Sepasang kelenjar submandibular adalah kelenjar liur yang kedua terbesar padatubuh yang masingmasing mempunyai berat kira-kira

10-15 gram. Setiap satu kelenjar submandibular terbagi kepada lobus superfisial dan dalam oleh bagian posterior dari ototmilohioid dan mencakup segitia submandibular. Dktus submandibular juga dikenalsebagai duktus Wharton, terletak anterior dan di atas otot milohioid dan berakhir dianterior dasar mulut. Duktus submandibular bersifat tidak elastis sehingga jika terjadi penyumbatan akan menyebabkan rasa sa

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Anatomy
Lying superior to the digastric muscles, each submandibular gland is divided into superficial and deep lobes, which are separated by the mylohyoid muscle:

The deep portion is the smaller portion. The mylohyoid muscle runs below it. The superficial portion comprises most of the gland.

Secretions are delivered into the Wharton's ducts on the deep portion after which they hook around the posterior edge of the mylohyoid muscle and proceed on the superior surface laterally. The ducts are then crossed by the lingual nerve, and ultimately drain into the sublingual caruncles (caruncula sublingualis) on either side of the lingual frenulum along with the major sublingual duct (Bartholin). There are 3 major salivary glands, which occur in pairs: The parotid glands, the largest salivary glands, are found on each side of the face, just in front of the ears. About 7 out of 10 salivary gland tumors start here. Most of these tumors are benign (non-cancerous), but the parotid gland is still where most malignant (cancerous) salivary gland tumors start. The submandibular glands are smaller and are found at the back of the jaw. They secrete saliva under the tongue area. About 1 or 2 out of 10 tumors start in these glands, and about half of these tumors are benign. The sublingual glands, which are the smallest, are found under the floor of the mouth and below either side of the tongue. Tumors starting in these glands are rare. In addition, there are several hundred minor salivary glands that are too small to see without a microscope. These glands are located beneath the lining of the lips, tongue, hard and soft palate, and inside the cheeks, nose, sinuses, and larynx (voice box). Tumors in these glands are uncommon, but they are more often malignant than benign.

Submandibular region
The region between the mandible and the hyoid bone contains the submandibular and sublingual glands, suprahyoid muscles, submandibular ganglion, and lingual artery. The lingual and hypoglossal nerves and the facial artery are discussed elsewhere.

Submandibular gland (fig. 49-1)

(fig. 49-1)
The large, paired salivary glands are the parotid, submandibular, and sublingual glands. The submandibular gland is usually just palpable. It has a larger superficial part (body) and a smaller deep process (fig. 49-1). The two parts are continuous with each other, forming a "U" shape around the posterior border of the mylohyoid muscle. The body of the gland is in and inferior to the digastric triangle and also partly under cover of the mandible. It has three surfaces: inferior (covered by skin and platysma), lateral (related to the medial surface of the mandible), and medial (related to the mylohyoid, hyoglossus, and digastric muscles). The deep process lies between the mylohyoid and hyoglossus muscles the submandibular duct, which is crossed by the llingual nerve, runs anterior from this process (fig. 49-1). The submandibular duct opens by one to three orifices into the oral cavity on the sublingual papilla, at the side of the frenulum linguae. The branches of the duct can be examined radiographically after injection of a radio-opaque medium (sialography). The submandibular gland is supplied by postganglionic parasympathetic, secretomotor fibers derived from the submandibular ganglion (see fig. 49-3). The preganglionic fibers leave the skull with the chorda tympani (a branch of the facial nerve) and then join the lingual nerve on their way to the submandibular ganglion.

(fig. 49-3).

Sublingual gland (fig. 49-1)

The sublingual gland (fig. 49-1) is inferior to the mucosa of the floor of the mouth and is anterior to the deep process of the submandibular gland. Most of the 10 to 30 sublingual ducts open separately into the floor of the oral cavity (fig. 49-1). The innervation of the gland from the submandibular ganglion is similar to that of the submandibular gland.

Suprahyoid muscles (table 49-1).

The suprahyoid muscles (see fig. 50-6), which connect the hyoid bone to the skull, are the digastric, stylohyoid, mylohyoid, and geniohyoid muscles. The genioglossus and hyoglossus are described with the tongue.

(see fig. 50-6), The digastric muscle (see fig. 50-2C and D) consists of two bellies united by an intervening tendon. The anterior belly, from the mandible, and the posterior belly, from the medial aspect of the mastoid process, develop from pharyngeal arches 1 and 2, respectively, and hence are innervated by cranial nerves V and VII. The tendon that connects the anterior and posterior bellies of the muscle is anchored to the hyoid bone, commonly passing through the stylohyoid muscle. The posterior belly of the digastric muscle and the stylohyoid muscle are crossed superficially by the facial vein, the great auricular nerve, and the cervical branch of the facial nerve. Deep to the muscles lie the external and internal carotid arteries, the internal jugular vein, cranial nerves X-XII, and the sympathetic trunk.

