Detailed anatomy and physiology of major and minor salivary glands including applied aspects and various pathologies

1. Salivary Glands –
Anatomy and Physiology
Saurabh Roy
11.11.151

2. Overlay :
 Introducing Glands
 Salivary Glands
 Classifying Salivary glands
 Embryology of Salivary glands
 Anatomy and Clinical implications
 Parotid
 Submandibular
 Sublingual
 Minor
 Physiology and Clinical implications
 Conclusion
 References 2

3. Introduction – What are Glands?:
 A cell, group of cells, or organ that selectively removes materials
from the blood, concentrates or alters them, and secretes them for
further use in the body or for elimination from the body
 Typically, a gland consists of either cuboidal or columnar epithelium
resting on a basement membrane and is surrounded by a plexus, or
meshwork, of blood vessels.
http://www.britannica.com/science/gland
3

4. Types of Glands:
 Endocrine, or ductless, glands (e.g., pituitary, thyroid, adrenal)
secrete substances known as hormones directly into the bloodstream
rather than through ducts.
 Exocrine glands (e.g., salivary, sweat, digestive) discharge their
products through ducts.
4

5. Types of Exocrine glands :
 Exocrine glands.
Max sweat glands,
Salivary glands,
Lacrimal glands
Sweat glands
around lips and arm
pits
Sebaceous glands,
Meibomian glands
5

6. Types based on Ductal Pattern :
 Exocrine glands.
6

7. Salivary Glands:
 Salivary glands are a group of exocrine, merocrine, simple/compound
tubulo-acinar type of glands secreting saliva
 The saliva forms a film of fluid coating the teeth and mucosa thereby
creating and regulating a healthy environment in the oral cavity
 Oral fluid, which is referred to as mixed or whole saliva, includes the
secretion of major glands, the minor glands, desquamated oral
epithelial cells, microorganisms and their products, food debris and
serum components and inflammatory cells that gain access through
the gingival crevice
7

8. Classifying Salivary Glands:
Based on size
Histochemical nature of
fluid
Ductal system
8

9. Classifying Salivary Glands:
 According to size :
 Major salivary glands : Parotid, Submandibular , Sublingual
 Minor salivary glands : Carmalt’s glands, Glands of Von ebner
9

10. Classifying Salivary Glands:
 According to nature of secretion:
 Pure Serous – Parotid, Glands of Von Ebner
 Pure Mucous – Anterior lingual Glands of Blandin and Nuhn
 Mixed – Submandibular and Sublingual
10

11. Classifying Salivary Glands:
 According to ductal systems :
 Simple – Minor Salivary glands
 Compound – Major Salivary glands
11

12. Embryology:
12

13. Embryology:
 The individual salivary glands arise as a proliferation of oral epithelial cells, forming
a focal thickening that grows into the underlying ectomesenchyme
 Continued growth results in the formation of a small bud connected to the surface
by a trailing cord of epithelial cells, with mesenchymal cells condensing around it
 Formation of clefts occurs; forming 2 or more buds
 Continuation of this process, called Branching Morphogenesis produces successive
generations of buds and a hierarchic ramification of the gland
 Branching morphogenesis, defined as growth and branching of epithelial tubules
during embryogenesis, is a fundamental feature of renal, lung, mammary gland,
submandibular gland, and pancreatic morphogenesis in mammals.
Hu MC, Rosenblum ND ;Genetic regulation of branching morphogenesis: lessons learned
from loss-of-function phenotypes.
Pediatric Res. 2003 Oct;54(4):433-8. Epub 2003 Aug 6.
13

14. Embryology:
14

15. Embryology:
The cells of secretory end pieces and ducts attain maturity during the last 2 months of
gestation 15

16. Microstructure of Glands:
Secretory
units(Acini):
• Serous cells
• Mucous cells Myoepithelial
cells
Ductal units
• Intercalated
ducts
• Striated ducts
• Excretory ducts
Connective
Tissue:
Surrounding
capsule
Tissue septae
Tissue
elements
16

17. Microstructure of Glands:
17

18. Serous cells:
 Pyramidal with a broad base on the
basement membrane, apex facing the
lumen
 Secretory granules – Zymogen granules
present in the apical cytoplasm
 Abundance of RER
 Mature zymogen granules expelled
from the cell surface by exocytosis
18

