Transcript
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
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