What are the major salivary glands and where are they located? How do the minor salivary glands differ from the major ones? What important nerves are found near the salivary glands and why is this relevant for salivary gland cancer treatment? Get the answers to these questions and more in our detailed article.

Understanding the Anatomy of Salivary Glands

Salivary glands play a crucial role in our daily lives, producing saliva that helps us chew, swallow, and maintain oral health. However, these glands can also be the site of various medical conditions, including salivary gland cancer. To fully comprehend this disease, it is essential to have a solid grasp of the anatomy of the salivary glands.

The Major Salivary Glands

The major salivary glands consist of three distinct glands on each side of the face: the parotid gland, the submandibular gland, and the sublingual gland. These glands are larger in size compared to the minor salivary glands and are surrounded by an envelope or fascial layer.

Parotid Glands

The parotid glands are the largest of the major salivary glands, situated in front of each ear and extending from below the cheekbones to the level of the angle of the lower jaw and back below the ear lobe. These glands sit on top of the masseter muscle, which is the main muscle used for chewing. The parotid glands taper down at the bottom into a “tail,” from which the saliva-carrying tubes join together to become a single duct (called the “Stenson’s duct”) that leaves the gland and travels to the mouth. The parotid glands produce the most saliva out of any of the other glands.

Submandibular Glands

The submandibular glands lie in the submandibular triangle, the area of the neck below the jawbone. The main saliva-carrying tube from the submandibular gland is called “Wharton’s duct,” and it opens into the mouth right under the tongue. One of the branches of the facial nerve, the marginal mandibular nerve, runs just over the top of the submandibular gland and controls the lower lip’s downward movement during normal facial expression.

Sublingual Glands

The sublingual glands sit on the floor of the mouth under the tongue, with one gland on either side of the mouth. The saliva-carrying tubes from these glands are called the “ducts of Rivinus,” and they open directly into the mouth. The lingual nerves, which provide sensation to the sides of the tongue, run in very close proximity to these glands.

The Minor Salivary Glands

In contrast to the major salivary glands, the minor salivary glands are much smaller and not surrounded by envelopes. They do not have their own saliva-carrying tubes. Thousands of minor salivary glands are found throughout the mouth, tongue, and throat, but they are mainly located in a few specific areas: the junction of the hard and soft palate on the roof of the mouth, lips, and along the inside of the cheeks.

The Importance of Nerves in Salivary Gland Anatomy

Many important nerves travel near the salivary glands, and this is a crucial consideration in the treatment of salivary gland cancer. The facial nerve, which controls the movement of the face, travels through the middle of the parotid glands and forms multiple branches within the gland. Surgeons must take great care to locate and preserve these nerve branches when operating on the parotid gland. Similarly, the marginal mandibular nerve, which controls the lower lip’s movement, runs just over the top of the submandibular gland. The lingual nerves, which provide sensation to the sides of the tongue, run in close proximity to the sublingual glands.

The Role of Salivary Gland Anatomy in Cancer

Understanding the anatomy of the salivary glands, including the location of the major and minor glands as well as the nearby nerves, is essential for the diagnosis and treatment of salivary gland cancer. For example, the fact that the parotid glands are the most common site of salivary gland tumors, with 80% of salivary gland tumors arising in this location, is crucial knowledge. Additionally, the presence of lymph nodes within the parotid gland envelope means that a lump in the parotid gland may not necessarily be a tumor, but could also be an enlarged lymph node due to cancer or infection from another part of the body.

Conclusion

The salivary glands play a vital role in our daily lives, and understanding their anatomy is crucial for the diagnosis and treatment of salivary gland cancer. By familiarizing ourselves with the location and characteristics of the major and minor salivary glands, as well as the important nerves that run in close proximity to them, we can better comprehend the complexities of this disease and the challenges faced by healthcare professionals in providing effective care.

