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Salivary gland

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Salivary gland
Blausen 0780 SalivaryGlands.png

Human salivary glands.
Details
System Digestive system
Identifiers
Latin Glandulae

salivariae
MeSH D012469
FMA 95971
Anatomical terminology

[ edit on Wikidata ]

The salivary glands in mammals are exocrine glands that produce saliva through a system of ducts . Humans have three paired major salivary glands ( parotid , submandibular , and sublingual ) as well as hundreds of minor salivary glands. [1] Salivary glands can be classified as serous , mucous or seromucous (mixed).

In serous secretions , the main type of protein secreted is alpha-amylase , an enzyme that breaks down starch into maltose and glucose , [2] whereas in mucous secretions the main protein secreted is mucin , which acts as a lubricant . [1]

In humans, between 0.5 and 1.5 litres of saliva are produced every day. [3] The secretion of saliva (salivation) is mediated by parasympathetic stimulation ; acetylcholine is the active neurotransmitter and binds to muscarinic receptors in the glands, leading to increased salivation. [3] [4]

Contents

  • 1 Structure
    • 1.1 Parotid glands
    • 1.2 Submandibular glands
    • 1.3 Sublingual glands
    • 1.4 Minor salivary glands
    • 1.5 Von Ebner’s glands
    • 1.6 Nerve supply
    • 1.7 Microanatomy
      • 1.7.1 Acini
      • 1.7.2 Ducts
    • 1.8 Gene and protein expression
  • 2 Development
    • 2.1 Aging
  • 3 Function
  • 4 Clinical significance
    • 4.1 Clinical tests/investigations
  • 5 Other animals
  • 6 See also
  • 7 References
  • 8 External links

Structure[ edit ]

Salivary glands: #1 Parotid gland , #2 Submandibular gland , #3 Sublingual gland .

The salivary glands are detailed below:

Parotid glands[ edit ]

Main article: Parotid gland

The two parotid glands are major salivary glands wrapped around the mandibular ramus in humans. [5] These are largest of the salivary glands, secreting saliva to facilitate mastication and swallowing , and amylase to begin the digestion of starches . [6] It is the serous type of gland which secretes alpha-amylase (also known as ptyalin). [7] It enters the oral cavity via the parotid duct . The glands are located posterior to the mandibular ramus and anterior to the mastoid process of the temporal bone . They are clinically relevant in dissections of facial nerve branches while exposing the different lobes, since any iatrogenic lesion will result in either loss of action or strength of muscles involved in facial expression . [7] They produce 20% of the total salivary content in the oral cavity. [6] Mumps is a viral infection , caused by infection in the parotid gland. [8]

Submandibular glands[ edit ]

Main article: Submandibular gland

The submandibular glands (previously known as submaxillary glands) are a pair of major salivary glands located beneath the lower jaws, superior to the digastric muscles . [5] The secretion produced is a mixture of both serous fluid and mucus , and enters the oral cavity via the submandibular duct or Wharton duct. [6] Approximately 65-70% of saliva in the oral cavity is produced by the submandibular glands, even though they are much smaller than the parotid glands. [6] This gland can usually be felt via palpation of the neck, as it is in the superficial cervical region and feels like a rounded ball. It is located about two fingers above the Adam’s apple (laryngeal prominence) and about two inches apart under the chin.

Sublingual glands[ edit ]

Main article: Sublingual gland

The sublingual glands are a pair of major salivary glands located inferior to the tongue, anterior to the submandibular glands. [5] The secretion produced is mainly mucous in nature; however, it is categorized as a mixed gland. [7] Unlike the other two major glands, the ductal system of the sublingual glands does not have intercalated ducts and usually does not have striated ducts either, so saliva exits directly from 8-20 excretory ducts known as the Rivinus ducts . [7] Approximately 5% of saliva entering the oral cavity comes from these glands. [6]

Minor salivary glands[ edit ]

There are 800 to 1,000 minor salivary glands located throughout the oral cavity within the submucosa [9] of the oral mucosa in the tissue of the buccal, labial, and lingual mucosa, the soft palate, the lateral parts of the hard palate, and the floor of the mouth or between muscle fibers of the tongue. [10] They are 1 to 2 mm in diameter and unlike the major glands, they are not encapsulated by connective tissue, only surrounded by it. The gland has usually a number of acini connected in a tiny lobule. A minor salivary gland may have a common excretory duct with another gland, or may have its own excretory duct. Their secretion is mainly mucous in nature and have many functions such as coating the oral cavity with saliva. Problems with dentures are sometimes associated with minor salivary glands if there is dry mouth present (see further discussion). [9] The minor salivary glands are innervated by the seventh cranial or facial nerve. [10]

Von Ebner’s glands[ edit ]

Main article: Von Ebner’s glands

Von Ebner’s glands are glands found in a trough circling the circumvallate papillae on the dorsal surface of the tongue near the terminal sulcus . They secrete a purely serous fluid that begins lipid hydrolysis . They also facilitate the perception of taste through secretion of digestive enzymes and proteins. [9]
The arrangement of these glands around the circumvallate papillae provides a continuous flow of fluid over the great number of taste buds lining the sides of the papillae, and is important for dissolving the food particles to be tasted.

Nerve supply[ edit ]

Salivary glands are innervated, either directly or indirectly, by the parasympathetic and sympathetic arms of the autonomic nervous system . Parasympathetic stimulation evokes a copious flow of saliva. In contrast, sympathetic stimulation produces either a small flow, which is rich in protein, or no flow at all. [11]

  • Parasympathetic innervation to the salivary glands is carried via cranial nerves . The parotid gland receives its parasympathetic input from the glossopharyngeal nerve (CN IX) via the otic ganglion , [12] while the submandibular and sublingual glands receive their parasympathetic input from the facial nerve (CN VII) via the submandibular ganglion . [13] These nerves release acetylcholine and substance P, which activate the IP3 and DAG pathways respectively.
  • Direct sympathetic innervation of the salivary glands takes place via preganglionic nerves in the thoracic segments T1-T3 which synapse in the superior cervical ganglion with postganglionic neurons that release norepinephrine, which is then received by β-adrenergic receptors on the acinar and ductal cells of the salivary glands, leading to an increase in cyclic adenosine monophosphate (cAMP) levels and the corresponding increase of saliva secretion. Note that in this regard both parasympathetic and sympathetic stimuli result in an increase in salivary gland secretions. [14] The sympathetic nervous system also affects salivary gland secretions indirectly by innervating the blood vessels that supply the glands.