19. Mucous cells:
 Typically have a tubular configuration
 Mucous end pieces in some cases have
serous cells associated with them in the
form of a demilune
 The most prominent feature of mucous
cells is the accumulation in the apical
cytoplasm of their secretory product –
mucus
 Have a large Golgi complex, located
basal to the mass of secretory granules
19

20. Myoepithelial cells:
20

21. Myoepithelial cells:
 Contractile elements associated with the secretory end pieces and
intercalated ducts
 Stellate shaped, numerous branching processes which envelop the
secretory end piece
 Fusiform shaped with fewer processes
 These processes are filled with actin and soluble myosin
 Contraction of these processes provides support to the end pieces during
active secretion of saliva
 Recent evidence also suggests that these cells provide signals to acinar
units to maintain cell polarity and structural organization of acini
21

22. Ductal Elements:
Acini
Intercalated
ducts
Striated ducts
Excretory ducts
Stenson’s/
Wharton’s ducts22

23. Ductal elements:
• Single layer of cuboidal cells
• Secretory units may also secrete lysozyme and
lactoferrin
Intercalated
ducts:
• Constitute largest portion of ductal system; Columnar
cells
• Modification of primary saliva by reabsorbtion and
secretion of electrolytes
Striated ducts:
• Pseudostratified columnar epithelium
• Other types of cells viz. Tuft cells, lymphocytes and
macrophages may be present within
Terminal
Excretory ducts: 23

24. Anatomy and Clinical
Implications :
24

25. Parotid Gland :
 Largest serous salivary gland
 Weighs around 15 gms
 Resembles a 3 sided pyramid with apex directed downwards
 4 surfaces:
 Superior
 Superficial
 Anteromedial
 Posteromedial
 Separated by 3 borders:
 Anterior
 Posterior
 Medial 25

26. Parotid Capsule :
 Formed by Investing layer of deep
cervical fascia
 Fascia splits to enclose the gland
 Superficial lamina – Thick and adherent
is attached to the zygomatic arch
 Deep lamina – Thin; attached to the
styloid process, the angle & posterior
border of ramus and tympanic plate
 A portion of the deep lamina thickens to
form the stylomandibular ligament which
separates the parotid from the
submandibular gland
26

27. Parotid Gland - Relations :
27

28. Parotid Gland - Relations:
 Superior Surface
 Concave, Related to
 Cartilaginous part of ext acoustic meatus
 Post. Aspect of temperomandibular joint
 Auriculotemporal Nerve
 Sup. Temporal vessels
 Apex
 Overlaps posterior belly of digastric and adjoining part of carotid triangle
 Superficial Surface; Covered by
 Skin
 Superficial fascia containing facial branches of great auricular N
 Superficial parotid lymph nodes and post fibres of platysma
28

29. Parotid Gland - Relations :
 Anteromedial Surface
 Grooved by posterior border of ramus of mandible
 Related to
 Masseter
 Lateral Surface of temperomandibular joint
 Medial pterygoid muscles
 Emerging branches of Facial N
29

30. Parotid Gland - Relations :
 Posteromedial Surface is related to
 Mastoid process with sternomastoid and posterior belly of digastric.
 Styloid process with structures attached to it.
 External Carotid Artery which enters the gland through the surface
 Internal Carotid Artery which lies deep to styloid process
30

31. Parotid Gland – Structures within:
 Arteries :
31

32. Parotid Gland – Structures within:
 Veins:
32

33. Parotid Gland – Structures within:
 Nerves:
33

34. Patey’s Faciovenous plane:
 Large superficial and small deep part of the gland interconnected by an isthmus
 Facial nerve divides along this plane
34

35. Patey’s Faciovenous plane:- Clinical Significance
 The facial nerve must be traced from behind forwards as it emerges from the
stylomastoid foramen and enters the parotid gland
 The nerve is surrounded by a leash of veins called the neuro-venous plexus of Patey
which must be followed with fine dissection, preferably under a microscope, to
surgically divide the isthmus.
35

36. Parotid duct/Ductus parotideus/Stenson’s Duct:
 Thick walled and about 5 cm long
 Emerges from the middle of the anterior border of the gland
 Superior relations:
 Accessory parotid
 Transverse facial vessels
 Upper Buccal branch of facial nerve
 Inferior relations:
 Lower buccal branch of facial nerve
36

