Salivary gland ent orl anatomy and physio

Hh

1. Anatomy and physiology of
Salivary Glands
Dr SandeepShrestha
2
nd
year Resident
ENT
NMCTH

2. Embryology
•Allmajorsalivaryglands-ectoderm
•Someminor-ectodermandendoderm
•Parotidgland(6
th
wk)----submandibular(6
th
wk)----sublingual(8
th
wks)
•Parotid-firsttodevelopbut-lastbecometo
encapsulated,afterthelymphaticsdevelop.
•Resultsinentrapmentofthelymphaticsdeep
tothecapsuleintheparenchymaofthegland.

3. Appliedanatomy
•Salivaryepithelialcells-includedwithinthese
lymphnodesandthismaybeimportantinthe
developmentofWarthin’stumoursand
lymphoepithelialcystswithintheparotid
gland.

4. •Themajorglandsliedistanttotheoral
mucosa,andareconnectedtothemucosaby
excretoryducts.
•Theminorglandsliewithinthemucosaor
submucosaoftheoralcavityandoropharynx
andeitheropendirectlyontothesurfaceof
themucosaorareconnectedtoitviashort
excretoryducts.

5. Microscopic anatomy
•Salivary glands are made up of secretoryacini
and ducts.

6. The acinus
Threetypesofacinus
•Serous(protein-secreting)–sphericalcellsrich
inzymogen(smallgranules)granules
•Mucous(mucin-secreting)–tubularshaped
cells;mucingranules(largergranulesproducing
mucoproteins)
•Mixed–varyingproportionsofserousand
mucousacinarcells.

7. •Withintheacinus,theacinarcellsandthecellsof
theproximalductalsystem(intercalatedduct)are
envelopedbypseudopodiaofsurrounding
myoepithelialcells.
•Contractilepropertiesandcreatetheperistalsis
actionwhichmovessalivaawayfromtheacinus,
distallyalongthesalivaryductsystem.
•Thelumenoftheacinuscommunicatesdirectly
withthelumenoftheduct.
•Theductalsystem,fromproximaltodistal,
comprisestheintercalatedduct,striatedductand
excretoryduct.

8. low cuboidal
epithelial
secrete
bicarbonate
and absorb
chloride
short and
poorly
developed in
mucinous
salivary glands
Theintercalatedduct

9. simple cuboidalcells
absorb sodium and
secrete potassium
producing hypotonic fluid
well developed in serous
glands
The striated and excretory duct
simple cuboidalepithelium
proximally and striated
cuboidalor pseudostratified
columnar epithelium distally

10. •Thesalivaryglandstromaisrichin
lymphocytesandplasmacells,whichare
responsiblefortheproductionofIgA,whichis
secretedintothesalivaryductsystemtobe
excretedinthesaliva.

11. Types of salivary glands
•Major salivary glands(paired)
1.Parotid gland
2.Submandibular gland
3.Sublingual gland
•Minor salivary glands

12. Parotid gland
•Largestsalivarygland
•Mainlyserous
•Invertedpyramid
•Averageweight-25gm
•Irregularwedgeshaped
•Extend
–Sup:zygomaticarch
–Inferior:upperpartofneck
–Ant:massetermuscle
–Post:externalauditory
canalandontothemastoid
process

13. •Glandhas4surfaces
–Superficial/lateral
–Superior
–Anteromedial
–Posteromedial
•3borders
–Anterior
–Posterior
–Medial

14. Superficial surface
•largest
•Concave
•Coveredbytheparotid
fascia,skinandthe
posteriorborderof
platysma.
•Somebranchesofthe
greatauricularnervelie
superficialtothegland
tissueandsuperficial
lymphnodeslieonor
deeptothefasciaaswell
aswithinthegland

15. Anteromedial surface
•Ascendingramusofthe
mandible
•Medialpterygoidmuscle
•Masseter
•Lateralsurfaceofthe
tempormandibularjoint
•Thefacialnerveand
parotidductemergefrom
thissurfaceandrun
forwardsdeeptothe
anteriorborder
•Themaxillaryarteryleaves
theanteromedialsurface

16. Posteromedialsurface
•lies on the mastoid process, the
posterior belly of the digastricand
the sternocleidomastoidmuscles.
•Medially it overlies the styloid
process with its attached muscles
(styloglossus, stylohyoidand
stylopharyngeus), which separate
the gland from the internal carotid
artery and internal jugular vein
within the carotid sheath.
•This surface is indented by the
external carotid artery prior to its
entering the gland.
•The facial nerve trunk enters the
gland high on the posteromedial
surface between the mastoid and
styloidprocesses.