Microanatomy[ edit ]

The gland is internally divided into lobules . Blood vessels and nerves enter the glands at the hilum and gradually branch out into the lobules.

Acini[ edit ]

Secretory cells are found in a group, or acinus (plural, acini). Each acinus is located at the terminal part of the gland connected to the ductal system, with many acini within each lobule of the gland. Each acinus consists of a single layer of cuboidal epithelial cells surrounding a lumen, a central opening where the saliva is deposited after being produced by the secretory cells. The three forms of acini are classified in terms of the type of epithelial cell present and the secretory product being produced: serous , mucoserous and mucous . [15]

Ducts[ edit ]

In the duct system, the lumina are formed by intercalated ducts , which in turn join to form striated ducts . These drain into ducts situated between the lobes of the gland (called interlobar ducts or secretory ducts). These are found on most major and minor glands (exception may be the sublingual gland). [15]

All of the human salivary glands terminate in the mouth, where the saliva proceeds to aid in digestion. The saliva that salivary glands release is quickly inactivated in the stomach by the acid that is present, however saliva also contains enzymes that are actually activated by stomach acid.

Gene and protein expression[ edit ]

About 20,000 protein coding genes are expressed in human cells and 60% of these genes are expressed in normal, adult salivary glands. [16] [17] Less than 100 genes are more specifically expressed in the salivary gland. The salivary gland specific genes are mainly genes that encode for secreted proteins and compared to other organs in the human body; the salivary gland has the highest fraction of secreted genes. The heterogeneous family of proline-rich, human salivary glycoproteins, such as PRB1 and PRH1 , are salivary gland specific proteins with highest level of expression. Examples of other specifically expressed proteins include the digestive amylase enzyme AMY1A , the mucin MUC7 and statherin , all of major importance for specific characteristics of saliva.

Development[ edit ]

[icon]
This section needs expansion. You can help by adding to it . (January 2018)

Aging[ edit ]

Aging of salivary glands show some structural changes, such as: [18] [19] [19]

  • Decrease in volume of acinar tissue
  • Increase in fibrous tissue
  • Increase in adipose tissue
  • Ductal hyperplasia and dilation [18]

In addition, there are also changes in salivary contents:

  • Decrease in concentration of secretory IgA [18]
  • Decrease in the amount of mucin

However, there is no overall change in the amount of saliva secreted.

Function[ edit ]

Further information: Digestion
[icon]
This section needs expansion. You can help by adding to it . (January 2018)

Salivary glands secrete saliva which has many benefits for the oral cavity and health in general. These benefits include:

  • Protection

Saliva consists of proteins (for example; mucins) that lubricate and protect both the soft and hard tissues of the oral cavity. Mucins are the principal organic constituents of mucus, the slimy visco-elastic material that coats all mucosal surfaces. [20]

  • Buffering

In general, the higher the saliva flow rate, the faster the clearance and the higher the buffer capacity, hence better protection from dental caries. Therefore, people with a slower rate of saliva secretion, combined with a low buffer capacity, have lessened salivary protection against microbes. [21]

  • Pellicle formation

Saliva forms a pellicle on the surface of the tooth to prevent wearing. The film contains mucins and proline-rich glycoprotein from the saliva.
The proteins (statherin and proline-rich proteins) within the salivary pellicle inhibit demineralisation and promote remineralisation by attracting calcium ions. [22]

  • Maintenance of tooth integrity

Demineralization occurs when enamel disintegrates due to the presence of acid. When this occurs, the buffering capacity effect of saliva (increases saliva flow rate) inhibits demineralisation. Saliva can then begin to promote the remineralisation of the tooth by strengthening the enamel with calcium and phosphate minerals. [23]

  • Antimicrobial action

Saliva can prevent microbial growth based on the elements it contains. For example, lactoferrin in saliva binds naturally with iron. Since iron is a major component of bacterial cell walls, removal of iron breaks down the cell wall, which in turn breaks down the bacteria. Antimicrobial peptides such as histatins inhibit the growth of Candida albicans and Streptococcus mutans. Salivary Immunoglobulin A serves to aggregate oral bacteria such as S. mutans and prevent the formation of dental plaque. [24]

  • Tissue repair

Saliva can encourage soft tissue repair by decreasing clotting time and increasing wound contraction. [25]

  • Digestion

Saliva contains the enzyme amylase, which hydrolyses starch into maltose and dextrin. As a result, saliva allows digestion to occur before the food reaches the stomach. [26]

  • Taste [27]

Saliva acts as a solvent in which solid particles can dissolve in and enter the taste buds through oral mucosa located on the tongue. These taste buds are found within foliate and circumvallate papillae, where minor salivary glands secrete saliva. [28]

Clinical significance[ edit ]

Micrograph of chronic inflammation of the salivary gland sialadenitis ).

Main article: Salivary gland disease

A sialolithiasis (a salivary calculus or stone) may cause blockage of the ducts, most commonly the submandibular ducts , causing pain and swelling of the gland. [29]

Salivary gland dysfunction refers to either xerostomia (the symptom of dry mouth) or salivary gland hypofunction (reduced production of saliva); it is associated with significant impairment of quality of life. [30] Following radiotherapy of the head and neck region, salivary gland dysfunction is a predictable side-effect. [30] Saliva production may be pharmacologically stimulated by sialagogues such as pilocarpine and cevimeline . [31] It can also be suppressed by so-called antisialagogues such as tricyclic antidepressants , SSRIs , antihypertensives , and polypharmacy . [32] A Cochrane review found there was no strong evidence that topical therapies are effective in relieving the symptoms of dry mouth. [33]

Cancer treatments including chemotherapy and radiation therapy may impair salivary flow. [34] [35] Radiotherapy can cause permanent hyposalivation due to injury to the oral mucosa containing the salivary glands, resulting in xerostomia, whereas chemotherapy may cause only temporary salivary impairment. [34] [35]

Graft versus host disease after allogeneic bone marrow transplantation may manifest as dry mouth and many small mucoceles . [36] Salivary gland tumours may occur, including mucoepidermoid carcinoma , a malignant growth . [37]

Clinical tests/investigations[ edit ]

A sialogram is a radiocontrast study of a salivary duct that may be used to investigate its function and for diagnosing Sjögren syndrome . [38]

Other animals[ edit ]

The salivary glands of some species are modified to produce proteins – salivary amylase is found in many, but by no means all, bird and mammal species (including humans, as noted above). Furthermore, the venom glands of venomous snakes , Gila monsters , and some shrews , are actually modified salivary glands. [32] In other organisms such as insects , salivary glands are often used to produce biologically important proteins like silk or glues, whilst fly salivary glands contain polytene chromosomes that have been useful in genetic research. [39]

See also[ edit ]

  • Serous demilune
  • Sialome

References[ edit ]

  1. ^ a b Edgar, Michael; Dawes, Colin; O’Mullane, Denis, eds. (2012). Saliva and oral health (4th ed.). Little Steine, Hill Farm Lane, Duns Tew, OX25 6JH: Stephen Hancocks Limited. p. 1. ISBN   978-0-9565668-3-6 .