Anatomy ‣ Salivary Gland Cancer ‣ THANC Guide

Video Summary

• There are 3 major salivary glands on each side of the face:
  • The parotid gland, located in front of the ear,
  • The submandibular gland, located below the jaw bone, and
  • The sublingual gland, located under the tongue.
• There are many minor salivary glands located throughout the mouth, tongue, and throat, which are much smaller than the major glands.
• There are many important nerves that travel near the salivary glands.

In order to begin to understand salivary gland cancer, it is important to gain some background knowledge on the anatomy of the salivary glands. In the head and neck, there are two main types of salivary glands: major salivary glands and minor salivary glands. The major salivary glands consist of three different glands: parotid, submandibular, and sublingual. The glands in the face and neck are symmetrical, meaning that there is one of each on either side of the face and mouth.  

There are many different nerves that travel around and through the salivary glands. The location of these nerves is important, as they can become involved by salivary gland tumors. If surgery becomes necessary to treat salivary gland cancer, these nerves must be identified and monitored very carefully in the hopes of preserving their function.  

Major Salivary Glands 

Illustration of the parotid gland sublingual gland and submandibular gland © Jill Gregory

The major salivary glands include the parotid glands, the submandibular glands, and the sublingual glands. They are called “major” because they are larger than the minor salivary glands. Each major salivary gland is surrounded by an envelope or fascial layer, and each one has its own tube (or duct) that connects it to the mouth and transports the saliva produced by the gland.

Parotid Salivary Glands 

The parotid glands are the largest salivary glands, sitting in front of each ear and extending from below the cheekbones to the level of the angle of the lower jaw and back below the ear lobe. The glands sit on top of the masseter muscle, which is the main muscle used for chewing. The parotid glands taper down at the bottom into a “tail,” from which the saliva-carrying tubes join together to become a single duct (called the “Stenson’s duct”) that leaves the gland and travels to the mouth. The parotid glands produce the most saliva out of any of the other glands. The nerve that controls the movement of the face, called the facial nerve, travels through the middle of the parotid glands. It forms multiple branches within the gland that control the 17 muscles for facial expression on each side of the face and are therefore very important. Surgeons will work to locate and preserve these nerve branches when operating on the parotid gland.

The parotid glands are the most common sites of salivary gland tumors, as 80% of salivary gland tumors arise in the parotid gland. However, most of these parotid tumors are benign and not cancerous. Just like the other major salivary glands, the parotid glands are enclosed by envelopes, which happen to also contain lymph nodes. This means that a lump in a parotid gland could actually be a lymph node that is enlarged due to cancer from another part of the body, or due to infection and inflammation (non-cancerous). The most common cause for an enlarged and cancerous parotid lymph node is due to a skin cancer located on the side of the face or head.

Submandibular Salivary Glands 

The submandibular glands lie in what is called the submandibular triangle, the area of the neck below the jawbone. The main saliva-carrying tube from the submandibular gland is called “Wharton’s duct,” and it opens into the mouth right under the tongue. One of the branches of the facial nerve runs just over the top of the submandibular gland and is called the marginal mandibular nerve.  This nerve controls the lower lip and allows it to move downwards during normal facial expression. 

Sublingual Salivary Glands 

The sublingual glands sit on the floor of the mouth under the tongue, with one gland on either side of the mouth. The lingual nerves, which provide sensation to the sides of the tongue, run in very close proximity to these glands. The saliva-carrying tubes from these glands are called the “ducts of Rivinus,” and they open directly into the mouth.

Minor Salivary Glands 

The minor salivary glands are much smaller than the major salivary glands. They are not surrounded by envelopes and do not have their own saliva-carrying tubes. There are thousands of minor salivary glands throughout the mouth, tongue and throat, but they are mainly located in a few places: the junction of the hard and soft palate on the roof of the mouth, lips, and along the inside of the cheeks.

Salivary Glands Anatomy | Memorial Sloan Kettering Cancer Center

The major salivary glands (shown above) are the largest and most important salivary glands. They produce most of the saliva in your mouth.

If you have been diagnosed with salivary gland cancer, knowing a little bit about the salivary glands will help you talk to your doctor about surgery or other aspects of your care.

