SALIVARY GLANDS

Oral Histology Dent 206

Salivary Glands

Characteristics

Compound more than one tubule entering the main duct Tubuloacinar morphology of secreting cells Merocrine only secretion of the cell is released Exocrine secretion onto a free surface
Stimulants-taste and mastication Autonomic nervous system Afferent nerves Salivary centre Autonomic nervous system Efferent nerves Secretion

Physiology

Classification of Salivary Glands

Size

Major

Parotid Submandibular Sublingual

Minor: scattered throughout the oral mucosa

Labial, buccal, palatoglossal, palatal, and lingual mucosae Not present in gingivae and dorsum of anterior 2/3 of the tongue

Secretion

Mucous Serous Mixed

Saliva

Constituents

Water-99% Organic

Proteins Glycoproteins Enzymes

Inorganic

Minerals

Saliva

Functions

Lubrication

Mucin Physical protection of oral mucosa

Taste Antibacterial and immunity

Lysozyme IgA produced by plasma cells Amylase Minerals Helps in maintaining the integrity of enamel Epidermal Growth Factor produced and secreted by the submandibular salivary glands Kallikrein

Digestion

Buffering

Wound healing and upper GI mucosal integrity

Blood coagulation

Salivary Glands

Main tissue elements

Glandular secretory tissue

Parenchyma Ectodermal Acini and duct epithelium

Supporting Connective tissue

Stroma Mesodermal

Macro-to-microscopic levels

Gland Lobe Lobule Secretory units Acini

The Secretory Units - ACINI

A grape-like cluster of parenchymal cells around a lumen Types

Serous Mucous Mixed

Serous demilunes capping mucous cells

Myoepithelial cells around the acini

Contactile cells with several processes Synonyms: basket cells

The Duct System

Intra-lobular
Acinus lumen Intercalated ducts Striated duct * In intra-lobular system, composition is affected

Plasma cells in stroma Electrolytes Epidermal GF and Kallikrein

Inter-lobular
Collecting ducts *The inter-lobular system is inert, does not affect the composition

Stroma

Connective tissue Mesenchymal origin Macro-to-microscopic levels

Capsular Inter-lobar Inter-lobular Inter-acinous

Capsular, inter-lobar, and interlobular septa contain blood vessels and nerves Constituents

Collagen fibers Fibroblasts Fat cells

With age, there is a decrease in parenchyma and an increase in stroma (esp. fat cells)

Synthesis of Saliva

Active secretory process Not a blood ultra-filtrate Serous cells

Watery proteinaceous fluid contains amylase Proteins linked to a greater amount of carbohyrates IgA

Mucous cells

Plasma cells

Secretion of Saliva

Throughout the day

Low level in general Periodic large addition from major glands 0.3 ml/min 500-700 ml/day

Average flow rate (90% from Major SG)

Contribution of gingival fluids Secretion

Spontaneous

Small amounts from sublingual and minor SGs The bulk of saliva from all glands Parotid and Submandibular SGs do not secret spontaneously

Stimulated (nerve-mediated)

Anaesthesia ceases secretion as it is nerve-mediated

Serous cells

Light Microscopy

Basophilic because of Rough Endoplasmic Reticulum Characteristic granular appearance with H & E Round prominent nuclei located at the basal third of the cell
Wedge-shaped outline Basal lamina separates from stroma Luminal part contains zymogen granules Microvilli Desmosomes, gap and tight junctions

Ultra-structure

Mucous cells

Appear pale in H & E stains Basally-compressed nuclei Acini may be surrounded by crescent-shaped serous demilunes Debate whether demilunes are connected with the lumen Mucin granules

Acinus lumen

Serous demilunes

Mucous cells

Myoepithelial cells

Lie between basal lamina and basal membranes of acinar cells and ICD Around acinar cells

Dendritic Long tapering processes Longitudinal Few short processes Parasympathetic Sympathetic Flattened nucleus Desmosomes with parenchymal cells Gap junctions and hemidesmosomes with basal lamina

Around ICD

Contracttion

Ultra-structure

Intercalated ducts

Drainage from several acini Compressed between the acini Cuboidal epithelial cells Prominent nuclei In Parotid, they are long, narrow, and branching

Striated ducts

Larger and longer than ICD Simple columnar epithelium Cells have large centrally-located nuclei Luminal surfaces have microvilli Basal surfaces separated from connective tissue by basal lamina Striation (in light microscopy) corresponds to multiple infoldings of the basal membrane of the cells Desmosomes Electrolyte re-absorption (active) and secretion Secretion of Epidermal GF and Kallikrein

Collecting ducts

Bi-layered epithelium (lacks striation)

Columnar epithelial layer Basal layer

As it enlarges, it gets a connective tissue adventitia Terminated as stratified epithelium to merge with the oral mucosa

Parotid gland

The largest Serous Acini Adult PG vs. Infants PG Fat cells vs. age

Submandibular gland

2nd largest Mixed serousmucous secretion (7:3) Intercalated ducts are short and difficult to locate Striated ducts are long and obvious

Sublingual glands

2 segments all empty to the sublingual fold

Major sublingual gland 8 - 30 mixed minor SGs

Mixed gland, mucous outnumber serous cells Most of the serous cells are in demilunes Lacking striated ducts

Minor Salivary glands

Primarily mucous Labial, buccal, palatal, palatoglossal, and lingual Lingual glands

Anterior glands

Embedded in muscle near the ventral surface of the tongue Mucous glands At the root of the tongue Mucous glands Serous Associated with the Circumvallate papillae

Posterior glands

Von Ebner glands

Clinical Considerations

Dry Mouth (xerostomia)

Causes

Ageing Parenchymal tissue < Stroma Drugs

Central action on the salivary centre Diuretics, sedatives, hypnotics, antihistamines, antihypertensives, antipsychotics, antidepressants, anticholinergics, and appetite suppressants Radiotherapy Autoimmune disorders

Loss / destruction of salivary tissue

Sjogrens syndrome destruction by lymphoid tissue (autoimmune disease)

Salivary gland surgery Diabetes Hyperthyroidism

Endocrine disorders

Clinical Considerations

Dry mouth (xerostomia)

Signs and symptoms

Dry, red, glossy atrophic mucosa Difficulty chewing, swallowing, or speaking Altered / diminished taste ability Dental caries Saliva contains re-mineralising minerals Periodontal disease Candidal infection

Treatment

Consider stopping offending medication Commercial saliva substitute Fluoride Supplementation Scrupulous dental care

Clinical considerations

Obstructive disorders

Sialolithiasis (salivary calculi)

80% in submandibular SG Minor SGs Retention of mucous outside the duct Submandibular and sublingual SGs
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Mucoceles and cysts

Ranula

Inflammatory disorders (Sialadenitis)

Viral

http://www.infocompu.com/adolfo_arthur/images/ranula.jpg

Mumps

Bacterial uncommon

Suppurative parotitis

Autoimmune diseases

Sjogrens syndrome

Salivary gland tumours