  2. ^ Martini, Frederic H.; Nath, Judi L.; Bartholomew, Edwin (2012). Fundamentals of anatomy & physiology (9th ed.). 1301 Sansome St., San Francisco, CA 94111: Pearson Benjamin Cummings.
  3. ^ a b Young, Carolyn A; Ellis, Cathy; Johnson, Julia; Sathasivam, Sivakumar; Pih, Nicky (2011-05-11). “Cochrane Database of Systematic Reviews”. Cochrane Database of Systematic Reviews (5): CD006981. doi : 10.1002/14651858.CD006981.pub2 . PMID   21563158 .
  4. ^ Davies, Andrew N; Thompson, Jo (2015-10-05). “Cochrane Database of Systematic Reviews”. Cochrane Database of Systematic Reviews (10): CD003782. doi : 10.1002/14651858.CD003782.pub3 . PMID   26436597 .
  5. ^ a b c Bialek EJ, Jakubowski W, Zajkowski P, Szopinski KT, Osmolski A (2006). “US of the major salivary glands: anatomy and spatial relationships, pathologic conditions, and pitfalls”. Radiographics. 26 (3): 745–63. doi : 10.1148/rg.263055024 . PMID   16702452 .
  6. ^ a b c d e Nanci A (2018). Ten Cate’s Oral Histology: Development, Structure, and Function (ninth ed.). ISBN   978-0-323-48524-1 .
  7. ^ a b c d Holmberg KV, Hoffman MP (2014). Anatomy, biogenesis and regeneration of salivary glands. Monographs in Oral Science. 24. pp. 1–13. doi : 10.1159/000358776 . ISBN   978-3-318-02595-8 . PMC   4048853 . PMID   24862590 .
  8. ^ Hviid A, Rubin S, Mühlemann K (2008). “Mumps”. Lancet. 371 (9616): 932–44. doi : 10.1016/S0140-6736(08)60419-5 . PMID   18342688 .
  9. ^ a b c Nanci A (2013). Ten Cate’s Oral Histology: Development, Structure, and Function (8th ed.). St. Louis, Mo.: Elsevier. pp. 275–65. ISBN   978-0-323-07846-7 .
  10. ^ a b Herring MJ, Fehrenbach SW (2012). Illustrated Anatomy of the Head and Neck (4th ed.). St. Louis, Mo.: Elsevier/Saunders. ISBN   978-1-4377-2419-6 .
  11. ^ Ekström J (1989). “Autonomic control of salivary secretion”. Proceedings of the Finnish Dental Society. Suomen Hammaslaakariseuran Toimituksia. 85 (4–5): 323–31, discussion 361–3. PMID   2699762 .
  12. ^ Frommer J (1977). “The human accessory parotid gland: its incidence, nature, and significance”. Oral Surgery, Oral Medicine, and Oral Pathology. 43 (5): 671–6. doi : 10.1016/0030-4220(77)90049-4 . PMID   266146 .
  13. ^ Ishizuka K, Oskutyte D, Satoh Y, Murakami T (2010). “Multi-source inputs converge on the superior salivatory nucleus neurons in anaesthetized rats”. Autonomic Neuroscience : Basic & Clinical. 156 (1–2): 104–10. doi : 10.1016/j.autneu.2010.03.014 . PMID   20435522 .
  14. ^ Costanzo L (2009). Physiology (3rd ed.). Saunders Elsevier. ISBN   978-1-4160-2320-3 .
  15. ^ a b Bath-Balogh M, Fehrenbach M (2011). Illustrated Dental Embryology, Histology, and Anatomy. Elsevier. p. 132. ISBN   978-1-4377-2934-4 .
  16. ^ “The human proteome in salivary gland – The Human Protein Atlas” . www.proteinatlas.org. Retrieved 2017-09-22.
  17. ^ Uhlén M, Fagerberg L, Hallström BM, Lindskog C, Oksvold P, Mardinoglu A, et al. (January 2015). “Proteomics. Tissue-based map of the human proteome” . Science. 347 (6220): 1260419. doi : 10.1126/science.1260419 . PMID   25613900 .
  18. ^ a b c Vissink A, Spijkervet FK, Van Nieuw Amerongen A (1996). “Aging and saliva: a review of the literature”. Special Care in Dentistry. 16 (3): 95–103. doi : 10.1111/j.1754-4505.1996.tb00842.x . PMID   9084322 .
  19. ^ a b Kim SK, Allen ED (June 1994). “Structural and functional changes in salivary glands during aging”. Microscopy Research and Technique. 28 (3): 243–53. doi : 10.1002/jemt.1070280308 . PMID   8068986 .
  20. ^ Tabak LA, Levine MJ, Mandel ID, Ellison SA (February 1982). “Role of salivary mucins in the protection of the oral cavity”. J. Oral Pathol. 11 (1): 1–17. doi : 10.1111/j.1600-0714.1982.tb00138.x . PMID   6801238 .
  21. ^ Comba, Allegra. “Saliva” . flipper e nuvola. Retrieved 25 February 2018.
  22. ^ “Function of Saliva” . Cariology. Retrieved 24 February 2018.
