Salute

Vivamus 2023 | Central Philippine University | College of Medicine

Otolaryngology: S01L09

Functional


Anatomy of Salivary Glands
Dr. JV Ponsaran | 11-12-2021 | F | 10:00-12:00 PM

OUTLINE • It is actually a pseudocoele/pseudocyst that forms after the
I. Functional Anatomy extrusion of the mucus-like secretions on the lining of the
A. Salivary Glands wound
B. Parotid Gland • Mucocoele aka Capillary Hemangioma or Epulis (in pregnant
C. Submandibular Gland women)
D. Sublingual Gland
II. Reference • Unstimulated saliva production: 1000-1500mL
® Parotid gland: 30%
® Submandibular gland: 60%
I. FUNCTIONAL ANATOMY ® Sublingual gland: 10%
® Minor salivary gland
A. SALIVARY GLAND • Stimulated saliva production: 1500ml (minimum)
® Parotid gland: 70%
• Three Major Salivary Glands: most of them are paired ® Submandibular gland: 20%
® Parotid ® Sublingual gland: 5%
® Submandibular Gland ® Minor salivary gland: 5%
® Sublingual Gland
NICE TO KNOW!
“If saliva production is less than the minimum (1500ml) it is in the
hyposecretory state or probably having medications that hamper
production or secretion of saliva.”
Doc Ponsaran

VIVA TRANS
• Submandibular gland produces the most saliva in unstimulated
production
• Parotid gland produces the most saliva in stimulated production
• Functions of the saliva:

Fig.1 Anatomy of the Salivary Glands ® Lubrication
® Digestion
NICE TO KNOW! ® Buffering
“ Salivary glands functions in different aspects of our human body. ® Anti-infective (because of secretory antibody IgA, a
There are different functions of the Salivary gland. One of the dimer)
best is it produces saliva. And saliva has many functions as
well. And also salivary glands is known to house lymphoid ® Speaking engagement or audio/vocal process
structures thus they can also help in localizing infections or
tumors.” • Quality of saliva produced
Doc Ponsaran ® Parotid gland: serous
o Has a long tract so technically speaking it is much easier
• Several Thousands of Minor Salivary glands for the saliva to be part of the floor of the oral cavity
® Entire GI/ Respiratory Tract ® Submandibular gland: seromucous
o Found in the upper portion of the Respiratory Tract ® Sublingual gland: mucus
o Also in the sinuses ® Minor salivary gland: mucus
o URT is a shared conduit between GIT such as the
pharynx, hypopharynx thus they are also found here. NICE TO KNOW!
® Oral Cavity: “Mucus saliva production can afford to be present because of a short
o Lower lip (“hi-ways”)- more tract before it reaches the oral cavity in contrast to your serous saliva
§ When you see patients with lip mucocoeles they are which has a long tract. However, in some cases the properties of the
saliva produced also contributes to the infection associated with the
often found in the lower lip because more of the
gland, to the condition associated with the duct,especially in the case
minor Salivary glands are there of Sialolithiasis.
o Upper lip (“by-ways”)- less Doc Ponsaran
o Hard Palate
§ Most common location where minor salivary glands VIVA TRANS
are situated
• Dry Mouth or Xerostomia: production of <1000 mL of saliva in
§ (“to avoid confusion, if it is between upper and lower
unstimulated state
lip, the lower lip has more minor salivary gland”)
• Hypersalivation: production of >1500 mL of saliva in
unstimulated state
VIVA TRANS
• Lower lip is more prone to develop mucocoele, so don’t bite too
much

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B. PAROTID GLAND
NICE TO KNOW!
• Biggest Salivary Gland “The part of the parapharyngeal space (is a significant space
because it’s where infections can go to from specific spaces). In
• Bi-lobed gland
this case, Parotid infections and abscesses can go to the
® (misnomer) there is no anatomical separation between two parapharyngeal space and then more devastating things happen to
lobes the patient. That is why we don’t just take parotid abscesses or
• Divided by facial nerve (CN VII)-surgically parotitis lightly because any infections in the parotid can lead to
® Leaves the skull through stylomastoid foramen and passes traversing to other parts of the neck.
anteriorly just lateral to the styloid process Doc Ponsaran
® Passage of the nerve into the parotid gland divides it to
Superficial lobe and Deep lobe (medial to the nerve) NICE TO KNOW! ( VIVA)
® Deep lobe: lie in close contact of IX, X, XI and XII nerves • Borders of the Parotid Gland serve as landmark and basis for
and the division of external carotid artery into superficial your judgement in doing parotidectomy or examining a facial
mass
temporal and internal maxillary arteries
• In cases of trauma (stab wound, open cuts, gunshot) involving
® Then it enters the substance of the parotid gland and the parotid, overzealous repair of the parotid can lead to clamping
divides into major trunks: Cervicofacial and Temporofacial or suturing of the facial nerve and may damage it.
• Retromandibullar vein- radiographically • Have a sound and educated judgement before you do anything
® Used as a landmark radiograpically to divide and locate the else based on these borders
mass or the lesion in the parotid gland

