What are the major salivary glands in the human body. Where are the parotid, submandibular, and sublingual glands located. How do minor salivary glands differ from major ones. What is the role of facial nerves in relation to salivary glands.

The Major Salivary Glands: Anatomy and Function

The human body contains three pairs of major salivary glands, each playing a crucial role in saliva production and oral health. These glands are symmetrically arranged on both sides of the face and neck, ensuring balanced saliva distribution throughout the mouth.

• Parotid glands
• Submandibular glands
• Sublingual glands

Each of these major salivary glands is encased in a fascial layer and connected to the oral cavity via its own unique duct. This arrangement allows for efficient saliva transport and secretion.

Parotid Glands: The Largest Salivary Producers

The parotid glands, the largest of the salivary glands, are situated in front of each ear. They extend from below the cheekbones to the angle of the lower jaw, reaching back below the ear lobe. These glands rest atop the masseter muscle, which is primarily responsible for chewing.

How do parotid glands secrete saliva? The glands taper down at the bottom into a “tail,” where saliva-carrying tubes converge to form a single duct called Stenson’s duct. This duct transports saliva directly into the mouth.

Interestingly, the parotid glands are the most prolific saliva producers among all salivary glands. They are also the most common site for salivary gland tumors, accounting for 80% of all such tumors. However, it’s important to note that most parotid tumors are benign.

Submandibular Glands: Below the Jawbone

The submandibular glands are located in the submandibular triangle, an area of the neck below the jawbone. These glands secrete saliva through Wharton’s duct, which opens into the mouth just under the tongue.

A notable anatomical feature is the proximity of the marginal mandibular nerve, a branch of the facial nerve, which runs just over the top of the submandibular gland. This nerve controls the downward movement of the lower lip during facial expressions.

Sublingual Glands: Under the Tongue

The sublingual glands are positioned on the floor of the mouth, beneath the tongue. One gland is present on each side of the mouth. These glands are closely associated with the lingual nerves, which provide sensation to the sides of the tongue.

How do sublingual glands release saliva? They use multiple small ducts called the ducts of Rivinus, which open directly into the mouth.

Minor Salivary Glands: Small but Numerous

In addition to the major salivary glands, the human body contains thousands of minor salivary glands. These are significantly smaller and lack the fascial envelope and dedicated ducts characteristic of their larger counterparts.

Where are minor salivary glands located? They are distributed throughout the mouth, tongue, and throat, but are primarily concentrated in three areas:

• The junction of the hard and soft palate on the roof of the mouth
• The lips
• Along the inside of the cheeks

Despite their small size, minor salivary glands play a crucial role in maintaining oral moisture and health.

The Crucial Role of Nerves in Salivary Gland Function

Several important nerves traverse the areas surrounding and within the salivary glands. Understanding their paths and functions is crucial, especially when considering salivary gland surgeries or diagnosing related conditions.

The Facial Nerve: Master of Facial Expressions

The facial nerve, responsible for controlling facial movements, plays a particularly significant role in relation to the parotid glands. This nerve travels through the middle of the parotid glands, forming multiple branches that control 17 muscles for facial expression on each side of the face.

Why is preserving the facial nerve crucial during parotid gland surgery? Damage to these nerve branches can result in partial or complete facial paralysis, significantly impacting a person’s ability to make facial expressions. Surgeons take great care to identify and preserve these nerve branches when operating on the parotid gland.

The Lingual Nerve: Sensation Provider

The lingual nerves, which provide sensation to the sides of the tongue, run in close proximity to the sublingual glands. This anatomical arrangement necessitates careful consideration during any procedures involving the sublingual area to avoid potential sensory loss in the tongue.

Salivary Gland Tumors: Understanding the Risks

While salivary gland tumors are relatively rare, they can occur in both major and minor salivary glands. The parotid glands are the most common site for these tumors, accounting for about 80% of all salivary gland tumors.