17. Superior surface
•Forms the upper end of
the gland
•Small and concave
•Cartilagenouspart of the
external acoustic meatus
•Posterior surface of the
TMJ
•Superficial temporal
vessel
•Auriculotemporalnerve

18. Anterior border
•Seperatessuperficial
surfacefrom the
anteromedialsurface
•Extendfromanteriorpart
ofthesuperiorsurfaceto
theapex
•Parotidduct
•Terminalbranchoffacial
nerve
•Transversefacialvessels
•Accessoryparotidgland
liesontheparotidduct

19. Posterior border
•Seperates the
superficialsurfacefrom
the posteromedial
surface.
•OverliestheSCM

20. Medial border
•Seperates the
anteromedialsurface
fromtheposteromedial
surface
•Relatedtothelateral
wallofthepharynx

21. Structure within the parotid gland
Arteries:
•ECAentersthegland
throughitsposteromedial
surface
•Dividesintothemaxillary
andsuperficialtemporal
arterywithinthegland
•Themaxillaryarteryleaves
theanteromedialsurface
•Superficialtemporalartery
continuessuperiorlytoexit
theglandfromitssuperior
surface

22. Veins
•Superficialtothemaxillaryand
superficialtemporalarterieslie
thecorrespondingveins-unite
-formtheretromandibular
vein.
•Theretromandibularvein
emergesfromthelowerpoleof
theglandanddividesintotwo
branches.
•Theanteriorbranchjoinsthe
facialveinbeforeenteringthe
internaljugularvein.
•Theposteriorbranchjoinsthe
posteriorauricularveintoform
theexternaljugularvein.
•Thedivisionmayoccurwithin
theglandandtwobranches
emergefromthelowerpole

23. Facial nerve
•Exitsfromcranialcavity
through stylomastoid
foramen
•Enterstheglandthrough
upperpartofits
posteromedialsurface.
•Dividesintotwomain
temporalandcervical
divisions.
•These passforwards
anteriorlydividingfurther
beforeemergingfromthe
anteromedialsurfaceofthe
gland.

24. •Thenervedividesthe
gland into
superficial(80%)anddeep
lobes(20%).
•Thenerveliessuperficial
totheretromandibular
vein,whichisinturn
superficialtotheexternal
carotidartery.
Appliedanatomy:Thevein
canbeauseful
radiologicallandmarkfor
thenerve.

25. Itexitstheskullbasevia
stylomastoidforamenit
givesoff3motor
branchesuponexiting
theforamentostyloid
muscle,post.Auricular
muscle,post.bellyof
digastric.

26. •Afterexitingforamen
facialnerveturns
laterallytoenterpost.
Marginofgland
•Nervebranchesatpes
anserinus(goosefoot)
approximately1.3cm
from stylomastoid
foramen
•Thengives2branches
–temporofacial(upper)
–cervicofacial(lower)

27. •Followedby5terminal
branches
1.Temporal
2.Zygomatic
3.Buccal
4.Marginalmandibular
5.Cervical

28. Katz and catalanoclassification of
facial branches
.Type1-classicaltype(25%),subtypes–divisionandreunion
withinthezygomaticandmandibularbranches
.Type2---(14%),buccalbranchessubdividedandfusewith
zygomaticbranch
.Type3-(44%),majorcommunicationfrombuccalbranchto
others
.Type4–(14%),twoormorebuccalbrancheswithseveral
anastomosiswitheachotherandotherbranches
.Type5-(3%),facialnerveleavetheskullasmorethanonetrunk

30. Surgical landmarks
1.Tragalpointer
2.Tympanomastoidsuture
3.Post.Bellyofdigastric
ms
4.Styloidprocess

31. Parotid lymph node
•Liespartlyinthesuperficialfasciaandpartly
deeptothedeepfasciaovertheparotid
gland.
•Drainintotemple,sideofthescalp,lateral
surfaceoftheauricle,EAC,ME,Parotidgland,
upperpartofthecheek,partsoftheeyelids
andorbit.
•Efferentsfromthisnodepasstotheupper
deepcervicalnodes.