The salivary glands make saliva and empty it into your mouth through openings called ducts. Saliva helps with swallowing and chewing. It can also help prevent infections from developing in your mouth or throat.

There are two types of salivary glands:

1. the major salivary glands
2. the minor salivary glands

Major Salivary Glands

The major salivary glands are the largest and most important salivary glands. They produce most of the saliva in your mouth.

There are three pairs of major salivary glands: the parotid glands, the submandibular glands, and the sublingual glands.

Parotid Glands

The parotid glands are the largest salivary glands. They are located just in front of the ears. The saliva produced in these glands is secreted into the mouth from a duct near your upper second molar.

Each parotid gland has two parts, or lobes: the superficial lobe and the deep lobe. Between the two lobes is the facial nerve. The facial nerve is important because it controls your ability to close your eyes, raise your eyebrows, and smile.

Other critical structures near the parotid glands include the external carotid artery, which is a major supplier of blood to the head and neck region, and the retromandibular vein, a branch of the jugular vein.

Surgery to treat a parotid gland tumor is called a parotidectomy. It requires great precision because the surgeon has to locate and operate around these important structures.

Learn more about parotidectomy.

Submandibular Glands

About the size of a walnut, the submandibular glands are located below the jaw. The saliva produced in these glands is secreted into the mouth from under the tongue.

Like the parotid glands, the submandibular glands have two parts called the superficial lobe and the deep lobe. Nearby structures include:

• the marginal mandibular nerve, which helps you smile
• the platysma muscle, which helps you move your lower lip
• the lingual nerve, which allows sensation in your tongue
• the hypoglossal nerve, which allows movement in the part of your tongue that helps with speech and swallowing

During treatment, we protect all of these important structures to avoid causing damage.

Learn more about submandibular gland cancer surgery.

Sublingual Glands

The sublingual glands are the smallest of the major salivary glands. These almond-shaped structures are located under the floor of the mouth and below either side of the tongue.

Tumors starting in these glands are particularly rare.

Learn more about surgery for cancers that begin in the sublingual glands.

Minor Salivary Glands

There are hundreds of minor salivary glands throughout the mouth and the aerodigestive tract. Unlike the major salivary glands, these glands are too small to be seen without a microscope. Most are found in the lining of the lips, the tongue, and the roof of the mouth, as well as inside the cheeks, nose, sinuses, and larynx (voice box).

Minor salivary gland tumors are extremely rare. However, they are more likely to be cancerous than benign. Cancers of the minor salivary glands most often begin in the roof of the mouth.

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treatment, symptoms and causes of the disease, diagnostics in the “SM-Clinic”

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• What is atheroma?
• Atheroma symptoms
• Causes of atheroma
• Atheroma diagnostics
• Atheroma treatment
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Atheroma can develop on the excretory duct of any sebaceous gland. The sebaceous glands are everywhere except the soles and palms. There are especially many glands on the face, scalp, back between the shoulder blades, chest, and groin. In some areas of the skin, the number of sebaceous glands reaches 900. Therefore, atheroma can have a variety of localization.

Atheroma – a small cavity, not soldered to the skin, easily moves under the skin. Contains a mushy mass, palpable as an elastic, painless ball. This is the result of blockage of the sebaceous gland. Although the excretory duct is blocked, sebum continues to be produced, gradually expanding the duct.

Atheroma increases in size slowly over several years. Patients apply only because of a cosmetic defect, since there are no painful manifestations. Sizes can reach 10 cm or more.

Symptoms of atheroma

A cyst is defined as a soft, round formation that protrudes slightly under the skin. If the contents of the cyst are liquid, then fluctuation (oscillatory movement) is felt. The skin over the atheroma is stretched so much that it cannot be folded. At the top point, a blocked duct can be seen in the form of a black dot. Atheroma is easy to displace relative to neighboring tissues. Education does not give any unpleasant sensations.