Fig. 2. A picture showing the several branches of facial nerve and the superficial lobe
of the parotid gland being removed after a superficial parotidectomy
NICE TO KNOW!
“ The facial nerve being the surgical landmark or surgical divisor of
the parotid gland marks the location of the deep and the superficial
lobe. The one below it is the deep lobe and above it or superficial to
it is the superficial lobe.” Fig. 3. PPS (Parapharyngeal Space): divided in to prestyloid compartment and post-styloid
compartment.
Doc Ponsaran
Image shows the parotid gland occupies the deeper spaces of the neck as it traverses the
• Divisions of the Facial Nerve (pes anserinus) mandible and reaches the PPS. It touches but is not involved in the parapharyngeal space

® Temporofacial Division (Upper Division) The deep fascia of the parotid is found in the pre- styloidcompartment in the parapharyngeal
o Buccal (accdg to Doc) space
o Temporal and branches
o Zygomatic • Arterial supplies
® Cervicofacial Division (Lower Division) ® Part of the 8 branches of the carotid artery
o Cervical o External maxillary artery - main blood supply
o Marginal mandibular o Superficial temporal artery
o Buccal ( from Viva trans) o Transversely facial artery
o 6 other arbitrary patterns and collection of the facial nerve
• Superficial Lobe: holds 80% of the parenchyma of the parotid
gland
® When a mass is found on the parotid it is often found on the
superficial lobe than in deeper lobe
• Deep Lobe: 20%
• Occupies lateral aspect of face
• Borders:
® Masseter muscle (anterior)
® Zygomatic arch (superior)
® Tragus/SCM (posterior)
® Ramus of the mandible (inferior)

Fig. 4. Shows the arterial supply of the parotid

® Pre-styloid compartment (deep or medial part)

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NOTE! • Ducts
In the recording, doc says that the main blood supply of the parotid ® Stensen’s duct
gland is the external maxillary artery. But in viva trans, it says that the o Arises deep to the parotid’s parenchyma
transverse facial artery is the main blood supply to the parotid gland § When you remove the superficial part of the parotid
(this branch is closer to the heart making it a more significant vessel gland (superficial parotidectomy), the secretion in that
to supply the parotid)
• 8 terminal branches of the External Carotid Artery: SALFOP side is not hampered
MS o Transverses over the masseter through the buffalos
o Superior thyroid artery muscle to the mucosa
o Ascending pharyngeal artery o Lingual artery § When removing the mandible, make sure not to remove
o Facial artery the duct as well as to avoid secretion accumulation in
o Occipital artery the parenchyma that would later on cystify
o Posterior auricular artery o Duct punctum exists oral cavity adjacent to the upper 2nd
o Maxillary artery molar
o Superficial temporal artery

C. SUBMANDIBULAR GLAND
NICE TO KNOW!
“the arteries run deeper than the vein” • Submandibular triangle
Doc Ponsaran ® Boundaries
o Anterior: belly of the
• Venous drainage digastric
o Posterior: belly of the
® The external jugular vein runs over the SCM
digastric
o Inferior: border of the
Maxillary and superficial temporal artery mandible
o Deep: mylohyoid muscle
§ the structure deep to
the myelohyoid
Retromandibular vein + posterior facial vein muscle carries the
Wharton’s duct
§ Wharton’s duct is over the Fig. 5. Submandibular triangle
lingual nerve
External jugular ® Part of the submandibular gland are crossing beyond the
mylohyoid muscle and is situated medial to the mylohyoid
® The external jugular vein can be lighted during surgical muscle
procedures because internal jugular and other ® Lies beneath the horizontal ramus of the mandible and is
anastomoses is still there enclosed by a thin layer of connective tissue
• Nerve supply ® Lies entirely within the digastric triangle formed by the
® Greater auricular nerve anterior and posterior bellies of the digastric muscle
o Arises from C2 and C3 ® Submandibular area: below the mandible and above the
o Divides to anterior and posterior branches SCM
o Gives the parotid gland sensory component ® Medially: bordered by the styloglossus and hyoglossus
o Divides into anterior and posterior branches muscles
§ To supply the deeper and superficial parotid ® Anteriorly: mylohyoid muscle
o Can be harvested as the closest nerve donor in case of ® More medial portion of gland is closely associated with the
facial nerve injuries floorof the mouth
o Main nerve supply of the parotid: for gentle tactile ® Mixed gland that contains both serous and mucous
sensation elements
o Posterior branch: supplies the conchal bone
® Resting state: produces 2/3 of saliva
NICE TO KNOW!
Is the facial nerve in the parotid area, a sensory or motor? NICE TO KNOW!
“When dissecting the submandibular gland through the cervical
area, it is deeper than the lingual nerve. But if you are approaching
Motor only facial nerve.
the submandibular gland through the oral cavity, the warton’s duct
Doc Ponsaran is superficial than the lingual nerve.

