SALIVARY GLANDS presentation for education.pptx

Salivary Glands

1. SALIVARY GLANDS Presented by :- dr. rohan shrivastava mds 1 st year pediatric and preventive dentistry Kd dental college and hospital

2. contents Introduction Classification Composition of saliva anatomy Development of salivary gland Histology Applied anatomy Conclusion references

3. introduction Definition :- Salivary Glands in mammals are exocrine glands composed of group of tissues that produce saliva in our mouth through a system of ducts. The human salivary glands produce saliva, an important fluid required for lubrication, immunity, mastication, deglutition, taste, speech, etc. It possesses tubuloacinar units, and these are merocrine.

4. classification BASED ON SIZE :- (serous) (serous) (mucous and serous) ( mucous ) (mixed) (mixed)

5. BASED ON HISTOLOGY :- Salivary Gland Mucous acini Serous acini Mixed-mucous and serous

6. Composition of saliva

7. ANATOMY OF SALIVARY GLANDS

8. Parotid gland The paired glands are the largest of the salivary glands.(wt.- 25 gm) The gland is an irregular, lobulated, yellowish mass, lying largely below external acoustic meatus between the ramus of mandible and sternocleidomastoid muscle. Anteriorly the parotid gland overlaps masseter muscle.

9. Transverse section relations :-

10. (causes secretion of saliva)

11. Parasympathetic pathway

12. (Causes vasoconstriction) (except parotid fascia and overlying skin)

13. * It drains through parotid duct ( stensen’s duct ) that opens into oral cavity near upper second molar .

14. Submandibular gland Weighs 10-20 gms

15. (lower side of mylohyoid) (upper side of mylohyoid)

16. SUPERFICIAL PART- - Situated in the digastric triangle. It extends upwards deep to the mandible up to mylohyoid line. -3 Surfaces: Inferior, Lateral, Medial surface. -Enclosed between two layers of deep cervical fascia. Deep layer- covers Medial surface of gland Superficial layer- covers Inferior surface of gland.

17. DEEP PART: Small in size Relation- Anterior- sublingual gland Posterior- mylohyoid Laterally- mylohyoid Medially- Hyoglossus Above- lingual nerve Below- Hypoglossal nerve.

18. Sublingual salivary gland Smallest, almond shaped, 3-4 gm weights

19. Venous- drains through lingual veins to internal jugular vein

20. Minor salivary glands Found through out oral cavity, except in the anterior part of hard palate and gingiva. 600-800 in number. Minor salivary glands of the mouth include: labial, buccal, palatal, palatoglossal, lingual. The labial and buccal glands contain both mucous and serous elements. Platoglossal glands are mucous glands and are located around the pharyngeal isthmus.

21. Palatal glands are mucous glands and occur in soft palate. The anterior and posterior lingual glands are mainly mucous. The anterior glands are embedded within muscle near ventral surface of tongue and posterior glands are located in the root of the tongue.

22. histology

23. Serous Cells: Parotid and submandibular gland. Serous cells are also present in demilune formations at the blind ends of mucous secretory tubules (submandibular and sublingual glands). Secretory end piece consisting of serous cells are typically spherical and consist of 8-12 cells surrounding a central lumen.

24. Pyramidal in shape, with broad base adjacent to connective tissue stroma and apex situated towards the central lumen. Nucleus is spherical and situated at the basal third of the cell. Sometimes binucleated. Cytoplasm stains intensely with H & E. Apical cytoplasm is filled with secretory granules ( macromolecular component of saliva).

25. Mucous cells: Predominant secretory cell type of sublingual gland and most of minor salivary glands and also submandibular gland. Secretory components are tubular or round in shape. Larger lumen than serous cell. Pyramidal n shape , broader luminal surface. Flattened nucleus located towards base. The process are filled with actin and myosin.

26. Apical cytoplasm is filled with mucous secretory droplets. Stain poorly in H&E. PAS or Acini blue +ve. Mucous droplets are larger and more irregular in shape. More prominent Golgi complexes.

27. Functions: They produce a glycoprotein, mucin that absorbs water to form a sticky secretion called mucus.

28. Cell membrane has numerous caveolae - initiation of contraction. Cellular organelle are located in perinuclear cytoplasm. Only their nuclei is visible in ordinary H&E section. Myoepithelial cells related to intercalated ducts are more spindle shaped and have fewer processes.

29. Functions: Expulsion of saliva from secretory end piece to ductal system. Contraction of myoepithelial cells of intercalated ducts may shorten or widen the ducts, helping in maintaining their patency. Maintaining cell polarity and structural integrity of secretory end piece. Produce proteins that have tumor suppressor activity, such as proteinase inhibitors that cell may act as effective invasive barrier against epithelial neoplasms.

30. Ducts: 3 classes of ducts -Intercalated -Striated -Terminal Terminal secretory units opens into a small duct called the intercalated duct. These ducts join to form larger striated ducts which finally empty into a larger excretory duct .

31. Ductal System of a salivary gland: Main excretory duct opens into the oral cavity. Excretory ducts are mostly located in the interlobular connective tissue. Striated ducts are the main intralobular ductal component. Intercalated ducts vary in length and connect the secretory end pieces with the stiated ducts. Intercellular canaliculi are extensions of the lumen of the end piece between adjacent secretory cells that serve to increase the luminal surface area available for secretion.

