Dr Supreet Singh Nayyar AFMC For more topics visit wwwnayyarENTcom Anatomy of Parotid Submandibular Sublingual glands Physiology structure of glands secretion of primary fluid neuronal control neurotransmitters ID: 394374
Download Presentation The PPT/PDF document "Anatomy And Physiology Of Salivary Gland..." is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.
Slide1
Anatomy And Physiology Of Salivary Glands
Dr. Supreet Singh Nayyar, AFMC
For more topics, visit
www.nayyarENT.comSlide2
Anatomy of Parotid, Submandibular, Sublingual glands
Physiology – structure of glands, secretion of primary fluid, neuronal control, neurotransmitters
Factors affecting salivary flow & composition
7/13/2012
www.nayyarENT.com
2
Layout Slide3
Anatomy
3 Pairs –
Major salivary glands
ParotidSubmandibular
Sublingual
Collection of salivary tissue within oral mucosa – Minor salivary glands
7/13/2012
www.nayyarENT.com
3Slide4
Ectoderm of oral cavity
Solid bulb from oropharyngeal epithelium
6 weeks - parotid gland
Dichotomous branching of solid bulb, development of lumen, condensation of mesenchyme
Formation of primitive ducts
7/13/2012
www.nayyarENT.com
4
Development Of Parotid GlandSlide5
Engulfment of facial nerve – 16
th
- 21st wk
Functional maturation after feeding is established
7/13/2012
www.nayyarENT.com
5
Contd…Slide6
Parotid Gland
Lobulated, “inverted pyramid”, extent
Superficial, deep lobes
Parotid space
Borders - ant, postSurfaces – superficial, superior, anteromedial, posteromedial
7/13/2012
www.nayyarENT.com
6Slide7
Condensed deep cervical fascia, tough, inelastic surface component, thin deep layer
Stylomandibular ligament
Fibrous septa arise from capsule
Contents of fascia – superficial lymph nodes, greater auricular nerve
7/13/2012
www.nayyarENT.com
7
Capsule Slide8
Structures Within The Gland
7/13/2012
www.nayyarENT.com
8
Facial nerve, division of gland
Retromandibular vein, anterior and posterior divisions
External carotid artery, terminal branchesSlide9
Capsule – Periparotid Nodes
Mostly superficial to Facial Nerve
Part of MALT, secrete IgA
Salivary gland tissue may be present within the lymph nodes
7/13/2012
www.nayyarENT.com
9
Lymphoid Tissue In The GlandSlide10
Intraparotid Facial Nerve
Stylomastoid foramen
Methods of identification during surgery
TM Sulcus
PBDTragal pointerMastoid
RetrogradeStyloid process
7/13/2012
www.nayyarENT.com
10Slide11
Branching Patterns
Varied, Surgically important
Single trunk, divides into
Zygomaticotemporal, Cervicomandibular
Temporal, upper / lower zygomatic, buccal
Buccal, cervical, mandibular
7/13/2012
www.nayyarENT.com
11Slide12
Type1-5 ( Katz and Catalano, 1987)Type 1 (25%) – No anastomotic links
Type 2 (14%) – Buccal fuses distally with Zygomatic
Type 3 (44%) – Major communication between Buccal & othersType 4 (14%) – Anastomosis between major divisions
Type 5 (3%) – More than one Facial Nv trunkUnpredictable preoperatively, to be precisely defined during surgery
7/13/2012
www.nayyarENT.com
12
Contd…Slide13
Autonomic Nerve Supply
Parasympathetic
Inferior salivatory nucleus
IX nerve
Lesser
Petrosal
nerve
Otic ganglion
Auriculotemporal nerve
PAROTID
Sympathetic
Superior cervical ganglion
Plexus around ECA
PAROTID
7/13/2012
www.nayyarENT.com
13Slide14
Parotid duct
Formed near the anterior border
Lies on superficial surface of Masseter
Opens in the mouth at parotid papilla
Accessory Parotid tissue
7/13/2012
www.nayyarENT.com
14Slide15
Development
6
th IU wkEctoderm in floor of primitive oral cavityLateral to primitive tongue
Development of acini – 12th wk
Large superficial, small deep lobeLocated in Submandibular triangleWell defined capsule
7/13/2012
www.nayyarENT.com
15
Submandibular Salivary GlandSlide16
Surgical Anatomy
Medial surface
–
Mylohyoid
,
Hyoglossus
, Lingual nerve, XII
nv
, Submandibular ganglion, Deep lingual
vein7/13/2012www.nayyarENT.com
16
Superficial Lobe
Inferior surface
–
Digastric, Deep fascia,
Platysma
, Skin
Lateral surface
–
Submandibular fossa, Facial arterySlide17
Extends for a variable distance between Mylohyoid & Hyoglossus
Relations