32. •Isthmus of parotid
gland runs between
mandibularramusand
post. Belly of digastric
to connect
retromandibular
portion of remainder of
gland

33. •This portion of gland lies
in prestyloid
compartment of
parapharyngealspace.
Applied anatomy
•Thus deep parotid
tumourpush-tonsillar
fossa
•Parotid tumour-that
involve parapharyngeal
space-dumbbell tumour

34. Patey’sfaciovenousplane
Glandcomposedofalargesuperficialandsmall
deeppart,connectedbyanisthmusaroundwhich
facialnervedivides.
Clinicalsignificance:
•Facialnervemustbetracedfrombehindforwards
asitemergesfromthestylomastoidforamenand
enterstheparotidgland.
•Nerveissurroundedbyaleashofveinscalled
neuro-venousplexusofpateywhichmustbe
followedwithfinedissection,tosurgicallydivide
theisthmus.

35. Stenson’sduct
•linedbylowcuboidal
epitheliumsurrounded
byasmoothmuscleand
fibroustissuewall.
•Itoriginateswithinthe
gland,envelopedbythe
deeplobeoftheparotid
•Onlysmallductules
connectthesuperficial
lobewiththeduct.

36. •Length–approx5cm
•Wide–3mm
•Diameter-internalcalibreof
about0.6mm
•Itemergesfromthe
anteriorborderofthe
parotidgland
•Travelsacrossthemasseter
muscle
•Havingreceivedtheduct
fromtheaccessoryglandit
turnsmediallyatthe
anteriorborderofthe
masseter.

37. •Itpiercesbuccinatorandruns
obliquelybetweenbuccinator
andtheoralmucosabefore
enteringtheoralcavityatthe
parotidpapillaoppositethe
seconduppermolartooth.
•Thefacialnerveandits
branchesarealwaysobserved
lateraltotheparotidduct.
•Thesurfacemarkingisthe
middleofalinebetweenthe
intertragalnotchofthe
auricleandthemidpointof
thephiltrum.

38. Accessory parotid gland
•Parsaccesoriaorsocia
parotidis
•Separatepartofthegland
usuallylyingonthe
massetermusclebetween
theparotidductbelow
andthezygomaticarch
above.
•Notedin20%ofpeople
•Typicallyliescranialto
stensen’sduct

39. Parotid fascia
•Derivedfromtheinvesting
layerofthedeepcervical
fascia.
•Continuousanteriorlywith
thefasciacoveringthe
masseter as the
parotidomassetericand
extendsuptothezygomatic
arch.
•Thedeeppartextendstothe
baseoftheskullandis
thickenedbetweenthe
styloidprocessandtheangle
ofthemandibleformingthe
stylomandibularligament.

40. •Thefasciaislargelytoughandinelasticbut
thinsanteriorly.
•Relativelythinfasciaovertheapexofthe
gland.
•Withinthecapsulearesuperficialparotid
lymphnodesandgreaterauricularnerve.

41. Appliedanatomy
•Apex-leadtothespreadofsepsisintothe
parapharyngealspace.
•Inflammatoryoedemapusandrapidlygrowing
tumourscontainedwithinthecapsulewillcause
ittostretchandbecomepainful.
•Mostparotidtumoursarisefromthesuperficial
lobeandexpandtowardsthesuperficialsurface
•Deeplobetumoursarelimitedbythe
stylomandibularligamentandexpandintothe
parapharyngealspace.