  23. ^ “6 Ways Saliva Protects Your Teeth” . Sunningdale Dental News & Views. 2012-07-17. Retrieved 25 February 2018.
  24. ^ Taylor, John. “Immunity in the oral cavity” . British Society for Immunology. Retrieved 25 February 2018.
  25. ^ Mandel, ID (February 1987). “The functions of saliva”. Journal of Dental Research. 66 Spec No (66): 623–7. doi : 10.1177/00220345870660S203 . PMID   3497964 .
  26. ^ “Saliva” . Science Daily. Retrieved 24 February 2018.
  27. ^ Nanci A (2003). Ten Cate’s oral histology: development, structure, and function (6th ed.). St. Louis: Mosby. pp. 300–1. ISBN   978-0-323-01614-8 .
  28. ^ Matsuo, R (2000). “Role of Saliva in the maintenance of taste sensitivity”. Critical Reviews in Oral Biology and Medicine. 11 (2): 216–29. doi : 10.1177/10454411000110020501 . PMID   12002816 .
  29. ^ Rzymska-Grala I, Stopa Z, Grala B, Gołębiowski M, Wanyura H, Zuchowska A, Sawicka M, Zmorzyński M (July 2010). “Salivary gland calculi – contemporary methods of imaging” . Polish Journal of Radiology. 75 (3): 25–37. PMC   3389885 . PMID   22802788 .
  30. ^ a b Riley, Philip; Glenny, Anne-Marie; Hua, Fang; Worthington, Helen V (2017-07-31). “Cochrane Database of Systematic Reviews” . Cochrane Database of Systematic Reviews. 7: CD012744. doi : 10.1002/14651858.CD012744 . PMID   28759701 .
  31. ^ Wolff A, Joshi RK, Ekström J, Aframian D, Pedersen AM, Proctor G, Narayana N, Villa A, Sia YW, Aliko A, McGowan R, Kerr AR, Jensen SB, Vissink A, Dawes C (March 2017). “A Guide to Medications Inducing Salivary Gland Dysfunction, Xerostomia, and Subjective Sialorrhea: A Systematic Review Sponsored by the World Workshop on Oral Medicine VI” . Drugs in R&D. 17 (1): 1–28. doi : 10.1007/s40268-016-0153-9 . PMC   5318321 . PMID   27853957 .
  32. ^ a b Romer AS, Parsons TS (1977). The Vertebrate Body. Philadelphia, PA: Holt-Saunders International. pp. 299–300. ISBN   978-0-03-910284-5 .
  33. ^ Furness, Susan; Worthington, Helen; Bryan, Gemma; Birchenough, Sarah; McMillan, Roddy (7 December 2011). “Interventions for the management of dry mouth: topical therapies”. Cochrane Database of Systematic Reviews (12): CD008934. doi : 10.1002/14651858.CD008934.pub2 . PMID   22161442 .
  34. ^ a b Furness S, Worthington HV, Bryan G, Birchenough S, McMillan R (December 2011). “Interventions for the management of dry mouth: topical therapies”. The Cochrane Database of Systematic Reviews (12): CD008934. doi : 10.1002/14651858.CD008934.pub2 . PMID   22161442 .
  35. ^ a b Riley P, Glenny AM, Hua F, Worthington HV (July 2017). “Pharmacological interventions for preventing dry mouth and salivary gland dysfunction following radiotherapy” . The Cochrane Database of Systematic Reviews. 7: CD012744. doi : 10.1002/14651858.CD012744 . PMID   28759701 .
  36. ^ Ogawa Y, Okamoto S, Wakui M, Watanabe R, Yamada M, Yoshino M, Ono M, Yang HY, Mashima Y, Oguchi Y, Ikeda Y, Tsubota K (October 1999). “Dry eye after haematopoietic stem cell transplantation” . The British Journal of Ophthalmology. 83 (10): 1125–30. doi : 10.1136/bjo.83.10.1125 . PMC   1722843 . PMID   10502571 .
  37. ^ Nance MA, Seethala RR, Wang Y, Chiosea SI, Myers EN, Johnson JT, Lai SY (October 2008). “Treatment and survival outcomes based on histologic grading in patients with head and neck mucoepidermoid carcinoma” . Cancer. 113 (8): 2082–9. doi : 10.1002/cncr.23825 . PMC   2746751 . PMID   18720358 .
  38. ^ Rastogi R, Bhargava S, Mallarajapatna GJ, Singh SK (October 2012). “Pictorial essay: Salivary gland imaging” . The Indian Journal of Radiology & Imaging. 22 (4): 325–33. doi : 10.4103/0971-3026.111487 . PMC   3698896 . PMID   23833425 .
  39. ^ Sehnal F, Sutherland T (2008). “Silks produced by insect labial glands” . Prion. 2 (4): 145–53. doi : 10.4161/pri.2.4.7489 . PMC   2658764 . PMID   19221523 .

