parasympathetic Superior Salivary Nucleus
Nervus Intermedius
Facial Nerve
Chorda Tympani
Lingual Nerve
Submandibular Ganglion
Sympathetic Superior Cervical
Ganglion
Plexus around Facial Artery
Submandibular Ganglion
SUBMANDIBULAR GLAND
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Skin incision – 4 cm below Mandible
Ligation of Facial vessels above & below
Dissected away from Lingual Nerve
Lymph nodes in substance of gland
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Surgery Of Submandibular Gland
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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Relations Of Sublingual Gland Sup – Oral floor mucosa
Inf – Mylohyoid
Post – Deep part Submandibular gland
Med – Lingual nerve, Submandibular duct, Genioglossus
Lat– Med surface of lower Mandible
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Ducts Multiple Drain into oral cavity directly or into Submandibular
duct
Blood supply
Nerve supply
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Contd…
Produce saliva – 1L / day (1ml/min/gm) 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 Salivary Glands
Lubrication and protection
Buffering and clearance
Maintenance of tooth integrity
Antibacterial activity
Taste and digestion
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Function Of Saliva
Parotid Largest, serous (Compound Tubuloacinar Gland)
Submandibular and Sublingual Mixed (Compound Tubuloacinar Glands)
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Structure of Salivary Gland
Secretory End Pieces (Acini) Serous Acini
◦ Pyramid shaped, basal nucleus, apical secretory granules
Mucus Acini ◦ Larger, columnar cells,
basal nucleus Mixed Acini
◦ Mucus acini capped by serous cells forming Serous Demilunes
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Acini
Intercalated Ducts
Striated Ducts
Interlobular Excretory Ducts
Stenson’s, Wharton’s duct
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Duct System
High rates
Rate of saliva production – 1ml/min/gm
Blood flow 10 times that of equal mass of skeletal muscle
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Control of Blood Flow And Metabolism
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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Secretion Of Saliva
Acini – Primary Fluid Secretion Isotonic to plasma, electrolyte composition fairly
constant, exocrine protein
Excretory ducts – extract Na+, Cl- and add K+, HCO3
- to saliva No addition in volume More of Na+, Cl- removed than addition of K+, HCO3
-
responsible for hypotonicity
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Secretion Of Water And Electrolytes
Osmotic process Transepithelial salt gradients
Four ion transport systems - luminal and basolateral membranes generate the gradient
Three mechanisms proposed – operate concurrently
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Mechanisms Of Primary Fluid Secretion
Mechanism 1 Stimulation – rise in cytosolic
Ca2+
Opening of K+, Cl- channels – KCl outflow
Cl- conc in lumen ↑, Na+, H2O follow
Cl- entry sustained via Na+K+2Cl- cotransporter
6 Cl- translocated to acinar lumen per ATP hydrolysed by Na+/K+ ATPase
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Mechanism 2 Cl-/HCO3
-, Na+/H+ exchanger
KCl outflow
Cl- entry via Cl-/HCO3- exchanger
Acidification buffered by Na+/H+
exchanger
3 Cl- translocated to lumen per ATP hydrolysed
Na+ & water follow into the lumen
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Mechanism 3 Involves acinar HCO3
- secretion
3 HCO3- secreted per
ATP molecule
H+ extruded via Na+/H- exchanger
Na+, H2O follow into the lumen
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Contained in zymogen granules present in serous acinar cells, ductal cells
Upon stimulation release contents in lumen by exocytosis
Conc and rate varies with level and type of stimulation
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Mechanism Of Macromolecule Secretion
Inconstant, underlying mechanisms partially understood
Produce final hypotonic solution
Influence of tubular cells more when flow rate is slow
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Mechanism Of Ductal Secretion
Predominant control – PARASYMPATHETIC
Sympathetic stimulation shorter and less strong
Probable synergistic action
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Neural Control Of Gland Function
Primary fluid secretion
Protein secretion
Vasodilatation
Increased metabolism and growth
Myoepithelial cell contraction
LARGE VOLUME LOW PROTEIN OUTPUT
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Parasympathetic Stimulation
High protein secretion
Vasoconstriction – decreased blood flow
Myoepithelial cell contraction
LOW VOLUME HIGH PROTEIN OUTPUT
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Sympathetic Stimulation
Neurotransmitters & Receptors Parasympathetic
◦ Ach binds to M3 Receptors
◦ Activation of G protein► Phospholipase C ►IP3 & DAG ► Intracellular Ca2+ release, Protein
exocytosis
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Contd… Sympathetic
◦ Noradrenaline binds to α1, β1 receptors
◦ Activation of G protein ► Adenylate Cyclase
activation ►↑cAMP dependant
Protein Kinase ►protein exocytosis
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Unstimulated – Submandibular
Stimulated – Parotid 2/3rd
Acidic tastes – Max stimulation
Sweet tastes – Least stimulation
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Factors Affecting Salivary Flow
Psychic factors Circadian rhythm Diurnal variation Age Drugs
Tricyclic antidepressants Phenothiazines
Depression and anxiety states Dehydration, hemorrhage,
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Contd…
Salivary Gland diseases Radiation sialadenitis Autoimmune sialadenitis
HIV infection
Iron overload
Sarcoidosis
Amyloidosis
Cystic fibrosis 7/13/2012www.nayyarENT.com 47
Contd…
Flow rate Source of secretion Type of stimulus Diurnal variation Diet Drugs – flow dependant components Hormones – mineralocorticoids, ovulation
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Factors Affecting Composition Of Saliva
Disease states Sialadenitis Radiation damage Sjorgen’s syndrome Cystic fibrosis HTN DM Alcoholic cirrhosis Aldosteronism Chronic pancreatitis
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Contd…
Valid medium, painless, non-invasive
Hormone monitoring Unconjugated steroids Proportional to free unbound plasma levels Useful in field studies Estradiol, progesterone, testosterone
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Salivary Assays In Diagnosis
Drugs Factors – lipid solubility, protein binding, molecular
size, flow rates Constant saliva / plasma ratio not established
Microbial antigens, antibodies Hepatitis A, B, C HIV Immunisation status
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Contd…
Tc 99m pertechnitate
Scintigraphy – objective measure of its uptake, concenteration, excretion
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Radioisotope Salivary Function Tests
Concentric shells of calcareous material alternating with organic material
Stasis of flow
Distribution Submandibular gland – 92% Parotid – 6% Sublingual / minor salivary glands – 2%
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Sialolithiasis
Scott-Brown’s Otolaryngology – 6th ed, Vol 1, Vol 5
Otolaryngology Head & Neck Surgery –Charles W Cummings, 4th ed, Vol 2
Skandalakis’ Surgical Anatomy Last’s Anatomy – 9th ed Physiology – Berne & Levy, 5th ed
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References