Otolaryngology-Head & Neck

Surgery

By Dr Abdissa ( MD)

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 Salivary glands

 Exocrine glands & open into oral cavity

• Major salivary glands
 parotid
 submandibular
 sublingual
• Minor salivary glands
 Lips and cheeks
 Palate
 Tongue
 Oropharynx 2
 Microanatomy of salivary glands
 Acinus

 Intercalated duct

 Striat duct

 Excretory duct

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 Parotid salivary glands
 Largest salivary gland
 25gm
 Irregular in shape
 Location
 Below EAC
 Between mandible and
SCM muscle
 Secretion ; serous

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 Consist of
 Superficial part
 Deep part
 Accessory gland
 Three borders
 Anterior
 Posterior
 Medial

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 Facial nerve
 Exit the skull at stylomastoid foramen
 Pes anserinus
 Temporofacial
 Temporal
 Zygomatic
 Cervico facial
 Buccal
 Marginal mandibular
 Cervical

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 Submandibular glands
 Second largest (15mg)
 C- shaped
 submandibular triangle
 Parts
 Deep part
 Superficial part
 Has capsule
 Deep cervical fascia

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 Sublingual glands
 Smallest of major salivary glands
 Almond in shape
 Has no fibrous capsule
 Superior relation
 Mucosa of oral cavity
 Inferior
 Mylohyoid
 posterior
 Deep part of submandibular gland

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 Minor salivary glands
 Found in
 Palate
 Tongue
 Lips &Cheeks
 Oropharynx
 Secretion mainly mucous
 Lacks branching pattern
 Neurovaculture
 by respective region 9
 REGULATION OF SALIVARY SECRETION

 Two varieties of salivary secretion

1. spontaneous: occurs all time with out any known stimulus keeping
mouth moist all the time
2. stimulated: occurs of known stimulus
Psychological
Visual
Taste
 Autonomic nervous system generally regulates the flow and secretion of
saliva 10
 Salivary flow rate
 Salivary flow rate varies in the stimulated and unstimulated state
Stimulated flow
 90% of average daily saliva production
 At rate of between 0.2-7ml/min
 Parotid gland contributes>50% of total salivary flow
Unstimulated flow
 Normal flow >0.1ml/min
 Submandibular gland contribute 65% of total flow
 Parotid gland 25%
 Sublingual and MSG 10%
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 Salivary gland diseases
Sialadenitis
 inflammation of salivary glands 
Etiology
 viral most common (mumps)
 bacterial causes: S. aureus, S. pneumoniae, H. influenzae
Predisposing Factors
 HIV
 Anorexia/bulimia
 Sjogren’s syndrome
 Cushing’s, hypothyroidism, DM
 Hepatic/renal failure
 Medictions that increase stasis: diuretics, TCAs, beta-blockers 12
 Sialadenitis
Clinical Features
 acute onset of pain and edema of parotid or submandibular gland that may
lead to marked swelling
 ± fever
 ± leukocytosis
 ± suppurative drainage from punctum of the gland
Investigations
 U/S imaging to differentiate obstructive vs. non-obstructive sialadenitis
Treatment
 bacterial: treat with cloxacillin ± abscess drainage
 viral: no treatment
N.B. Mumps presents with bilateral parotid enlargement, ± sensorineural
hearing loss, ± orchitis 13
 Sialolithiasis
 Ductal stone (mainly hydroxyapatite) leading to chronic sialadenitis
 80% in submandibular gland, <20% in parotid gland, ~1% in sublingual
gland
 Risk Factors
 Any condition causing duct stenosis or a change in salivary secretions
(e.g. dehydration, diabetes, alcohol, hypercalcemia)
 Clinical Features
 Pain and tenderness over involved gland
 Intermittent swelling related to meals
 Digital palpation reveals presence of calculi  14
 Sialolithiasis
Investigations
 Sialogram , U/S
Treatment
 May resolve spontaneously
 Encourage salivation to clear calculus
 Remove calculi by dilating duct and orifice or excision through floor of
mouth
 If calculus is within the gland parenchyma then the whole gland must be
excised
N.B. Enlargement of the parotid glands may be a manifestation of a systemic
disease, such as Sjögren’s Syndrome
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