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

11/6/2014 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 University of California, San Francisco Function of Salivary Glands Salivary Gland and Duct Anatomy • Parotid Gland and Stensen’s Duct • Food digestion – Lubrication • Submandibular Gland and Wharton’s Duct – Clearance • Sublingual Gland and Duct System • Tooth protection • Minor Salivary Glands • Taste • Antimicrobial function 1

11/6/2014 Duct Ultrastructure Embryology Parotid Gland • 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 Parotid Gland Parotid Gland • Largest and 1 st to • Tail develop • Accessory parotid • Serous acinar cells – 20% – Purely serous – seromucinous • Parotid fascia • Borders – Lateral Skin – Medial Parapharyngeal space – Superior Zygomatic arch – Posterior EAC – Inferior Styloid/carotid/jugular – Anterior Masseter 2

11/6/2014 Parotid Gland Parotid Gland Hollinshead • Arterial supply • Nerve Supply – External carotid – Parasympathetic • Maxillary • IX- preganglionic • Superficial temporal – LSP (ovale) to otic ganglion • Transverse facial • Postganglionic • Venous drainage – Auriculotemporal – Retromandibular – Sympathetic • Maxillary • Superior cervical ganglion • Superficial temporal – Via external carotid plexus – External jugular – Internal jugular Facial Nerve Surgical Nerves Hollinshead • Facial nerve • Greater Auricular 3

11/6/2014 LSD: Stenosis LSD Classification Marchal, F et al., Salivary stones and stenosis, A comprehensive classification. Rev Stomatol Chir Maxillofac 2008; 109: 233-236 Marchal, F et al., Salivary stones and stenosis, A comprehensive classification. Rev Stomatol Chir Maxillofac 2008; 109: 233-236 • Lithiasis Lithiasis • S0 no stenosis • Stenosis • L0 no stones • S1 diaphragmatic • Dilation • L1 floating stone • S2 Unique (main) • L2 fixed stone totally • S3 Diffuse (main) visible • S4 Generalized – A. <8 mm – B. >8 mm • L3 fixed stone partially visibile – A palpable – B non-palpable LSD: Dilations Stensen’s Duct Marchal, F et al., Salivary stones and stenosis, A comprehensive classification. Rev Stomatol Chir Maxillofac 2008; 109: 233-236 • Diameter: 3 mm • D0 none • Length: 6 cm • D1 unique • Papilla: .5 mm • D2 multiple • Main 1.4 mm • D3 generalized • Primary • Secondary • Tertiary • Terminal 4

11/6/2014 Endoscopic Duct Anatomy Endoscopic Duct Anatomy Main Primary Secondary Tertiary Transillumination Stensen’s Duct • Key points in the duct – Papilla – Buccinator – Masseter – Accessory – Intra-parotid 5

11/6/2014 Stensen’s Duct Kiringoda R, Eisele DW, Chang JL. A comparison of parotid imaging Papilla 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 Submandibular Gland 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. 6

11/6/2014 SMG Submandibular Gland • Submandibular triangle • Arterial Supply – Level 1 – Facial artery – Borders: • Venous drainage • Mandible – Facial vein • Digastric • Mylohyoid • Hayes-Martin Maneuver – Superficial lobe • Nerve supply » Above mylohyoid – Parasympathetic – Deep lobe • Seromucinous • 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 7

11/6/2014 [fom] Medial/Below/Above [neck] Papilla Combs et al, Int. J of OMFS 2009 Wharton’s Duct Wharton’s Duct Hollinshead 8

11/6/2014 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 9

11/6/2014 OHNS Faculty and Residents Thank you! 10