32. CONNECTIVE TISSUE: Capsule- demarcate gland from adjacent structure. Septa- divide gland into lobes and lobules. carry the nerves and blood vessels and excretory ducts. Fibroblast, Macrophages, Dendritic cells, Mast cells, Plasma cells, Adipose tissue. Collagen fibers and elastic fibers along with glycoprotein, proteoglycans.

33. DEVELOPMENT OF SALIVARY GLAND

34. Applied aspect

35. Acute Parotitis: Acute inflammation of the parotid can occur due to bacterial or non bacterial causes. It can be unilateral or bilateral. Causes- -Mumps parotitis- Acute generalized viral disease with painful enlargement of salivary glands, chiefly parotids. - Recurrent parotitis of childhood- recurrent, mistaken for mumps, resolves at puberty. - Bacterial infection, allergic, sexual diseases. PAROTID GLAND

36. MUMPS

37. Parotid abscess- swelling and pus formation due to inflammation of parotid, enclosed by parotid fascia. If the abscess is not drained, it is likely to rupture into external auditory canal. Treatment : - Conservative management- ~ mouthwash with KMnO4 ~ Antibiotics Surgical treatment- drainage of abscess.

38. During parotidectomy, facial nerve is preserved by removing the gland in two parts, superficial and deep separately. Parotid Calculi- With in parotid gland or stenson’s duct. This can be located by injecting radiopaque dye through its opening in the vestibule of the mouth- Sialogram.

39. SUBMANDIBULAR GLAND Chronic submandibular sialadenitis- -Inflammation of salivary glands, usually caused by virus or bacteria. -Associated with pain, tenderness, redness, localized swelling. -T/T: excision of salivary gland. Incision Mobilization Excision. Stone in the submandibular duct - -calculus within the submandibular gland. -Lobular, firm . -T/T: remove the stone by incising the mucosa over the floor of the mouth, lithotripsy.

40. SIALADENITIS CALCULI IN SUBMANDIBULAR DUCT

41. Salivary Glands Tumors International Classification: 1.Epithelial tumors

42. Epithelial tumor- A. Adenoma- 1. Pleomorphic (most common benign tumor) 2. Monomorphic (Adenolymphoma- Warthin tumor) B. Mucoepidermoid tumor (mixed tumor, benign, slow growing and hard swelling) C. Acinic cell tumor (uncommon parotid gland tumor, commonly seen in woman). D. Carcinoma- 1. Adenocarcinoma 2. Adenoid cystic carcinoma (most common minor salivary gland tumor) 3. Acinic cell carcinoma(uncommon parotid gland tumor) 4. Mucoepidermoid carcinoma (In childhood commonest salivary gland tumor- always carcinomatous) 5. Malignant mixed tumor

43. PLEOMORPHIC ADENOMA ADENOLYMPHOMA

44. MUCOEPIDERMOID CARCINOMA ACINIC CELL TUMOR

45. Non epithelial tumor - 1. Lipoma 2. Lymphoma 3. Neurofibroma 4. Lymphangioma 5. Sarcoma 6. Hemangioma (benign parotid tumor in child) LIPOMA

46. LYMPHOMA SKIN RASH NUROFIBROMA LYMPHANGIOMA OF LOWER LIP HEMANGIOMA

47. Other salivary gland disorders- -Frey’s syndrome (Auriculotemporal nerve injury) -Sjogren’s syndrome (dry eyes, dry mouth) -Mikulicz’s disease (Autoimmune mechanism) -Drugs ( carbimazole, thiouracil) -Metabolic disorders(diabetes) -Parotid fistula(Occurs due to surgery of parotid gland) -Facial nerve palsy (during IAN block, if inject into parotid gland) FREY’S SYNDROME

48. SJOGREN’S SYNDROME MIKULICZS DISEASE DRUGS PAROTID FISTULA

49. FACIAL NERVE PALSY

50. CLINICAL EXAMINATION

51. History- swelling- onset, duration, progress Pain- throbbing/sharp Discharge- watery Inspection & Palpation- Swelling- Surface smoothness, extent .

52. Masseter contraction test : Ask the patient to clench the teeth and cheek, the mobility of the gland. Bidigital palpation of the submandibular gland – -Inserting the finger between the alveolus and tongue and the other finger is placed under the jaw. -Slowly both fingers are withdrawn, If there is calculi in the duct it can be appreciated. -Also check submandibular gland swelling.

53. Intraoral examination: -Examination of parotid duct: Stensen’s duct- opp. the upper 2 nd molar. -Examination of orifice of Wharton’s duct- at the base of the tongue. -Examination of tonsils and pharyngeal wall: movement of tonsil.

54. conclusion Salivary glands are compound, exocrine and tubuloacinar in nature secreting saliva which keeps the oral cavity moist. The secretory units are acini and saliva reached the oral cavity through ducts. Saliva is of a great importance to diagnostic and prognostic pathology.

55. References BDC HUMAN ANATOMY BOOK INDERBIR SINGH HUMAN EMBRYOLOGY BOOK ORBAN’S ORAL HISTOLOGY BOOK MANIPAL MANUAL SURGERY BOOK SHAFER’S TEXTBOOK OF ORAL PATHOLOGY GHOM’S ORAL MEDICINE BOOK