Superior – Lingual nerveInferior – XII Nv, Deep lingual vein, Submandibular duct
7/13/2012
www.nayyarENT.com
17
Deep Lobe
Slide18
5 cm in length
Middle of deep part
Crosses Sublingual spaceProximally – b/w Mylohyoid & HyoglossusDistally – b/w Genioglossus & Sublingual gland
Opening – on sides of frenulum of tongueRelation to Lingual nerve
7/13/2012
www.nayyarENT.com
18
Wharton’s ductSlide19
Branches of Facial & Lingual arteries
Lymph nodes adjacent to the superficial part
7/13/2012
www.nayyarENT.com
19
Blood Supply & Lymphatic DrianageSlide20
Autonomic nerve supply
Parasympathetic
Superior Salivary Nucleus
Nervus Intermedius
Facial Nerve
Chorda Tympani
Lingual Nerve
Submandibular Ganglion
Sympathetic
Superior Cervical Ganglion
Plexus around Facial Artery
Submandibular Ganglion
SUBMANDIBULAR GLAND
7/13/2012
www.nayyarENT.com
20Slide21
Skin incision – 4 cm below Mandible
Ligation of Facial vessels above & below
Dissected away from Lingual Nerve
Lymph nodes in substance of gland
7/13/2012
www.nayyarENT.com
21
Surgery Of Submandibular GlandSlide22
Sublingual Gland
Development
8th wk
Epithelial buds present in paralingual sulcus
Almond shapedLocated in anterior part of floor of mouth
7/13/2012
www.nayyarENT.com
22Slide23
Relations Of Sublingual Gland
Sup
– Oral floor mucosa
Inf – Mylohyoid
Post –
Deep part Submandibular glandMed –
Lingual nerve, Submandibular duct, Genioglossus
Lat
–
Med surface of lower Mandible
7/13/2012
www.nayyarENT.com
23Slide24
Ducts
Multiple
Drain into oral cavity directly or into Submandibular duct Blood supply
Nerve supply
7/13/2012
www.nayyarENT.com
24
Contd…Slide25
Physiology Of Salivary Glands
www.nayyarENT.comSlide26
Produce saliva – 1L / day (1ml/min/gm)
Contents
Mucin (glycoprotein)
Salivary amylaseSecretory Immunoglobulins
Other enzymes – DNase, RNase, lysozyme, lactoperoxidase, lingual lipaseKallikerin
Inorganic compounds – Na+, K+, HCO3
-
, Ca
2+
7/13/2012
www.nayyarENT.com
26
Function of Salivary GlandsSlide27
Lubrication and protection
Buffering and clearance
Maintenance of tooth integrity
Antibacterial activity
Taste and digestion
7/13/2012
www.nayyarENT.com
27
Function Of SalivaSlide28
Parotid Largest, serous (Compound Tubuloacinar Gland)
Submandibular and Sublingual
Mixed (Compound Tubuloacinar Glands)
7/13/2012
www.nayyarENT.com
28
Structure of Salivary GlandSlide29
Secretory End Pieces (Acini)
Serous Acini
Pyramid shaped, basal nucleus, apical secretory granules
Mucus Acini Larger, columnar cells, basal nucleus
Mixed Acini Mucus acini capped by serous cells forming
Serous Demilunes
7/13/2012
www.nayyarENT.com
29Slide30
Acini
Intercalated Ducts
Striated Ducts
Interlobular Excretory Ducts
Stenson’s
, Wharton’s duct
7/13/2012
www.nayyarENT.com
30
Duct SystemSlide31
High rates
Rate of saliva production – 1ml/min/gm
Blood flow 10 times that of equal mass of skeletal muscle
7/13/2012
www.nayyarENT.com
31
Control of Blood Flow And MetabolismSlide32
Active transport process under neuronal control
Composition
Hypotonic to plasmaTonicity more when rates of production are high( at max rate - 70% to that of plasma)
K+,HCO
3- higher than in plasma pH – acidic during resting phase, basic during active phase(
↑ HCO3- secretion)
7/13/2012
www.nayyarENT.com
32
Secretion Of SalivaSlide33
Acini
– Primary Fluid Secretion
Isotonic to plasma, electrolyte composition fairly constant, exocrine protein
Excretory ducts – extract Na+,
Cl- and add K+
, HCO3- to salivaNo addition in volume
More of Na
+
,
Cl- removed than addition of K+, HCO3- responsible for hypotonicity7/13/2012
www.nayyarENT.com
33
Secretion Of Water And ElectrolytesSlide34
Osmotic process Transepithelial salt gradients
Four ion transport systems - luminal and basolateral membranes generate the gradient
Three mechanisms proposed – operate concurrently
7/13/2012
www.nayyarENT.com
34
Mechanisms Of Primary Fluid SecretionSlide35
Mechanism 1
Stimulation – rise in cytosolic Ca
2+
Opening of K+
, Cl- channels – KCl
outflow
Cl
-
conc in lumen ↑, Na+, H2O follow
Cl
- entry sustained via Na+K
+
2Cl
-
cotransporter
6
Cl
-
translocated
to
acinar
lumen per ATP
hydrolysed
by Na
+
/K
+