• Nerve supply: autonomic supply What happens when you dissect the lingual nerve?
® Parasympathetic: glossopharyngeal nerve Doc Ponsaran
o Begins in the inferior salivatory nucleus which leaves the
brain through the glossopharyngeal nerve and passes • Arterial Supply/Venous Drainage
through the middle ear, crossing the promontory in ® Facial Artery/Vein
Jacobson’s nerve o Artery funds deeper than the vein
o In the tympanic plexus: enters the lesser petrosal nerve o Vein is always lateral to the artery
to reach the otic ganglion ® Parasympathetic supply
o Postganglionic fibers reach the gland through the o Arises in the superior salivatory nucleus
auricular temporal division of the Fifth nerve
® Sympathetic: Superior cervical ganglion

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o Enters the nervus intermedius (nerve of Wrisberg) and o Stimulation cause an increased flow followed by a
follow the facial nerve into its vertical portion in the compensatory decrease in flow
mastoid o No muscle elements within the glands themselves, it is
o Leaves the seventh nerve in the chorda tympani, passes believed that this increase in flow may be due to
through the middle ear and joins the lingual nerve contraction of the myoepithelial, or basket cells
o Follows the lingual nerve to a small ganglion closely associated with the striated ducts.
associated with the gland
o Sectioning of the chorda tympani nerve and Jacobson’s
nerve does not always reduce salivary secretion, other
pathways to the gland must exist (Hypoglossal and
Glossopharyngeal nerve)
• Ducts
® Wharton’s duct
o Opening of the submandibular gland
o Seromucus secretion
o The punctum is narrower than the main track and is the
reason why there can have development of stones
o Has the capacity to hold the secretion of the
submandibular gland
Fig. 6. Sublingual glands
o Channels or acts as a conduit for saliva to be excreted
o Submandibular duct
NICE TO KNOW!
o 6 cm in length
• It should not be less than 10 unless your tongue is short
o Passes between the mylohyoid and hyoglossus muscles
• Because of the short and numerous ductlets, sublingual
just medial to the sublingual gland and enters the mouth gland has the least chances of forming stones
just lateral to the lingular frenulum • Parotid Gland: Stensen’s Duct
• Submandibular Gland: Wharton’s Duct
NICE TO KNOW! • Sublingual Gland: Ducts of Rivinus and Bartholin’s duct
Three reasons why Wharton’s Duct has higher chance of forming Viva trans
ductal stone (recording):
• If you look at the image, it is elevating, it goes down to a notch
before going up to the wharton’s duct to the ampulla thus it has
more tendency to ductal stones II. REFERENCES
• More so that it has seromucous content (not liquid), thus higher
chance of forming stones • Doc’s lecture recording
• Wharton’s duct is wider proximally than it is distally, so much that • Boies Fundamentals of Otolaryngology 6th Edition p.317-318
it gives a funnel effect (narrow effect) as it goes out of the oral • ViVa trans
cavity, thus again, having higher chances of forming ductal
stones
One more reason is that it is coursing through the sublingual gland,
and sublingual gland has this connection that it drains its secretions
into the wharton’s duct, so that it will add to seromucous content of
the wharton’s duct, so more secretion = more stone formation. The
connection is called Bartholin’s Duct.
Viva trans

D. SUBLINGUAL GLAND

• Sublingual gland
® Paired glands
® Located at both sides of the frenulum
o Frenulum: medial connection of the tongue
® Sits on the floor of the mouth
o Means it sits on the mylohyoid muscle because this
muscle is the main composition of the “floor of the mouth”
® Contains 15-20 duct-lets directly pouring its salivary
secretions into the oral cavity or through the Bartholin’s duct
o Ducts of Rivinus: duct-lets of the sublingual gland
o Bartholin’s duct connect the sublingual gland to the
Wharton’s duct
® Lie just beneath the anterior floor of the mouth
® Large collections of the minor salivary glands
® Secreted saliva enters the floor of the mouth through
multiple short ducts
® Mixed gland that contain both serous and mucous elements
® Salivary response to stimulation is dependent upon neural
reflexes carried along the parasympathetic nervous system
® Sympathetic nerve supply to the major salivary glands is
from the superior cervical ganglion by way of arterial plexus
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