37. Parotid duct/ ductus parotideus/ Stenson’s Duct:
 At the anterior border of the masseter, the
parotid duct turns medially and pierces:
 Buccal fat pad
 Buccopharyngeal fascia
 Buccinator
 The duct runs forwards for a short distance
between the buccinator and the oral mucosa.
 Finally, the duct opens into the gingivobuccal
vestibule opposite the crown of the maxillary
2nd molar tooth
37

38. Parotid duct/ ductus parotideus/ Stenson’s Duct :
 Surface anatomy:
 Corresponds to middle third of a line drawn from lower border of tragus to a
point midway b/w nasal ala and upperlabial margin
38

39. Parotid Gland – Blood Supply :
 Arterial supply: External carotid artery and its branches within the gland
 Venous drainage: External & internal jugular vein
39

40. Parotid Gland – Nerve Supply:
• Secretomotor
• Reach through
auriculotemporal
nerve
Parasympathetic
40

41. Parotid Gland – Nerve Supply:
• Vasomotor
• Derived from the plexus around
the middle meningeal artery
Sympathetic
nerves
• Derived from the
auriculotemporal nerve but the
parotid fascia is innervated by
the sensory fibres of Great
Auricular nerve(C2,C3)
Sensory
nerves
41

42. Parotid Gland – Lymph Nodes:
 Lie partly in the superficial and partly in the deep fascia over the
parotid gland
 Drainage:
 Temple
 Side of the scalp
 External acoustic meatus
 Middle ear
 Parotid gland
 Upper part of the cheek
 Parts of eyelids and orbit
42

43. Anatomy – Clinical implications :
 Parotid swellings are extremely painful due to the unyielding nature of
parotid fascia – Acute Parotitis
43

44. Anatomy – Clinical implications :
 A Parotid abscess may be caused by spread
of infection from the opening of parotid
duct in the oral cavity
 Else it may present as a slight swelling with
redness on the surface of the swelling
accompanied by acute, excruciating pain
 It results from bacterial parotitis with the
spread of pathogen in a retrograde manner
 Does not show fluctuation due to unyielding
nature of parotid capsule
 Best drained by Horizontal incision known
as Hilton’s Method below the angle of the
mandible 44

45. Anatomy – Clinical implications :
 Parotidectomy is the surgical removal of the parotid gland
 Injury to the auriculotemporal nerve can occur at a site where it turns
around the neck of the mandible
 Because of the injury, postganglionic parasympathetic fibres from the
Otic ganglion unite with sympathetic fibres of superior cervical ganglion
which supplies vessels and sweat glands over skin overlying parotid
region
45

46. Anatomy – Clinical implications :
 This causes stimulation of the sweat
glands and hyperemia in its area of
distribution, producing redness and
sweating in the area of the skin
supplied by the nerve
 This clinical entity is called Frey’s
Syndrome/Auriculotemporal
Syndrome
46

47. Anatomy – Clinical implications :
 Diagnosis : Minor’s Starch iodine test
 Prevention:
 Physical barrier between the skin and parotid bed by using muscle flaps from
temporalis or SCM
 Treatment:
 Reassurance, aluminium chloride – antiperspirant(astringent)
 Denervation by tympanic neurectomy
 Injection of botulinum toxin into the affected skin
47

48. Anatomy – Clinical implications :
 During parotidectomy, the facial nerve is preserved by removing the
gland in 2 parts, superficial and deep separately.
 Plane of cleavage is defined by tracing the nerve from behind forwards
48

49. Anatomy – Clinical implications :
 Swellings of parotid may either be due to inflammation or due to
tumours (benign or malignant)
 Since the gland is positioned below, behind and in front of the lobule of
the ear its swellings obliterate the normal hollow just below the lobule
of the ear, which is invariably lifted in the parotid swellings
 A painless slow growing tumour is usually benign in nature which does
not damage the facial nerve
 On the contrary, the malignant growth is characterized by rapidly
growing painful swelling which involves the facial nerve producing facial
palsy. Fixity with hardness and enlargement of cervical lymph nodes are
other features
49