42. Greater auricular nerve
•1
st
nervetoencounterin
surgerylat.toparotidfascia
anddeepplatysma.
•Passesdeeptosuperficial
aroundthepost.Borderof
SCMthentraversesup.and
post.toext.jugularvein
•Nervearisefromcervical
plexus,providessensationto
post.Pinnaandlobule
•Erb’spoint-1cmabove
whereGANwindaround
SCMonitswaytosupply
parotidfascia

43. Auriculotemporalnerve
•Branchofmandibular
nerve
•RunsanttoEAC
parallelingthesup.
Temporalart.andvein
•Carriesparasympathetic
postganglionicfibersto
parotidgland

44. •Itprovidessensoryinnervationtoparotid
capsule,skinofauricleandtemporalregion
Appliedanatomy:
•ReferredpainfromparotitiscaninvolveEAC,
TMJandtemples
•InjuryofAuriculotemporalnervecanleadto
Frey’ssyndrome.

45. Blood supply
•Branchesofthe
externalcarotidartery
supplythegland.
•Venousdrainageisvia
theretromandibular
veinintotheexternal
andinternaljugular
veins.

46. Lymphatic drainage
•Parotidlymphaticsdrain
intoupperdeepcervical
lymphnode.

47. Nerve supply
parasympathetic
Inferior salivatorynucleus
CN IX
Tympanic branch
Tympanic plexus
Lesser superficial petrosalnerve
Relay in Oticganglion
Auriculotemporalnerve
Salivary gland

48. sympathetic
•Viatheplexusonthe
externalcarotidand
middle meningeal
arteriesfromthe
superior cervical
ganglion.

49. Clinical implication
•Acute parotitis: painful due to unyielding nature
of parotid fascia.
•A Parotid abscess may be caused by spread of
infection from the opening of parotid duct in the
oral cavity.
•Does not show fluctuation due to unyielding
nature of parotid capsule.
•Parotid abscess is best drained by horizontal
incision known as hilton’smethod below angle of
mandible.

51. Submandibulargland
•Secondlargest
•Sizeofwalnut
•Lies in the
submandibulartriangle
•Weighs:7–16g
•Roughlyjshaped
dividedbymylohyoid
1.Superficial(larger)
2.Deep(smaller)

52. Superficial part
•Fillsthedigastrictriangle
•Extendupwardsdeeptothemandibleupto
themylohyoidline
•3surfaces
–Inferior
–Lateral
–Medial
•Coveredbyskin,platysmaandafibrous
capsule,derivedfromthedeepcervicalfascia.

53. •Thecapsulerunsfromthe
greatercornuofthehyoid
boneandsplitstoenclose
theglandbeforeblending
withtheperiostiumofthe
mandiblealongthe
mylohyoidlinemedially,
andthelowerborderofthe
bodyofthemandible
laterally.
•Thefasciaiscrossedbythe
facialvein,thecervical
branchofthefacialnerve
and the marginal
mandibularbranchofthe
facialnerve.

54. Lateral surface
•liesadjacenttothebodyof
themandibleinthe
mandibularfossaandthe
originofthemedial
pterygoid.
•Thefacialarteryentersor
deeplygroovesthegland
posteriorly,afteremerging
fromdeeptothesuperior
marginoftheposteriorbelly
ofthedigastric.
•Itinitiallyliesdeeptothe
glandbeforeturning
anterolaterallytoemerge
betweentheglandandthe
lowerborderofthemandible.

55. Medial surface
•Liesonthesurfaceof
mylohyoidanteriorly,
withthenerveto
mylohyoid and
submentalvessels.
•Posteriorlythegland
overlieshyoglossus,the
lingualnervewithits
submandibularganglion,
hypoglossal nerve,
stylohyoidandposterior
bellyofthedigastric.