If the atheroma is located in a place of close contact with clothing, then scuffs and signs of inflammation may be present.

When located on the scalp, the hair over the atheroma thins and almost always falls out. Due to constant trauma, necrosis (necrosis) often occurs, ulcers form, and slight bleeding occurs. In some patients, the skin over the atheromas on the head becomes dense, cyanotic and painful to the touch.

Causes of atheroma

Blockage of the sebaceous gland occurs for the following reasons:

• genetic – structural features of the sebaceous glands are such that in some glands there is no excretory duct. In this case, the accumulation of sebum begins even in utero, and the born child is covered with atheromas;
• acne, when the mouth of the excretory duct becomes keratinized, and the secretion of the gland becomes more viscous;
• oily seborrhea, when a large amount of sebum forms on the scalp;
• mechanical damage to the gland – boils, cuts, abrasions, scars, permanent hair removal;
• exposure to ionizing radiation;
• ultraviolet irradiation;
• burns and frostbite;
• various hormonal factors resulting from stress.

Usually several pathological mechanisms work simultaneously in one person.

Thus, a blockage can occur for any reason. The resulting secret stretches the duct, and a cavity is obtained. Vessels and nerves are not affected, and the person does not feel anything. However, over time, a dense capsule of connective tissue forms around the swollen cavity. Attempts to puncture and empty the cyst do nothing, as the contents are recruited again and again.

Complicated atheroma is rare, and complications include suppuration. This happens with mechanical pressure or irritation, as well as after independent attempts to empty the cyst. A connective tissue capsule separates the cavity with its contents from the rest of the tissues, and when you try to squeeze it out, it can collapse, and suppuration passes to neighboring areas.

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If you experience these symptoms, we recommend that you make an appointment with your doctor. Timely consultation will prevent negative consequences for your health.

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Diagnosis of atheroma

Diagnosis is carried out by a dermatologist or surgical oncologist. During the examination, the doctor detects characteristic changes, paying attention to the location, mobility and size. The speed at which the cyst formed matters.

In a difficult case, an ultrasound of the soft tissues is performed at the site of the cyst. On ultrasound, a capsule is visible, inside it is a thin cyst and contents. During ultrasound, atheroma is delimited from other similar formations – hygromas (sweat gland cyst), fibromas (connective tissue), lipomas (benign tumor of adipose tissue).

If there is still doubt about the nature of the cyst, a histological analysis (study of the cellular composition) is performed during surgical removal.

Treatment of atheroma

The treatment is complex, since it is necessary not only to remove the cyst with the capsule, but also to choose skin care products to prevent the formation of new cysts.

If the cyst is inflamed, then before surgical treatment, all measures are taken to stop the inflammation. Antibacterial and disinfectants, agents to reduce the formation of sebum are prescribed.

Operative treatment is possible in two variants:

• classical cystectomy — exfoliation of the capsule with a scalpel with a cosmetic suture;
• radio wave removal – high frequency waves evaporate the liquid from the capsule, as a result, the formation is eliminated. This method is preferable because it is not accompanied by bleeding and scarring, but cannot be used in patients with a pacemaker and the presence of metal structures in the body.
• With festering atheroma, pus is first evacuated and the inflammation subsides, and only then the capsule is husked.

The best prevention of atheroma is to see a dermatologist for any skin changes. After the examination, the doctor selects skin care medications that normalize the production of sebum. The entire range of medical services for the diagnosis, treatment and prevention of atheroma is available at the SM-Clinic.

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causes, symptoms of the disease, diagnosis and treatment

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Atheroma: causes, symptoms, diagnosis and treatment.

Definition

Atheroma is a cyst (pathological cavity) of the sebaceous gland, resulting from difficulty or complete cessation of the outflow of secretion (sebum) from the gland. The sebaceous glands are external secretion glands and are located in almost all parts of the skin, with the exception of the palms, soles and back of the feet. The secret produced by them is part of the water-lipid mantle of the skin. If the duct of the gland is clogged, then the secret begins to accumulate in it, stretches it with the formation of a cavity lined with the epidermis and containing the secretion products of the sebaceous gland, cholesterol crystals, keratinized epidermal cells and detritus (decay products) – this is atheroma.