External links[ edit ]

Wikimedia Commons has media related to Salivary glands .
  • Salivary gland at the Human Protein Atlas
  • Illustration at merck.com
  • Illustration at .washington.edu
  • plastic/371 at eMedicine – “Parotid Tumors, Benign”
  • Medical Encyclopedia Medline Plus: Salivary gland
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      Parotid gland

      From Wikipedia, the free encyclopedia

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      “Parotid” and “parotids” redirect here. For the carotids, see Common carotid artery .
      For the amphibian skin gland, see Parotoid gland .

      Location of the left parotid gland in humans (shown in green).

      The parotid gland is a major salivary gland in many animals. In humans, the two parotid glands are present on either side of the mouth and in front of both ears . They are the largest of the salivary glands. Each parotid is wrapped around the mandibular ramus , and secretes serous saliva through the parotid duct into the mouth, to facilitate mastication and swallowing and to begin the digestion of starches . There are also two other types of salivary glands; they are submandibular and sublingual glands. [1]

      The word parotid (paraotic) literally means “beside the ear”.

      Contents

      • 1 Structure
        • 1.1 Location
        • 1.2 Blood supply
        • 1.3 Lymphatic drainage
        • 1.4 Nerve supply
        • 1.5 Histology
      • 2 Development
      • 3 Parotid gland swellings
        • 3.1 Causes
          • 3.1.1 Mumps
          • 3.1.2 Neoplasms
            • 3.1.2.1 Benign
            • 3.1.2.2 Malignant
          • 3.1.3 Polycystic Parotid Disease
      • 4 Clinical significance
        • 4.1 Parotitis
        • 4.2 Fibrous reactions
        • 4.3 Salivary stones
        • 4.4 Injury
        • 4.5 Cancer and tumours
        • 4.6 Surgery
      • 5 Infections
        • 5.1 Bacterial infections
          • 5.1.1 Acute bacterial parotitis
          • 5.1.2 Chronic bacterial parotitis
        • 5.2 Viral infections
          • 5.2.1 Mumps
          • 5.2.2 HIV / AIDS
        • 5.3 Autoimmune related
          • 5.3.1 Systemic lupus erythematosus
          • 5.3.2 Sarcoidosis
          • 5.3.3 Sjogren’s syndrome
        • 5.4 Mycobacterial infection
      • 6 Examination of the Salivary Gland
        • 6.1 History and Examination
        • 6.2 Physical Examination
        • 6.3 Salivary Testing
        • 6.4 Further Tests
      • 7 Additional images
      • 8 See also
      • 9 References
      • 10 External links

      Structure[ edit ]

      The parotid glands are a pair of mainly serous salivary glands located below and in front of each ear canal , draining their secretions into the vestibule of the mouth through the parotid duct . [2] Each gland lies behind the mandibular ramus and in front of the mastoid process of the temporal bone . The gland can be felt on either side, by feeling in front of each ear, along the cheek, and below the angle of the mandible . [3]

      The parotid duct, a long excretory duct, emerges from the front of each gland, superficial to the masseter muscle . The duct pierces the buccinator muscle , then opens into the mouth on the inner surface of the cheek, usually opposite the maxillary second molar . The parotid papilla is a small elevation of tissue that marks the opening of the parotid duct on the inner surface of the cheek. [3]

      The gland has four surfaces — superficial or lateral, superior, anteromedial, and posteromedial. The gland has three borders — anterior, medial, and posterior. The parotid gland has two ends — superior end in the form of small superior surface and an inferior end (apex).

      A number of different structures pass through the gland. From lateral to medial , these are:

      1. Facial nerve
      2. Retromandibular vein
      3. External carotid artery
      4. Superficial temporal artery
      5. Branches of the great auricular nerve
      6. Maxillary artery

      Location[ edit ]

      • Superficial or lateral relations: The gland is situated deep to the skin, superficial fascia, superficial lamina of investing layer of deep cervical fascia and great auricular nerve (anterior ramus of C2 and C3).
      • Anteromedial relations: The gland is situated posterolaterally to the mandibular ramus, masseter and medial pterygoid muscles. A part of the gland may extend between the ramus and medial pterygoid, as the pterygoid process. Branches of facial nerve and parotid duct emerge through this surface.
      • Posteromedial relations: The gland is situated anterolaterally to mastoid process of temporal bone with its attached sternocleidomastoid and digastric muscles, styloid process of temporal bone with its three attached muscles (stylohyoid, stylopharyngeus, and styloglossus) and carotid sheath with its contained neurovasculature (internal carotid artery, internal jugular vein, and 9th, 10th, 11th, and 12th cranial nerves).
      • Medial relations: The parotid gland comes into contact with the superior pharyngyeal constrictor muscle at the medial border, where the anteromedial and posteromedial surfaces meet. Hence, a need exists to examine the fauces in parotitis.

      Blood supply[ edit ]

      The external carotid artery and its terminal branches within the gland, namely, the superficial temporal and the Maxillary artery, supply the parotid gland. Venous return is to the retromandibular veins.

      Lymphatic drainage[ edit ]

      The gland is mainly drained into the preauricular or parotid lymph nodes which ultimately drain to the deep cervical chain.

      Nerve supply[ edit ]

      The parotid gland receives both sensory and autonomic innervation. General Sensory innervation to the parotid gland, its sheath, and the overlying skin is provided by the great auricular nerve . The autonomic innervation controls the rate of saliva production and is supplied by the glossopharyngeal nerve . [4]
      Postganglionic sympathetic fibers from superior cervical sympathetic ganglion reach the gland as periarterial nerve plexuses around the middle meningeal artery and their function is mainly vasoconstriction. The cell bodies of the preganglionic sympathetics usually lie in the lateral horns of upper thoracic spinal segments. Preganglionic parasympathetic fibers leave the brain stem from inferior salivatory nucleus in the glossopharyngeal nerve and then through its tympanic and then the lesser petrosal branch pass into the otic ganglion . There, they synapse with postganglionic fibers which reach the gland by hitch-hiking via the auriculotemporal nerve , a branch of the mandibular nerve . [5] [6] :255

      Histology[ edit ]

      The parotid gland

      The gland has a capsule of its own of dense connective tissue, but is also provided with a false capsule by investing layer of deep cervical fascia. The fascia at the imaginary line between the angle of mandible and mastoid process splits into the superficial lamina and a deep lamina to enclose the gland. The risorius is a small muscle embedded with this capsule substance.

      The gland has short, striated ducts and long, intercalated ducts. [7] The intercalated ducts are also numerous and lined with cuboidal epithelial cells, and have lumina larger than those of the acini. The striated ducts are also numerous and consist of simple columnar epithelium, having striations that represent the infolded basal cell membranes and mitochondria. [6] :273

      Though the parotid gland is the largest, it provides only 25% of the total salivary volume. The serous cell predominates in the parotid, making the gland secrete a mainly serous secretory product. [7]

      The parotid gland also secretes salivary alpha-amylase (sAA), which is the first step in the decomposition of starches during mastication. It is the main exocrine gland to secrete this. It breaks down amylose (straight chain starch) and amylopectin (branched starch) by hydrolyzing alpha 1,4 bonds. Additionally, the alpha amylase has been suggested to prevent bacterial attachment to oral surfaces and to enable bacterial clearance from the mouth. [8]

      Development[ edit ]

      The parotid salivary glands appear early in the sixth week of prenatal development and are the first major salivary glands formed. The epithelial buds of these glands are located on the inner part of the cheek, near the labial commissures of the primitive mouth (from ectodermal lining near angles of the stomodeum in the 1st/2nd pharyngeal arches; the stomodeum itself is created from the rupturing of the oropharyngeal membrane at about 26 days. [9] ) These buds grow posteriorly toward the otic placodes of the ears and branch to form solid cords with rounded terminal ends near the developing facial nerve. Later, at around 10 weeks of prenatal development, these cords are canalized and form ducts, with the largest becoming the parotid duct for the parotid gland. The rounded terminal ends of the cords form the acini of the glands. Secretion by the parotid glands via the parotid duct begins at about 18 weeks of gestation. Again, the supporting connective tissue of the gland develops from the surrounding mesenchyme. [7]

      Parotid gland swellings[ edit ]

      See also: Parotid gland § Clinical significance

      Causes[ edit ]

      Mumps[ edit ]