56. Inferior surface
Overlaps stylohyoidand the posterior belly of
the digastric.

57. Deep part
•Smallpart
•Glandliesbetweenmylohoidandhyoglossus.
•Posteriorlycontinouswiththesupericialpart
aroundtheposteriorborderofthemylohyoid.
•Anteriorly:extenduptotheposteriorendofthe
sublingualgland
Relation
Laterally:mylohyoid
Medially:hyoglossus
Above:lingualnervewithsubmandibularganglion
Below:hypoglossalnerve

58. Submandibularduct(wharton’sduct)
•Approximately5cmlong
•Meanductdiameter:0.5-
1.5mm
•Itisformedbythe
coalescenceofnumerous
ductswithinthesuperficial
partofthegland
•Emergingfromthemedial
surfaceofthispartofthe
gland
•Traversingthedeeppart
beforerunninganteriorly
alongthefloorofthemouth
betweenmylohyoidand
hyoglossus.

59. •Itemergesonthesummitofthesublingual
papillaadjacenttothelingualfrenulumafter
passingbetweenthesublingualglandand
genioglossus.
•Whilerunningforwardsonhyoglossus,itlies
betweenthehypoglossalandlingualnerves.
•Thelingualnervecrossestheductlaterallyatthe
anterioredgeofhyoglossusbeforebranchesof
thenerveemergeonthemedialsurfaceofthe
duct.

60. Nerve supply
•Thesympatheticinnervation:superiorcervical
ganglionviathelingualartery.
•Presynapticparasympatheticinnervation:via
thelingualnerve,abranchofthemandibular
divisionoftheVthcranialnervetothe
submandibularganglion.
•Innervationisinitiallyfromthesuperior
salivatorynucleusintheponspassingthrough
thenervusintermediusandcarriedbythe
chordatympaninerve.

61. Superior salivatorynucleus
NervusIntermedius
Facial nerve
Chordatympani
Lingual nerve,brof V3
Submandibularganglion
Post ganlionicfibres
Submandibulargland

62. Arterial supply
•Submentalbranchof
facialartery(br.Ofext.
carotidart)forms
grooveindeeppartof
theglandthencurveup
aroundtheinf.Margin
ofmandibletosupply
theface.

63. Venous drainage
•Anterior facial vein
deep to marginal
mandibularvein
Lymphatic drainage
•Into the deep cervical
group, particularly the
jugulo-omohyoid
nodes.

64. Appliedanatomy
•80-90%ofsialolithiasis
insubmandibulargland
•85%inwharton’sduct
•Complete ductal
obstructionresultin
atrophyofgland
•Partialobstruction
glandularmucocele

65. Appliedanatomy
•Animportantanatomicalrelationshipisthatthe
marginalmandibularnervepasseslateraltothe
veinand,therefore,dissectingdeeptothevein,
canbeusedtopreserveoridentifythenerve.
•PerivascularL.Nnearthefacialartareoften
involvedwithcanceroriginatingin
submandibularglandandnodesshouldbe
removedwithsubmandibularresection

66. Sublingual gland
•Smallestofmajorsalivary
gland
•Wt-approx4gm
•Almondshaped
•Liesdeeptofloorofmouth
mucosabetweenmylohyoid
msandbodyofmandible
closeto symphysis
(sublingualfossa)
•Whartonsductandlingual
nervepassbetween
sublingualglandand
genioglossusms

68. •Hasnotruecapsule
•Lacksingledominant
duct-drainedbyapprox.
10smallducts(ductof
rivinus)whichopenalong
thesublingualglandon
thefloorofmouth
•Occassioonallyseveral
moreantductmayjointo
form common
duct(bartholinduct)
whichtypicallyopensinto
whartonsduct

69. Innervation
•Sympathetic-cervicalchainviafacialartery
•Parasympathetic-submandibularganglion

70. Arterialsupply
•Sublingualbranchof
lingualartery
•Submentalbranchof
facialartery
Venousdrainage-reflects
arterysupply
Lymphatic-submandibular
nodes

71. Physiology of salivary glands

72. Introduction
•Salivaryglandsproducesaliva,whichplaysan
importantroleinthemaintenanceoforalhealth.
•Thelargestportionoftotalsalivavolumeis
producedbythreepairedmajorsalivaryglands:
theparotid,thesubmandibularandthe
sublingualsalivaryglands.
•Inaddition,thereare600–1000minorsalivary
glandspresentinthemucosalliningoftheoral
cavityandoropharynxthatalsocontributeto
totalsalivaproduction.