ATPase
7/13/2012
www.nayyarENT.com
35Slide36
Mechanism 2
Cl
-/HCO3
-, Na+/H+
exchanger KCl outflow
Cl- entry via Cl-/HCO
3
-
exchanger
Acidification buffered by Na+/H+ exchanger3 Cl- translocated to lumen per ATP hydrolysedNa
+ & water follow into the lumen
7/13/2012
www.nayyarENT.com
36Slide37
Mechanism 3
Involves acinar HCO
3- secretion
3 HCO3
- secreted per ATP molecule
H+ extruded via Na+/H-
exchanger
Na
+
, H2O follow into the lumen
7/13/2012
www.nayyarENT.com
37Slide38
Contained in zymogen granules present in serous acinar cells, ductal cells
Upon stimulation release contents in lumen by exocytosis
Conc and rate varies with level and type of stimulation
7/13/2012
www.nayyarENT.com
38
Mechanism Of Macromolecule SecretionSlide39
Inconstant, underlying mechanisms partially understood
Produce final hypotonic solution
Influence of tubular cells more when flow rate is slow
7/13/2012
www.nayyarENT.com
39
Mechanism Of Ductal SecretionSlide40
Predominant control –
PARASYMPATHETIC
Sympathetic stimulation shorter and less strong
Probable synergistic action
7/13/2012
www.nayyarENT.com
40
Neural Control Of Gland FunctionSlide41
Primary fluid secretion
Protein secretion
Vasodilatation
Increased metabolism and growthMyoepithelial cell contraction
LARGE VOLUME LOW PROTEIN OUTPUT
7/13/2012
www.nayyarENT.com
41
Parasympathetic StimulationSlide42
High protein secretion
Vasoconstriction – decreased blood flow
Myoepithelial cell contraction
LOW VOLUME HIGH PROTEIN OUTPUT
7/13/2012www.nayyarENT.com
42
Sympathetic StimulationSlide43
Neurotransmitters & Receptors
Parasympathetic
Ach binds to M3 Receptors
Activation of G protein
►
Phospholipase C ►IP3 &
DAG ► Intracellular Ca2+
release, Protein exocytosis
7/13/2012
www.nayyarENT.com
43Slide44
Contd…
Sympathetic
Noradrenaline binds to
α
1, β1
receptors
Activation of G protein
►
Adenylate Cyclase activation ►↑cAMP dependant Protein Kinase ►protein exocytosis
7/13/2012
www.nayyarENT.com
44Slide45
Unstimulated – Submandibular
Stimulated – Parotid 2/3
rd Acidic tastes – Max stimulation
Sweet tastes – Least stimulation
7/13/2012
www.nayyarENT.com
45
Factors Affecting Salivary FlowSlide46
Psychic factors
Circadian rhythm
Diurnal variationAgeDrugsTricyclic antidepressants
PhenothiazinesDepression and anxiety states
Dehydration, hemorrhage,
7/13/2012
www.nayyarENT.com
46
Contd…Slide47
Salivary Gland diseases
Radiation sialadenitis
Autoimmune sialadenitis
HIV infection
Iron overload
Sarcoidosis
Amyloidosis
Cystic fibrosis
7/13/2012
www.nayyarENT.com
47
Contd…Slide48
Flow rate
Source of secretion
Type of stimulusDiurnal variationDietDrugs – flow dependant components
Hormones – mineralocorticoids, ovulation
7/13/2012
www.nayyarENT.com
48
Factors Affecting Composition Of SalivaSlide49
Disease states
Sialadenitis
Radiation damageSjorgen’s syndromeCystic fibrosis
HTNDMAlcoholic cirrhosis
AldosteronismChronic pancreatitis
7/13/2012
www.nayyarENT.com
49
Contd…Slide50
Valid medium, painless, non-invasive
Hormone monitoring
Unconjugated steroidsProportional to free unbound plasma levels
Useful in field studiesEstradiol, progesterone, testosterone
7/13/2012
www.nayyarENT.com
50
Salivary Assays In DiagnosisSlide51
DrugsFactors – lipid solubility, protein binding, molecular size, flow rates
Constant saliva / plasma ratio not established
Microbial antigens, antibodies
Hepatitis A, B, CHIVImmunisation status
7/13/2012
www.nayyarENT.com
51
Contd
… Slide52
Tc 99m
pertechnitate
Scintigraphy – objective measure of its uptake, concenteration, excretion
7/13/2012
www.nayyarENT.com
52
Radioisotope Salivary Function TestsSlide53
Concentric shells of calcareous material alternating with organic material
Stasis of flow
Distribution Submandibular gland – 92%
Parotid – 6%Sublingual / minor salivary glands – 2%
7/13/2012
www.nayyarENT.com
53
SialolithiasisSlide54
Scott-Brown’s Otolaryngology – 6th
ed, Vol 1, Vol 5
Otolaryngology Head & Neck Surgery –Charles W Cummings, 4th ed, Vol 2Skandalakis’ Surgical Anatomy
Last’s Anatomy – 9th edPhysiology – Berne & Levy, 5
th ed
7/13/2012
www.nayyarENT.com
54
ReferencesSlide55
Thank you