      See also: mumps

      Mumps is seen to be a common cause of parotid gland swelling – 85% of cases occur in children younger than 15 years. The disease is highly contagious and spreads by airborne droplets from salivary, nasal, and urinary secretions. [10] Symptoms include oedema in the area, trismus as well as otalgia. The lesion tends to begin on one side of the face and eventually becomes bilateral. [10] The transmission of the paramyxovirus is by contact with the infected persons saliva. [10] Initial symptoms tend to be a headache and fever. Mumps is not fatal, however further complications can include swelling of the ovaries or the testes. [10] Diagnosis of mumps is confirmed through viral serology, management of the condition includes hydration and good oral hygiene of the patient [10] requiring excellent motivation. However, since the development of the mumps vaccine, given at the age of between 4–6 years, the incidence of this viral infection has greatly reduced. This vaccine has reduced the incidence by 99%. [10]

      Neoplasms[ edit ]

      Benign[ edit ]

      Neoplastic lesions of the parotid salivary gland can either be benign or malignant. Within the parotid gland, nearly 80% of tumours are benign . [11] Benign lesions tend to be painless, asymptomatic and slow – growing. The most common salivary gland neoplasms in children are hemangiomas , lymphatic malformations, and pleomorphic adenomas . [10] Diagnosis of benign lesions require a fine -needle like aspiration biopsy . [10] With various benign lesions, most commonly the pleomorphic adenoma, there is a risk of developing malignancy over time. [10] As a result, these lesions are typically resected.

      Pleomorphic adenoma is seen to be a common benign neoplasm of the salivary gland and has an overall incidence of 54-68%. [10] The Warthin tumour has a fewer incidence of 6-10%, this tumour is associated with smoking and is more common in older men. [10] Benign lesions of the parotid gland have a significantly higher incidence than malignant lesions.

      Malignant[ edit ]

      Malignant salivary gland lesions are rare. However, when a tumour extends to the submandibular, sublingual and the minor salivary glands, they tend to be malignant. [10] Distinguishing a malignant lesion from a benign one may be difficult as they both present as painless lesions. [10] A biopsy is crucial in aiding diagnosis. There are common signs that can highlight the presence of a malignant lesion. These include facial nerve weakness, rapid increase of the size of the lump as well as ulceration of the mucosa of the skin. [10]

      Mucoepidermoid carcinoma is a common malignant tumour of the salivary glands and has a low incidence of 4-13%. [10] The Adenoid cystic carcinoma is also a common malignant salivary gland lesion and has an incidence of 4-8%. This carcinoma tends to invade nerves and can re-occur post – treatment. [10]

      Polycystic Parotid Disease[ edit ]

      A polycystic disease of the salivary gland is seen to be extremely rare and is seen to be independent of recurrent parotitis . [12] The cause is thought to be a defect in the interactions between activin , follistatin and TGF-β , leading to a developmental disorder of glandular tissue. [12]

      Clinical significance[ edit ]

      See also: Salivary gland disease

      Parotitis[ edit ]

      Main article: Parotitis

      Inflammation of one or both parotid glands is known as parotitis . The most common cause of parotitis is mumps . Widespread vaccination against mumps has markedly reduced the incidence of mumps parotitis. The pain of mumps is due to the swelling of the gland within its fibrous capsule. [2]

      Apart from viral infection, other infections, such as bacterial, can cause parotitis (acute suppurative parotitis or chronic parotitis). These infections may cause blockage of the duct by salivary duct calculi or external compression. Parotid gland swellings can also be due to benign lymphoepithelial lesions[ clarification needed ] caused by Mikulicz disease and Sjögren syndrome . Swelling of the parotid gland may also indicate the eating disorder bulimia nervosa , creating the look of a heavy jaw line. With the inflammation of mumps or obstruction of the ducts, increased levels of the salivary alpha amylase secreted by the parotid gland can be detected in the blood stream.

      Fibrous reactions[ edit ]

      Tuberculosis and syphilis can cause granuloma formation in the parotid glands.

      Salivary stones[ edit ]

      Salivary stones mainly occur within the main confluence of the ducts and within the main parotid duct. The patient usually complains of intense pain when salivating and tends to avoid foods which produce this symptom. In addition, the parotid gland may become enlarged upon trying to eat. The pain can be reproduced in clinic by squirting lemon juice into the mouth. Surgery depends upon the site of the stone: if within the anterior aspect of the duct, a simple incision into the buccal mucosa with sphinterotomy[ clarification needed ] may allow removal; however, if situated more posteriorly[ clarification needed ] within the main duct, complete gland excision may be necessary.

      Injury[ edit ]

      The parotid salivary gland can also be pierced and the facial nerve temporarily traumatized when an inferior alveolar local anesthesia nerve block is incorrectly administered, causing transient facial paralysis. [3]

      Cancer and tumours[ edit ]

      About 80% of tumors of the parotid gland are benign. [13] The most common of these include pleomorphic adenoma (70% of tumors, [13] affecting predominantly females (60% [13] )) and Warthin tumor (i.e. adenolymphoma ) more in males than in females. Their importance is in relation to their anatomical position and tendency to grow over time. The tumorous growth can also change the consistency of the gland and cause facial pain on the involved side. [3]

      Around 20% of parotid tumors are malignant, with the most common tumors being mucoepidermoid carcinoma and adenoid cystic carcinoma . Other malignant tumors of the parotid gland include acinic cell carcinoma, carcinoma expleomorphic adenoma, adenocarcinoma (arising from ductal epithelium of parotid gland), squamous cell carcinoma (arising from parenchyma of parotid gland), and undifferentiated carcinoma. Metastasis from other sites like phyllodes tumour of breast presenting as parotid swelling have also been described. [14] Critically, the relationship of the tumor to the branches of the facial nerve ( CN VII) must be defined because resection may damage the nerves, resulting in paralysis of the muscles of facial expression.