Atheromas occur in 5-10% of the population, mainly formed at the age of 20-30 years, with the same frequency in men and women.

Causes of atheroma

Atheroma occurs as a result of disruption of the sebaceous glands, which is manifested by increased production of sebum and blockage of the duct. A number of factors predispose to this: increased sweating, insufficient hygiene, narrowness of the ducts of the sebaceous glands, individually determined high viscosity of sebum, chronic skin trauma, hormonal disorders, frostbite and burns. Affects the development of atheroma and hereditary factor.

The use of antiperspirants can contribute to blockage of the duct.

Disease classification

Allocate true and false cysts. True sebaceous cysts are a hereditary disease and are extremely rare. They develop as a result of a genetic defect that affects the formation of the gland. Typically, such cysts are found in newborns and are small in size. False cysts are actually atheromas that have arisen due to a violation of the outflow of the secretion of the sebaceous gland.

Symptoms of atheroma

Atheromas most often occur in areas of the body where there are many sebaceous glands, for example, on the scalp, face, neck, in the interscapular space.

Atheroma is a mobile formation of a round or slightly elongated shape, dense or elastic consistency, covered with unchanged skin. A characteristic sign of atheroma, which distinguishes it from other formations, is the presence of a point retraction of the skin (crater) in the area of ​​​​the excretory duct of the gland and adhesion of the skin to the cyst membrane in the same place. Sometimes in the middle of the atheroma there is a hole through which its contents are released – curdled masses with an unpleasant odor.

The size of atheroma can vary from a pea to a chicken egg and even more, reaching 10 cm. Atheroma always rises above the level of the skin, increases slowly, usually painless.

Diagnosis of atheroma

To make a diagnosis, the doctor performs a clinical examination, in some cases an ultrasound examination may be required.

Ultrasound of soft tissues

Examination of soft tissues to detect pathological changes and diagnose neoplasms.

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A biopsy of the formation is rarely performed, since the risk of degeneration of atheroma into a malignant neoplasm is extremely low.

Which doctors to contact

Diagnosis can be made by a dermatologist,
general practitioner or
therapist. Surgical treatment is performed
surgeon.

In order to prevent the appearance of new foci, patients turn to a cosmetologist for a consultation.

Treatment of atheroma

Surgical removal of atheroma together with the capsule gives the best results – this reduces the risk of recurrence. The operation is performed under local anesthesia, usually on an outpatient basis. If the atheroma is located on the face, then sparing methods can be used for aesthetic purposes, such as cystotomy, which involves cutting the skin, opening the atheroma capsule and evacuating the contents of its cavity.

Laser destruction of atheroma is an alternative to surgical removal. There are three methods of laser intervention – laser photocoagulation, laser excision of atheroma together with the shell and laser evaporation of the atheroma shell from the inside. The type of intervention is determined by the surgeon, choosing the most optimal for each individual patient.

Complications

Atheroma may suppurate. This process is accompanied by pain, redness and swelling of the skin. As a rule, the inflammatory process develops slowly. Education is delimited by a capsule, so local and general inflammatory changes during suppuration are poorly expressed. Festering atheroma can spontaneously open with the release of pus with an unpleasant odor.

Atheroma prevention

For prevention, it is recommended to thoroughly cleanse the skin, preventing its pollution and removing excess sebum. If there is a predisposition to the formation of atheromas, it is better to abandon the use of antiperspirants. Beauticians recommend limiting the intake of foods containing a large amount of animal fats and quickly digestible carbohydrates.

Sources:

1. Clinical guidelines “Cysts of the maxillofacial region and neck”. Society of specialists in the field of maxillofacial surgery. 2020.
2. Tarasenko G.N. et al. Atheroma: a problem for a cosmetologist or a dermatologist? // Hospital medicine: science and practice.