73. Types of salivary gland secretion
Gland Acinartype Viscocity %of whole
unstimulatedsaliva
Parotid Serous Watery 26
Submandibular Mixed semiviscous 69
Sublingual Mucous Viscous 5
Minors Mucous Viscous trace

74. Composition of saliva
•99.5%-water
•Proteins
•Glycoproteins
•Electrolytes
•Highink+(7*plasma)HCO3(3*plasma),Ca,P,
Cl,thiocynateandurea
•LowinNa+(1/10*plasma)
•pHof5.6–7.4

77. Phases of salivary secretion
•Activeprocessin2phase
1.Primaryphase-occurinacinarcells(product
similarincompositionandosmolalityto
plasma)
•2.Ductalsecretion-resultinhypotonicsalivary
fluidwithdecreasedsodiumandincreased
potassiumconcentrations.

79. THE AUTONOMIC NERVOUS SYSTEM
AND SALIVARY SECRETION
•Parasympatheticprincipalimpetusforsalivary
secretion
•Actthroughneurotransmitteracetylcholine
•Alsocauses1.exocytosis
2.proteinsecretion
3.myoepithelialcontraction
4.vasodilation

80. •Sympathetic-weakmobilizerofsalivaryfluid
•Actthroughnorepinephrine
•Alsocauses-1.highlevelofproteinsecretion
2.myoepithelialcontraction
3.maintenanceofvasculature

81. Ingeneral
•Parasympatheticactivityleadtooutputof
salivathathaslargevolumeandlowprotein
•Sympatheticactivityleadtosecretionoflow
volumeofsalivawithhighproteincontent

82. MECHANISMS OF
SALIVARY SECRETION

84. MECHANISMS OF ION TRANSPORT
IN SALIVARY ACINI
•Asinallsecretoryepithelia,fluidtransportinsalivary
glandcellsisthoughttobedrivenosmoticallyby
transepithelialconcentrationgradients.
•Threemechanismsthatactconcurrentlyresultinginthe
productionofprimarysalivaryfluidsecretion.
•Thefirstmechanismdependsonthecombinedactionof
fourmembranetransportsystems
–Na+-Cl−co-transporterthatislocatedinthebasolateral
membraneoftheacinarcells
–BasolateralCa++-activatedK+channel
–AnapicalconductivepathwayforCl−,whichispresumablya
Ca++-activatedCl−channel
–BasalNa+/K+ATPase

85. MECHANISMS OF ION TRANSPORT
IN SALIVARY ACINI
Na
K2
CL

86. Factors affecting salivary flow
•Age–postmenopausalwomen
•Drugs–TCA,neuroleptics,antiparkinsonian
agents,antiemetics,antihistamine
•Disease-autoimmunesialadenitis,HIV,
radiationdamage,graftversushostdisease,
sarcoidosis,ironoverload,amyloidosis,and
typevhyperlipoproteinemia
•Anxietyanddepressioninducedxerostomia

88. Constituents
Inorganic
constituent(mEq/L)
Parotid gland Submanibulargland
K+ 20 17
Na+ 23 21
Cl- 23 20
HCO3- 20 18
Ca++ 2 3.6
Mg++ 0.2 0.3
HPO4-- 6 4.5

89. Organic
constituents(mg/dl)
Parotid Submandibular
Urea 15 7
Ammonia 0.3 0.2
Uric acid 3 2
Glucose <1 <1
Cholesterol <1 -
Fatty acids 1 -
Total lipids 2-6 2-6
Aminoacids 1.5 -
Protein 250 150

90. Salivary flow
•Theaveragevolumeofsalivasecretedfromthemajor
salivaryglandina24-hourperiodis1–1.5litres.
•Mostsalivaissecretedduringmastication.
•Thebasalsalivaryflowrateis0.001–0.2ml/minute/gland
•Stimulatedsalivaryflowrateincreasesto0.18–1.7ml/
minute/gland
•Incontrast,thesalivaryflowfromtheminorsalivaryglands
isindependentofstimulationandconstitutes7–8%oftotal
salivaryoutput.
•Thesalivaproducedbyminorsalivaryglandsisrichin
mucinandisprimarilyresponsibleformaintainingoral
mucosallubrication.

