Function of Salivary Glands Salivary Gland and Duct Anatomy - - PowerPoint PPT Presentation

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University of California, San Francisco

Andrew H. Murr, MD

Professor and Chairman Roger Boles, MD Endowed Chair in Otolaryngology Education Department of Otolaryngology- Head and Neck Surgery

Salivary Gland and Duct Anatomy

UCSF Sialendoscopy/Salivary Duct Surgery Course November 6, 2014

Salivary Gland and Duct Anatomy

• Parotid Gland and Stensen’s Duct
• Submandibular Gland and Wharton’s Duct
• Sublingual Gland and Duct System
• Minor Salivary Glands

Function of Salivary Glands

• Food digestion

– Lubrication – Clearance

• Tooth protection
• Taste
• Antimicrobial function

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Embryology

• Ectoderm origin

– Surrounded by mesenchyme

• 6-8 weeks of life
• Originate at duct orifice

– Parotid develops around and between facial nerve

• Salivary tissue becomes

encapsulated

– *Parotid encapsulates last: only in parotid- lymphatic system is contained within parotid tissue prior to encapsulation

Duct Ultrastructure

Parotid Gland

Parotid Gland

• Largest and 1st to

develop

• Serous acinar cells

– Purely serous

• Parotid fascia
• Borders

– Lateral Skin – Medial Parapharyngeal space – Superior Zygomatic arch – Posterior EAC – Inferior Styloid/carotid/jugular – Anterior Masseter

Parotid Gland

• Tail
• Accessory parotid

– 20% – seromucinous

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Parotid Gland

Hollinshead

• Arterial supply

– External carotid

• Maxillary
• Superficial temporal
• Transverse facial
• Venous drainage

– Retromandibular

• Maxillary
• Superficial temporal

– External jugular – Internal jugular

Parotid Gland

• Nerve Supply

– Parasympathetic

• IX- preganglionic

– LSP (ovale) to otic ganglion

• Postganglionic

– Auriculotemporal

– Sympathetic

• Superior cervical ganglion

– Via external carotid plexus

Surgical Nerves

• Facial nerve
• Greater Auricular

Facial Nerve

Hollinshead

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LSD Classification

Marchal, F et al., Salivary stones and stenosis, A comprehensive classification. Rev Stomatol Chir Maxillofac 2008; 109: 233-236

• Lithiasis
• Stenosis
• Dilation

Lithiasis

• L0

no stones

• L1

floating stone

• L2

fixed stone totally visible

– A. <8 mm – B. >8 mm

• L3

fixed stone partially visibile

– A palpable – B non-palpable

LSD: Stenosis

Marchal, F et al., Salivary stones and stenosis, A comprehensive classification. Rev Stomatol Chir Maxillofac 2008; 109: 233-236

• S0

no stenosis

• S1

diaphragmatic

• S2

Unique (main)

• S3

Diffuse (main)

• S4

Generalized

LSD: Dilations

Marchal, F et al., Salivary stones and stenosis, A comprehensive classification. Rev Stomatol Chir Maxillofac 2008; 109: 233-236

• D0

none

• D1

unique

• D2

multiple

• D3

generalized

Stensen’s Duct

• Diameter:

3 mm

• Length:

6 cm

• Papilla:

.5 mm

• Main

1.4 mm

• Primary
• Secondary
• Tertiary
• Terminal

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Endoscopic Duct Anatomy

Main Primary

Endoscopic Duct Anatomy

Secondary Tertiary

Transillumination Stensen’s Duct

• Key points in the duct

– Papilla – Buccinator – Masseter – Accessory – Intra-parotid

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Papilla Stensen’s Duct

Kiringoda R, Eisele DW, Chang JL. A comparison of parotid imaging characteristics and sialendoscopic findings in obstructive salivary disorders.

• Laryngoscope. 2014 Jun 16. doi: 10.1002/lary.24787. [Epub ahead of print] PubMed

PMID: 24932900.

Masseter

Kiringoda R, Eisele DW, Chang JL. A comparison of parotid imaging characteristics and sialendoscopic findings in obstructive salivary disorders.

• Laryngoscope. 2014 Jun 16. doi: 10.1002/lary.24787. [Epub ahead of print] PubMed

PMID: 24932900.

Submandibular Gland

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SMG

• Submandibular triangle

– Level 1 – Borders:

• Mandible
• Digastric
• Mylohyoid

– Superficial lobe » Above mylohyoid – Deep lobe

• Seromucinous

Submandibular Gland

• Arterial Supply

– Facial artery

• Venous drainage

– Facial vein

• Hayes-Martin Maneuver
• Nerve supply

– Parasympathetic

• VII (nervous intermedius) to

Chorda Tympani

• Lingual nerve via

submandibular ganglion

– Sympathetic- superior cervical ganglion

Wharton’s Duct

Eisele and Chang, Laryngoscope, 2012

• ~ 4 mm
• 5 cm in length
• Papilla

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Papilla

[fom] Medial/Below/Above [neck]

Combs et al, Int. J of OMFS 2009

Wharton’s Duct Wharton’s Duct

Hollinshead

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Imaging Sublingual Gland

• Unencapsulated
• B/t mylohyoid and

geniohyoid/genioglossus

• Within sublingual space
• Mucous secreting
• Ducts of Rivinus

– 8-10 ducts opening into FOM

• Bartholin Duct which joins

Wharton’s Duct

Sublingual Duct(s) Ranula

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OHNS Faculty and Residents

Thank you!