50. Submandibular Gland :
 Location : Anterior part of Digastric triangle
 Size of a walnut, roughly J-shaped
 Superficial Part:
 Larger part, filling up the digastric triangle
 Extends up till the mylohyoid line
 It has inferior, medial and lateral surfaces
 Partially enclosed between 2 layers of deep
cervical fascia
50

51. Submandibular Gland :
 Superficial Part: - Relations :
Inferiorly:
Skin
Platysma
Cervical branch of facial nerve
Deep fascia
Facial vein
Submandibular Lymph Nodes
Medially:
Mylohyoid
Hyoglossus
Styloglossus
Laterally:
Submandibular fossa on the
mandible
Insertion of medial pterygoid
Facial Artery
51

52. Submandibular Gland :
 Deep part:
 Small sized, lies deep to Mylohyoid, superficial to hyoglossus
and styloglossus
 Relations: Laterally:
Mylohyoid
Medially:
Hyoglossus
Superiorly:
Lingual nerve with
submandibular
ganglion
Inferiorly:
Hypoglossal Nerve
52

53. Wharton’s Duct:
 Thin walled, about 5 cm long
 Emerges at the anterior end of the deep part of the gland
 Crossed by the lingual nerve at the region of anterior border of the hyoglossus
 Opens on the floor of the mouth, on the summit of the sublingual papilla, at
the side of tongue frenulum
53

54. Blood and Lymph Supply:
 Supplied by the facial artery
 Veins drain into the common facial or lingual vein
 Lymph passes into submandibular lymph nodes
54

55. Nerve Supply:
Submandibular
ganglion:
Secretomotor
fibres
Vasomotor
sympathetic
fibres from
facial artery
plexus
Sensory
fibres from
lingual
nerve
55

56. Submandibular Gland – Clinical Implications:
 The chorda tympani supplying secretomotor fibres to
submandibular and sublingual glands lies medial to the spine of
sphenoid
 The auriculotemporal nerve supplying secretomotor fibres to
parotid is related to the lateral aspect of the sphenoid
 Injury to spine may involve both these nerves with loss of
secretion from all 3 salivary glands
56

57. Submandibular Gland – Clinical Implications:
Chronic
Submandibular
Sialadenitis :
Obstruction
Trauma to floor
of mouth
57

58. Submandibular Gland – Clinical Implications:
 Sialadenitis due to calculi :
 Disease starts with acute bacterial
Sialadenitis which occurs secondary
to obstruction
 Submandibular gland has a poor
capacity for recovery following
obstruction
58

59. Submandibular Gland – Clinical Implications:
 Sialadenitis due to calculi :
 Calculi are more common in the submandibular gland because of the
following reasons
 Higher mucin content
 Higher Calcium and phosphate content
 Non dependent drainage
 Kinking of Wharton’s duct
59

60. Submandibular Gland – Clinical Implications:
 Sialadentis due to calculi :
 Clinical features:
 Salivary colic
 Lingual colic
 H/O Enlargement of glands during meals
 Palpable calculi within the gland, the duct or the orifice
 Progression into severe septic Sialadentis mimicking Ludwig’s
60

61. Submandibular Gland – Clinical Implications:
 Sialadentis due to calculi :
 Treatment:
1. Stone in duct : removed by incising the mucosa over floor of mouth
and/or milking the stone, followed by a gush of blocked contents
2. Chronic Sialadentis : Excision of submandibular gland
 Complications :
 Damage to lingual nerve, marginal mandibular nerve, hypoglossal nerve
 Seroma and infection
61

62. Sublingual Gland :
 Smallest of the 3 salivary glands
 Almond-shaped and weighs 3-4 g
 About 15 ducts emerge from this
gland
 Most open directly onto the floor
of the mouth while some join the
submandibular duct
62

63. Sublingual Gland :
 Blood supply:
 Lingual and submental
arteries
 Nerve supply:
 Similar to submandibular
gland
Relations:
Anteriorly:
Meets with
gland on
opposite side
Posteriorly:
Contacts with
deep part of
Submandibular
Gland
Superiorly:
Mucous
membrane of
the mouth
Inferiorly:
Mylohyoid
muscle
Laterally :
Sublingual fossa
Medially:
Genioglossus
muscles
63