91. Inanunstimulatedstatethecontributionofmeasured
Salivaryglandis:
•Submandibulargland:69%
•Parotidgland:26%
•Sublingualgland:5%
Inastimulatedphasetherelativecontributionsofmajor
salivaryglandsare:
•Parotidgland:69%
•Submandibulargland:26%
•Sublingualgland:5%

92. Collection of saliva
•Thecollectionofsalivaisperformedunderthree
circumstances:
•Unstimulatedflowoftotalsaliva
•Stimulatedflowoftotalsaliva
•Stimulatedorunstimulatedflowofanindividual
gland.

93. •Systemicorlocalsialagoguesmaybeusedtostimulate
flow.
•Systemicsalivarysialagogueispilocarpine,a
parasympathomimetic,althoughthisisrarelyusedoutside
research.
•Acommonlyusedprotocolinvolvesthedropwise
applicationof5%citricacidsolutiononthedorsumofthe
tongue.
•Asforcollectingsaliva,avarietyofmethodsareused.
–Spitting
–Drainage
–Suction
–cottonwoolrolls.

94. Collection of parotid gland saliva
•Collectedbycannulatingparotidductwith
polythenecatheterorsuctioncup.
•Suctioncup(Carlson-Crittendencup/Lashley’s
cup)

95. Collection of submandibularand
sublingual gland saliva
•Salivaproducedbythesubmandibularandsublingual
glandsistypicallycollectedusingasyringe.
•Individualglandproductionistechnicallyimpossible
duetothecloseproximityofductorificesinthe
anteriorfloorofmouthormorepertinentlybythe
numerouspotentialcommunicatingchannelsbetween
theductsystemsofallfourglands.

96. Radioisotope salivary function test
•99mTcpertechnicateisusedforstudyof
salivaryglandfunction.
•Withscintigraphyobjectivemeasureofits
uptake,concentrationandexcretioncanbe
made
•Bothparotidandsubmandibularglandcanbe
studiedatsametime.

97. Change in condition of inorganic ion
condition Change in concentration of inorganic ion
sialadenitis Raised Na+, K+ Ca++&P+level
Radiation damage Raised Na+, Ca++, Mg++, Cl-
Sjogren’ssyndrome Raised Na+, Cl-& P+in parotid gland saliva
Cystic fibrosis Raised Na+, Ca++&P+levels
hypertension Decreased Na+ level
Aldosteronism Decreased Na+ , but raised K+ level
Alcoholic cirrhosis Raised K+
Hyperparathyroidism Raised Ca++ levels
Diabetes mellitus Raised Ca++ levels
Chronic pancreatitisDepressed HCo3 level
Psychiatric illness Raised Na+ level

98. Conditions affecting composition of
saliva
Condition Effect on composition of saliva
Sjogren’ssyndrome Raised total protein and beta 2
microglobulinin parotid gland saliva
Cystic fibrosis Raised protein, amylase, lysozymein
submandibulargland saliva and
glycoprotein in parotid gland saliva
Cirrhosis Raised protein & amylase in parotid gland
saliva
Hyperparathyroidism Raised total protein
Diabetsmellitus Raisedtotal protein , IgA, IgG, IgM&
raised glucose level
Sarcoidosis Depressed amylase and lysozymelevel

99. Salivary assays in diagnosis
Malignancy screening P53 tumor suppressor protein and
increased level of peptide defensin1 on
oral sq cell ca
Raised level of c-erB2 and ca Ag 15-3 in
breast ca
Hormone monitoring Testorone, estradiol(unproven)
Drug monitoring Caffeine, carbamazepine, cisplatin,
cyclosporine,diazepam, digoxine,
ethosuximide,lithium, cocaine ,
marijuana, nicotine, opoids, phencyclidien
etc

100. Thank you