SALIVARY GLANDS

Parotid gland

Surgical anatomy

• Serous gland

• Irregular shape

• Fills the gap

• Upper& lower poles

• Lateral, anterior & deep surfaces

• Surrounded by parotid sheath

• Derived from cervical fascia

• Very tough capsule

• Upper pole concave

• Adheres to ext acoustic meatus

• Lower pole rounded

Ant surface

• U shaped

• Clasping the ramus of mandible

• Masseter & medial pterygoid

• Stylomandibular ligament

Anterior border

• Parotid duct

• Branches of facial nerve

• Terminal branches of ECA

Deep surface

• Mastoid with the muscles

• Styloid with the muscles, two ligaments

• Styloid seperates it from ICA &IJV

Lateral surface

• Subcutaneous

• flat

• Facial nerve

• Retromandibular vein

• ECA

Parotid duct

• 5cm long

• Across masseter

• Pierces buccinator

Nerve supply

• Otic ganglion- secretomotor fibres

• Inferior salivatory nucleus - 9th N – tympanic branch – tympanic plexus – lesser petrosal N – otic ganglion

• Sympathetics - superior cervical ganglion

• Sensory fibres auriculotemporal N

• Parotid fascia great auricular N

Submandibular gland

Surgical anatomy

• Mixed gland

• Large superficial part

• Small deep part

Superficial lobe

• Fills space b/n mandible , mylohyoid &cervical fascia

• Three surfaces

Lateral surface

SM fossa of mandible

• Medial pterygoid insertion

• Facial artery

Superficial surface

• Covered by skin , platysma , deep fascia

• Crossed by facial vein & cervical br of facial N

• SM lymph nodes lie outside & within the gland

Medial surface

• lies against the mylohyoid and its NV bundle

• Hyoglossus, lingual N , SM ganglion , hypoglossal N

Deep part

• b/n mylohyoid & hyoglossus

• Lingual N above

• Hypoglossal SM duct below

Submandibular duct

• 5cm long

• Emerges from superficial part

• b/n mylohyoid & hyoglossus

• Then b/n SL gland & geniohyoid

Nerve supply

• Secretomotor SM ganglion

• Sup salivary N - nervus intermedius - chorda tympani - lingual N

Sublingual gland

• Almond shaped

• In front of ant border of hyoglossus

• b/n mylohyoid & genioglossus

• Mucous gland

Diseases of salivary glands

benign

Sialolithiasis

• Most commonly occurs in c/c sialadenitis

• 80% of stones occur in whartons duct

Reasons

• More alkaline

• More viscous

• Higher concentration of Ca & PO4

• Angulation of duct & vertical orientation

Diagnosis

• History & clinical examination

• X – ray

• sialography

Treatment

• Mannual pushing of stones to the opening

• Surgical incision over the stone & removal

Parotitis

• Mumps MC cause of non suppurative parotitis

• Bilateral

• Paramyxo virus

• 1-2 days prodromal period – fever ,chills , head ache

• Followed by pain & swelling of parotid glands

• Very severe pain aggravated by eating & drinking

• Resolve spontaneously in 5 – 10 days

• Life long immunity

Bacterial parotitis

• Acute – parotid

• Ascending infection

• Dehydration , cachexia , obstruction

Presentation

• Tender,red, painful parotid swelling

• Malaise, pyrexia

• Lower part more involved

• Staph & strep

Treatment

• Conservative

• Drainage – in case of abscess

c/c sial adenitis

• Sub mandibular gland

• Poor recovery

• Intial conservative treatment

• Sial adenectomy

Parotitis

• HIV – SGD

• Lymphoproliferative & cystic enlargement

• Virus in saliva

• surgery

Granulomatous

• TB

• Non TB mycobacteria

• Actinomycosis

• Cat scratch disease

Salivary fistula

• Common in parotid

• Congenital/acquired

• Surgery, trauma , sepsis

• Salivary gland fistula – saliva collects S/c

• Aspiration

• Pressure bandage

Salivary duct fistula

• Intra oral - no treatment

• Cutaneous