anatomy: parotid gland
TRANSCRIPT
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Anatomy and Physiology of the
Salivary Glands
Frederick S. Rosen, MD
Faculty Advisor: Byron J. Bailey, MD
The University of Texas Medical Branch
Department of Otolaryngology
Grand Rounds Presentation
January 24, 2001
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Introduction
The Major Salivary
Glands
Parotid
Submandibular
Sublingual
The Minor Salivary
Glands
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Embryology
6th-8th Weeks of Gestation
Parotid
First to develop
Last to become encapsulated
Autonomic Nervous System Crucial
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Embryology
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Anatomy: Parotid Gland
Wedge shaped with 5 processes
3 Superficial
2 Deep
Parotid Compartment
Superior – Zygoma
Posterior – EAC
Inferior – Styloid, ICA, Jugular Veins
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Anatomy: Parotid Gland
80% overlies
Masseter & Mandible
20%
Retromandibular
Stylomandibular
Tunnel, Isthmus of
Parotid
Tail of Parotid
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Anatomy: Parotid Gland
Parapharyngeal Space
Prestyloid Compartment
Poststyloid Compartment
(Paragangliomas)
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Anatomy: Parotid Gland
Stensen’s Duct
Arises from anterior border
1.5 cm inferior to Zygomatic arch
Pierces Buccinator at 2nd Molar
4-6 cm in length
5 mm in diameter
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Anatomy: Parotid Gland
Parotid Capsule
Superficial layer Deep Cervical Fascia
Superficial layer
Deep layer
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Anatomy: Parotid Gland
CN VII
2 Surgical zones
3 Motor branches
immediately
Pes Anserinus – 1.3 cm
Temperofacial Division
Cervicofacial Division
5 Terminal branches
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Anatomy: Parotid Gland
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Anatomy: Parotid Gland
Localization of CN VII
Tragal pointer
Tympanomastoid suture
Posterior belly Digastric
Styloid process
Retrograde dissection
Mastoidectomy
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Anatomy: Parotid Gland
Great Auricular
nerve
Auriculotemporal
nerve
Superficial
Temporal vessels
Frey’s Syndrome
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Anatomy: Parotid Gland
Neural compartment
VII, Great Auricular, Auriculotemporal
Venous compartment
Retromandibular vein
Arterial compartment
Superficial Temporal/Transverse Facial
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Anatomy: Parotid Gland
Lymphatics
Paraparotid & Intraparotid nodes
Superficial & Deep Cervical nodes
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Anatomy: Submandibular Gland
The ‘Submaxilla’
Submandibular Triangle
Mylohyoid ‘C’
Marginal Mandibular branch
Capsule from superficial layer of Deep Cervical fascia
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Anatomy: Submandibular Gland
Wharton’s duct
Exits medial
surface
Between Mylohyoid
& Hyoglossus
5 cm in length
Lingual nerve & CN
XII
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Anatomy: Submandibular Gland
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Anatomy: Submandibular Gland
Innervation
Superior Cervical Ganglion (symp)
Submandibular Ganglion (para)
Artery: Submental branch of Facial a.
Vein: Anterior Facial vn.
Lymphatics: Deep Cervical and Jugular
chains
Facial artery nodes
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Anatomy: Sublingual Gland
Between Mandible & Genioglossus
No capsule
Ducts of Rivinus +/- Bartholin’s duct
Sialogram not possible
Innervation: Same as Submandibular
Artery/Vein: Sublingual branch of Lingual
& Submental branch of Facial
Lymphatics: Submandibular nodes
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Anatomy: Sublingual Gland
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Anatomy: Minor Salivary Glands
600-1,000
Simple ducts
Buccal, Labial, Palatal, Lingual
Tumor sites: Palate, upper lip, cheek
Lingual & Palatine nn.
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Imaging
CT – Inflammatory
MR – Tumor
Children: U/S & MR
NO sialogram
during active
infection
Parotid is fatty
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Microanatomy
The Secretory Unit
Acinus (serous,
mucous, mixed)
Myoepithelial
cells
Intercalated duct
Striated duct
Excretory duct
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Microanatomy
Striated & Intercalated ducts well
developed in serous, NOT mucous glands
Striated duct: HCO3 into, Cl from lumen
Intercalated duct: K into lumen, Na from
lumen, producing hypotonic fluid
Excretory ducts do NOT modify saliva
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Microanatomy
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Microanatomy
The Bicellular
Theory
Intercalated duct
Excretory duct
The Multicellular
Theory
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Microanatomy
Parotid: serous & fatty
Submandibular: mixed
serous
Sublingual: mixed
mucous
Stroma: Plasma cells
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Microanatomy
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Microanatomy
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Function of Saliva
Moistens oral
mucosa
Moistens & cools
food
Medium for
dissolved food
Buffer (HCO3)
Digestion
(Amylase, Lipase)
Antibacterial
(Lysozyme, IgA,
Peroxidase, FLOW)
Mineralization
Protective Pellicle
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Function of Saliva
Salivary hypofunction
Candidiasis
Lichen Planus
Burning Mouth
Aphthous ulcers
Dental caries
Xerostomia not
reliable
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Production of Saliva
Primary secretion
Ductal secretion
The “secretory
potential”
(hyperpolarizes)
Increased flow rate
yields decreased
hypotonicity & K
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Autonomic Innervation
Parasympathetic
Abundant,
watery saliva
Amylase down
Sympathetic
Scant, viscous
saliva
Amylase up
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Salivary Flow
1-1.5 L/day (1 cc/min)
Unstimulated state
Submandibular
Stimulated state
Parotid
Sublingual & minor
Mucin
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Effects of Aging
Total salivary flow independent of age
Acinar cells degenerate with age
Submandibular gland more sensitive to
metabolic/physiologic change
Unstimulated salivary flow more greatly
affected by physiologic changes