(see fig. 50-2C and D)

The stylohyoid muscle (see fig. 50-6) lies along the upper border of the posterior belly of the digastric muscle and is innervated by cranial nerve VII.

(fig. 49-2) The mylohyoid muscle (fig. 49-2) lies superior to the anterior belly of the digastric muscle and is innervated by cranial nerve V. The right and left mylohyoid muscles extend from the mandible to join each other in a median raphe and form a muscular floor (diaphragma oris) for the anterior mouth. This muscular sling supports the tongue and is important in propelling both solids and liquids from the oropharynx into the laryngopharynx. The geniohyoid muscle (see figs. 49-4 and 53-4) lies superior to the mylohyoid muscle and is in contact or fused with the geniohyoid muscle of the opposite side.

Submandibular ganglion (fig. 49-3).

(fig. 49-3).

The submandibular ganglion lies on the lateral surface of the hyoglossus muscle, medial to the mylohyoid muscle, superior to the submandibular duct and hypoglossal nerve, and inferior to the lingual nerve, from which it is suspended by several branches. Preganglionic parasympathetic fibers derived from the chorda tympani travel in the lingual nerve and synapse in the submandibular ganglion. Some of the postganglionic secretory fibers enter the submandibular gland; others, by entering the lingual nerve, reach the sublingual gland. Postganglionic sympathetic fibers (from the superior cervical ganglion) pass through the submandibular ganglion and are distributed with the parasympathetic fibers.

Lingual artery (fig. 49-4).

(fig. 49-4).
The lingual artery arises from the external carotid artery near the level of the hyoid bone. It passes successively (1) posterior, (2) deep, and (3) anterior to the hyoglossus muscle. The first part of the artery lies mainly in the carotid triangle. It forms a loop on the middle constrictor and is crossed by the hypoglossal nerve. The second part runs deep to the hypoglossus muscle superior to the hyoid bone and gives branches to the dorsum of the tongue. The third part (arteria profunda linguae) ascends between the muscles of the tongue and anastomoses with the artery of the opposite side.
RISK FACTORS

A risk factor is anything that affects your chance of getting a disease such as cancer. Different cancers have different risk factors. For example, exposing skin to strong sunlight is a risk factor for skin cancer. Smoking is a risk factor for cancers of the lung, larynx (voice box), mouth, throat, esophagus (tube that carries food to the stomach),

kidneys, bladder, and several other organs. But risk factors don't tell us everything. Having a risk factor, or even several risk factors, does not mean that you will definitely get the disease. And many people who get the disease may not have had any known risk factors. Even if a person has one or more risk factors, it is not possible to know for sure how much that risk factor contributed to causing the cancer. Scientists have found few risk factors that make a person more likely to develop salivary gland cancer.

Radiation exposure
Radiation treatment to the head and neck area for other medical reasons increases your risk of salivary gland cancer. Workplace exposure to certain radioactive substances may also increase the risk of salivary gland cancer.

Family history
Very rarely, members of some families seem to have a higher than usual risk of developing salivary gland cancers.

Other possible risk factors

Certain workplace exposures
Some studies have suggested that working with certain metals (nickel alloy dust) or minerals (silica dust) may increase the risk for salivary gland cancer, but these links are not certain. The rarity of these cancers makes this a difficult area to study.

Tobacco and alcohol use

Tobacco and alcohol can increase the risk for several cancers of the head and neck area, but they have not been strongly linked to salivary gland cancers in most studies.

Diet
Some studies have found that a diet low in vegetables and high in animal fat may increase the risk of salivary gland cancer, but more research is needed to confirm this possible link.

Cell phones
One recent study suggested an increased risk of parotid gland tumors among heavy cell phone users. In this study, most of the tumors seen were benign (not cancer). Other studies looking at this issue have not found such a link. Research in this area is still in progress. If there is any excess risk, it could be decreased by using corded or cordless earpieces that move the device away from the user's head and decrease the amount of radiation that reaches the body.

There are 3 major salivary glands, which occur in pairs: The parotid glands, the largest salivary glands, are found on each side of the face, just in front of the ears. About 7 out of 10 salivary gland tumors start here. Most of these tumors are benign (non-cancerous), but the parotid gland is still where most malignant (cancerous) salivary gland tumors start. The submandibular glands are smaller and are found at the back of the jaw. They

secrete saliva under the tongue area. About 1 or 2 out of 10 tumors start in these glands, and about half of these tumors are benign. The sublingual glands, which are the smallest, are found under the floor of the mouth and below either side of the tongue. Tumors starting in these glands are rare. In addition, there are several hundred minor salivary glands that are too small to see without a microscope. These glands are located beneath the lining of the lips, tongue, hard and soft palate, and inside the cheeks, nose, sinuses, and larynx (voice box). Tumors in these glands are uncommon, but they are more often malignant than benign.