Are all salivary gland tumors cancerous? No, in fact, most parotid tumors are benign. However, it’s important to note that a lump in the parotid gland region could be due to several factors:

• A benign tumor of the gland itself
• An enlarged lymph node due to cancer from another part of the body
• An enlarged lymph node due to infection or inflammation (non-cancerous)

Interestingly, the most common cause of an enlarged and cancerous parotid lymph node is actually due to skin cancer located on the side of the face or head. This underscores the importance of comprehensive evaluations when dealing with salivary gland abnormalities.

The Importance of Salivary Glands in Oral Health

Salivary glands, both major and minor, play a crucial role in maintaining oral health and facilitating various functions related to eating and speaking. They produce saliva, which serves multiple purposes:

1. Lubrication: Saliva moistens food, making it easier to chew and swallow.
2. Digestion: It contains enzymes that begin the process of breaking down food.
3. Oral hygiene: Saliva helps wash away food particles and bacteria, protecting against tooth decay and gum disease.
4. pH balance: It helps neutralize acids in the mouth, further protecting teeth from decay.
5. Taste: Saliva dissolves food particles, allowing them to interact with taste buds.

How much saliva do healthy salivary glands produce? On average, the salivary glands produce about 1-1.5 liters of saliva per day. This constant production is essential for maintaining oral health and comfort.

Diagnostic Approaches for Salivary Gland Disorders

When salivary gland disorders are suspected, healthcare professionals employ various diagnostic techniques to assess gland function and identify any abnormalities. These may include:

• Physical examination
• Imaging studies (CT scans, MRI, ultrasound)
• Sialography (X-ray examination of the salivary glands and ducts)
• Salivary gland biopsy
• Blood tests to check for autoimmune disorders or infections

Why is early diagnosis of salivary gland disorders important? Prompt identification of issues can lead to more effective treatment, potentially preventing complications and preserving gland function.

Treatment Options for Salivary Gland Conditions

The treatment of salivary gland disorders varies depending on the specific condition and its severity. Some common treatment approaches include:

1. Medications: Antibiotics for bacterial infections, anti-inflammatory drugs for certain conditions.
2. Sialendoscopy: A minimally invasive procedure to remove stones or clear blockages in the salivary ducts.
3. Surgery: For tumors, severe cases of chronic sialadenitis, or to remove chronically infected glands.
4. Radiation therapy: Sometimes used in conjunction with surgery for malignant tumors.
5. Lifestyle modifications: Increased hydration, gum chewing to stimulate saliva production, and avoiding tobacco and alcohol.

In cases of salivary gland cancer, what factors influence the treatment plan? The choice of treatment depends on several factors, including the type and stage of cancer, the specific gland affected, and the patient’s overall health. A multidisciplinary approach involving surgeons, oncologists, and radiation therapists is often employed to provide comprehensive care.

Emerging Research and Future Directions in Salivary Gland Science

The field of salivary gland research is continually evolving, with scientists exploring new avenues for diagnosis, treatment, and regeneration of these essential organs. Some promising areas of research include:

• Salivary diagnostics: Using saliva as a non-invasive method to detect and monitor various diseases.
• Gene therapy: Exploring ways to restore function in damaged salivary glands.
• Tissue engineering: Developing artificial salivary glands for patients with severe gland damage.
• Targeted therapies: Creating more precise treatments for salivary gland cancers with fewer side effects.
• Stem cell research: Investigating the potential of stem cells to regenerate damaged salivary tissue.

How might these advancements impact patient care in the future? As research progresses, we may see more personalized and effective treatments for salivary gland disorders, improved diagnostic capabilities, and potentially even the ability to fully restore function in damaged glands.

The intricate anatomy and vital functions of salivary glands underscore their importance in human health. From facilitating digestion to maintaining oral hygiene, these small but mighty organs play a crucial role in our daily lives. As our understanding of salivary gland biology continues to grow, so too does our ability to diagnose, treat, and potentially even regenerate these essential structures. The future of salivary gland science holds exciting possibilities for improving patient care and quality of life.

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”

The surgeon deals with the treatment of this disease

• What is atheroma?
• Atheroma symptoms
• Causes of atheroma
• Atheroma diagnostics
• Atheroma treatment
• Doctors

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.

You can find out more about the disease, prices for treatment and sign up for a consultation with a specialist by phone:

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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.