      Surgery[ edit ]

      Surgical treatment of parotid gland tumors is sometimes difficult because of the anatomical relations of the facial nerve parotid lodge, as well as the increased potential for postoperative relapse. Thus, detection of early stages of a parotid tumor is extremely important in terms of postoperative prognosis. [13] Operative technique is laborious, because of relapses and incomplete previous treatment made in other border specialties. [13]

      After surgical removal of the parotid gland ( Parotidectomy ), the auriculotemporal nerve is liable to damage and upon recovery it fuses with sweat glands. This can cause sweating on the cheek on the side of the face of the affected gland. This condition is known as Frey’s syndrome . [15]

      Infections[ edit ]

      Bacterial infections[ edit ]

      See also: Parotitis

      Acute bacterial parotitis[ edit ]

      Commonly caused by a retrograde bacterial infection as a result of illness, sepsis , trauma, surgery, reduced salivary flow due to medications, diabetes , malnutrition and dehydration. Classically symptoms of painful swelling in the parotid region when eating seen. Management is based upon antibacterials, rehydration combined with gentle massage to encourage salivary flow. [16]

      Chronic bacterial parotitis[ edit ]

      A latent infection despite clinical resolution of the disease resulting in impaired function. Histologically glandular duct dilation, abscess formation and atrophy may be seen. Parotid secretions are viscous. Disease course shows pain and swelling, waxing and waning. Radiographic screening should be undertaken to rule out sialolith . Management with palliative care with parotidectomy as a last resort. [16]

      Viral infections[ edit ]

      Mumps[ edit ]

      See also: mumps

      Acute non-suppurative disease that often occurs in epidemics. Prevented by MMR vaccine. Caused by paramyxovirus that is transmitted by infected saliva and urine. A prodromal period of 24 – 28hrs is experienced, followed by rapid and painful swelling of the parotid gland. Treatment is supportive (bedrest, hydration) as spontaneous resolution occurs within 5 – 10 days. [16]

      HIV / AIDS[ edit ]

      See also: HIV/AIDS

      Diffuse gland enlargement is seen, and may affect patients throughout all stages of the infection. Lymphoepithelial cysts [17] seen via imaging help aid diagnosis. Pathogenic process occurs due to circulating CD8 lymphocytes within the salivary gland. Medical management via use of antiretrovirals , excellent oral hygiene measures and sialogogues. [16]

      Autoimmune related[ edit ]

      Systemic lupus erythematosus[ edit ]

      See also: Systemic lupus erythematosus

      Most commonly seen in fourth and fifth decades in women, and can affect any salivary gland. Presentation is a slowly enlarging gland, with diagnosis made by identification of the underlying systemic disorder and measurements of salivary chemical levels. Sodium and chloride ion levels will be elevated two or three times normal levels. Treatment is by addressing the underlying systemic condition. [16]

      Sarcoidosis[ edit ]

      See also: Sarcoidosis

      Sarcoidosis is a chronic systemic disease characterised by the production of non-caseating granulomas of unknown aetiology. It can affect any organ of the body, depressing cellular immunity and enhancing humoral immunity.

      Salivary gland involvement primarily involves the parotid gland, causing enlargement and swelling. Salivary gland biopsy with histopathologic examination is needed to make the distinction between whether Sjoren’s syndrome or Sarcoidosis is the cause of this. [16]

      Sjogren’s syndrome[ edit ]

      See also: Sjögren syndrome

      Salivary gland enlargement occurs in up to 30% of patients with Sjogren’s syndrome, with the parotid gland being most often enlarged, and bilateral parotid gland enlargement seen in 25-60% of patients. However, the parotid glands have a longer-lasting secretory capacity in Sjogren’s syndrome patient and therefore are the last glands to manifest hyposalivation in the disease. Histopathology shows clustering of lymphocytic infiltrates and epimyoepithelial islands. [16]

      Mycobacterial infection[ edit ]

      See also: Tuberculosis

      The most common head and neck manifestation of tuberculosis mycobacterial disease is infection of cervical lymph nodes. The infection is thought to originate in the tonsils or gingiva, ascending to the parotid gland. Two clinical forms; acute and chronic lesions. Acute lesions have diffuse glandular edema, easily confused with acute sialdentitis or abscess. The chronic lesions occur as slow growing masses mimicking tumors. [16]

      Examination of the Salivary Gland[ edit ]

      Ensure you take a detailed history a patient with obvious swelling, or a patient who is complaining of pain/discomfort in the area of the parotid.

      History and Examination[ edit ]

      A patient with parotid swelling may complain of swelling, pain, xerostomia , bad taste and sometimes sialorrhoea . [18]

      The most common presenting symptom of neoplasms (both benign and malignant) is an asymptomatic swelling. Pain is more common in patients with parotid cancer (10-29% feel pain) than those with benign neoplasms (only 2.5-4%), [18] but pain itself it not diagnostic of malignancy.

      Episodic swelling of major salivary glands accompanied by pain and related to salivary stimuli suggests duct obstruction.

      Also need to assess the facial nerve. The facial nerve passes through the parotid so may be affected if there is a change in the parotid gland. Facial nerve paralysis in a previously untreated patient usually indicates that a tumour is malignant. [18]

      Physical Examination[ edit ]

      The superficial location of the salivary glands allows palpation and visual inspection. The inspection must be systematic, both intraorally and extraorally, so no area is missed.

      For extraoral examination the patients head should be inclined forwards in order to maximally expose the parotid and submandibular glands. A normal parotid gland is barely palpable and a normal sublingual gland is not palpable. [18]

      Intra-oral examination should include observations for asymmetry, discolouration, pulsation and obstructions in the duct orifices. Swelling of the deep lobe of the parotid gland may be seen intra-orally, and may also displace the tonsil. The minor salivary glands should be examined. The labial, buccal and posterior palatal mucosa should be dried with an air blower or tissue and pressed to assess the flow of saliva. [18]

      Salivary Testing[ edit ]

      Salivary stimulation

      • This can be done by palpating the parotid gland, thus stimulating it. Assess to see whether there is saliva flowing from the parotid papilla.

      Sialography

      • Sialograms can identify changes in salivary gland architecture and are useful in the evaluation of major gland swellings
      • It involves the instillation of a radio-opaque fluid into the major gland ductal system. This outlines the major and minor ductal systems, and also gives an outline of the glandular tissue
      • For example, sialadenitis creates an appearance known as “pruning of the tree” [19] on a sialogram, where there are less branches visible from the duct system. Also, a space occupying lesion that occurs within or adjacent to a salivary gland can displace the normal anatomy of the gland. This may create an appearance known as “ball in hand” [19] on a sialogram, where the ducts are curved around the mass of the lesion.

      Sialochemistry

      • The composition of saliva changes in disease states, and analysis of saliva for enzymes, electrolytes, hormones, drugs and immunisation status can be performed.

      Radioisotope scintigraphy

      • Gives an objective measure of isotope uptake and excretion using a gamma scintillation camera. After about 20 minutes, a salivary stimulant will be given to promote salivary flow through the gland. [20] They are used to assess patients with persistent symptoms of dry mouth and also to evaluate salivary gland swelling due to infection, inflammation or obstruction. [21]

      Further Tests[ edit ]

      • Imagining techniques
        • Ultrasounds, CT Scans or MRIs can aid with disease localisation
      • Sialoendoscopy
        • A camera is inserted into the duct of a salivary gland to assess blockages
      • Biopsy
        • This can be done by fine needle aspiration biopsy , which provides an opportunity to obtain information about the histology of a salivary tumour prior to initiation of treatment. [18]

      Additional images[ edit ]

      • Parotid gland (incorrect muscle name)

      • Mandibular division of the trigeminal nerve(5th Cranial Nerve)

      See also[ edit ]

      Wikimedia Commons has media related to Parotid gland .
      This article uses anatomical terminology; for an overview, see anatomical terminology .
      • Sjögren’s syndrome
      • John Leonora
      • Juxtaoral organ of Chievitz

      References[ edit ]

      1. ^ https://www.colgate.com/en-us/oral-health/basics/mouth-and-teeth-anatomy/submandibular-gland–location–function-and-complications
      2. ^ a b Jacobs S (2008). “Chapter 7: Head and Neck”. Human Anatomy. Elsevier. p. 193. doi : 10.1016/B978-0-443-10373-5.50010-5 . ISBN   978-0-443-10373-5 .

      3. ^ a b c d Fehrenbach MJ, Herring SW (2012). Illustrated anatomy of the head and neck (4th ed.). St. Louis, Mo.: Elsevier/Saunders. p. 154. ISBN   978-1-4377-2419-6 .
      4. ^ “The Parotid Gland” . TeachMeAntatomy.info. Retrieved 11 November 2015.
      5. ^ Spratt JD, Abrahams PH, Boon JM, Hutchings RT (2008). McMinn’s Clinical Atlas of Human Anatomy (6th ed.). St. Louis, Mo.: Elsevier/Mosby. p. 54. ISBN   978-0-8089-2318-3 .
      6. ^ a b Nanci A (2013). Ten Cate’s Oral Histology: Development, Structure, and Function (8th ed.). St. Louis, Mo.: Elsevier. ISBN   978-0-323-07846-7 .
      7. ^ a b c Bath-Balogh M, Fehrenbach MJ (2011). Illustrated Dental Embryology, Histology, and Anatomy (3rd ed.). Elsevier. p. 135. ISBN   978-1-4377-1730-3 .
      8. ^ Arhakis A, Karagiannis V, Kalfas S (2013). “Salivary alpha-amylase activity and salivary flow rate in young adults” . The Open Dentistry Journal. 7: 7–15. doi : 10.2174/1874210601307010007 . PMC   3601341 . PMID   23524385 .
      9. ^ Moore P (2003). The Developing Human (7th ed.). Saunders. pp. 203, 220. ISBN   978-0-8089-2265-0 .
      10. ^ a b c d e f g h i j k l m n o p Wilson KF, Meier JD, Ward PD (June 2014). “Salivary gland disorders” . American Family Physician. 89 (11): 882–8. PMID   25077394 .
      11. ^ Mehanna H, McQueen A, Robinson M, Paleri V (October 2012). “Salivary gland swellings” . BMJ. 345: e6794. doi : 10.1136/bmj.e6794 . PMID   23092898 .
      12. ^ a b Iro H, Zenk J (2014-12-01). “Salivary gland diseases in children” . GMS Current Topics in Otorhinolaryngology, Head and Neck Surgery. 13: Doc06. doi : 10.3205/cto000109 . PMC   4273167 . PMID   25587366 .
      13. ^ a b c d e Bucur A, Dincă O, Niță T, Totan C, Vlădan C (Mar 2011). “Parotid tumors: our experience” . Rev. chir. oro-maxilo-fac. implantol. 2 (1): 7–9. ISSN   2069-3850 .(webpage has a translation button)
      14. ^ Sivaram P, Rahul M, Jayan C, Sulfekar MS (2015). “Metastatic Malignant Phyllodes Tumour: An Interesting Presentation as a Parotid Swelling”. New Indian Journal of Surgery. 6 (3): 75–77. doi : 10.21088/nijs.0976.4747.6315.2 . ISSN   0976-4747 .
      15. ^ Office of Rare Diseases Research (2011). “Frey’s syndrome” . National Institutes of Health. Retrieved 17 December 2012.
      16. ^ a b c d e f g h Carlson ER, Ord RA (2015). Salivary Gland Pathology: Diagnosis and Management (Second ed.). Hoboken, New Jersey: Wiley/Blackwell. ISBN   978-1-118-93375-6 . OCLC   904400135 .
      17. ^ Sujatha D, Babitha K, Prasad RS, Pai A (November 2013). “Parotid lymphoepithelial cysts in human immunodeficiency virus: a review”. The Journal of Laryngology and Otology. 127 (11): 1046–9. doi : 10.1017/S0022215113002417 . PMID   24169222 .
      18. ^ a b c d e f Anniko M, Bernal-Sprekelsen M, Bonkowsky V, Bradley P, Iurato S, eds. (2010). Otorhinolaryngology, Head and Neck Surgery. Springer. ISBN   978-3-540-42940-1 .
      19. ^ a b Schlieve T, Kolokythas A, Miloro M (2015). “Chapter 14: Salary Gland Infections” . In Hupp JR, Ferneini EM. Head, Neck and Orofacial Infections: An Interdisciplinary Approach. p. 235. ISBN   978-0-323-28946-7 .
      20. ^ Kumar BS, Sathasivasubramanian SP (January 2012). “The role of salivary gland scintigraphy in detection of salivary gland dysfunction in type 2 diabetic patients” . Indian Journal of Nuclear Medicine. 27 (1): 16–9. doi : 10.4103/0972-3919.108832 . PMC   3628255 . PMID   23599592 .
      21. ^ “Salivary gland function scan” . Johns Hopkins Sjogrens Center. Retrieved 2018-03-25.

      External links[ edit ]

      • Illustration at yoursurgery.com
      • lesson4 at The Anatomy Lesson by Wesley Norman (Georgetown University)
      • Salivary gland infections from Medline Plus
      • Salivary gland cancer from American Cancer Society
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