64. Clinical Implications:
 Ranula :
Translucent cystic swelling with a bluish tinge
situated on one side of frenulum linguae
Almost always unilateral
Painless, slow growing ,soft, movable mass
located at the floor of the mouth
When a ranula herniates through the mylohyoid
& extends into the neck so that it can be
palpable in the submandibular triangle, its
called a Plunging Ranula
64

65. Minor Salivary Glands:
 They are located beneath the oral epithelium in almost all parts of the oral
cavity except in the gingiva, ant. Hard palate and ant. 2/3rd of tongue dorsum
 600 – 1000 in number present in small clusters of secretory units
 Classified according to their anatomic location
 Continuous slow secretory activity
 Often supersede the activity of major salivary glands at night
65

66. Minor Salivary Glands:
 Glands of Blandin and Nuhn
 Mostly Located near apex of tongue, some also found posteriorly
 Chiefly mucous
 Anterior glands open on ventral surface near lingual frenum
 Posterior glands open on tongue dorsum
66

67. Minor Salivary Glands:
 Glands of Von ebner
 Located on posterior aspect of
tongue
 Exclusively serous
 Functions:
 Washout of trough papillae
 Readying taste receptors for a new
stimulus
 Antibacterial activity (lysozyme and
peroxidase)
 Lipolytic activity (lingual lipase) with
significant activity in newborn when
pancreatic lipase activity is low 67

68. Clinical Implications :
 Mucocoele :
 Clinical term that describes swelling caused
by accumulation of saliva at the site of a
traumatized or obstructed salivary duct
 Extravasation mucocoeles most commonly
occur on the lower lip,buccal mucosa,
tongue and floor of the mouth
 Retention mucocoeles commonly occur on
the palate
68

69. Clinical Implications:
 Minor Salivary gland tumour :
 They can present either as a mucous
retention cyst or as malignant tumour
 Since they are submucosal, they start as a
submucosal nodule whuch helps them to
differentiate from carcinoma lip/buccal
mucosa etc
 Presence of an ulcer may be a feature of
malignancy
 Treatment of benign cyst/tumour is by
simple excision while malignant tumours
require wide excision
69

70. Physiology of Salivary Secretion
70

71. Physiology of Salivary Secretion :
 Production – 1l/day (0.1 – 4 ml/min) varying from rest to stimulation
Constituents:
Water 94-99.5% Solids – 0.5-6%
Inorganic Organic
Organic
micromolecules
Gases
71

72. Functions of Saliva:
 Lubrication and protection
 Buffering and clearance
 Maintenance of tooth integrity
 Antibacterial activity
 Taste and digestion
 Excretion of certain drugs and inorganic ions
72

73. Mechanism of Salivary Secretion :
 Mechanism of Salivary Secretion:
 Active transport process under
neuronal control
 Osmotic process
73

74. Mechanism of Salivary Secretion :
1. Acinar cells: K, Na and HCO3 ions along with Cl to preserve neutrality
 Primary secretion – Isotonic
 Ductal cells(rich blood supply) –
 Reabsorption of Na ions
 Secretion of HCO3 and K ions
 Final salivary secretion - Hypotonic
74

75. Mechanism of Salivary Secretion :
2. Since saliva is a hypo-osmotic secretion of salivary glands
 Hence, metabolic activity i.e. Oxygen consumption is increased by 5
folds during secretory activity as compared to that at rest
3. At rest, Saliva contains more K ions, less of Na, Cl and Bicarbonate ions
compared to plasma
 However, as salivary flow increases, there is less time for ion exchange
in the ducts, the result being less hypotonic and more isotonic
resembling primary secretion
75

76. Mechanism of Salivary Secretion :
4. Aldosterone increases the K concentration and decreases the Na
concentration of saliva
 Thus, a high salivary Na/K ratio is seen when aldosterone is deficient
76

77. Control of Salivary Secretion :
1. Stimulation of parasympathetic nerves:
 Liberates Kallikrein from the gland cells which acts on plasma globulins to
form bradykinin
 Effect mediated by release of Ach
 Also causes release of Vasoactive Intestinal Polypeptide
 Thus ,the effects being:
 Vasodilatation in salivary glands
 Increased secretion from the acini
77

78. Control of Salivary Secretion :
2. Stimulation of sympathetic nerves:
 Shorter and less strong
 Probable synergistic action
 Causes secretion of small amounts of saliva rich in organic constituents and
mucus from submandibular and sublingual glands
3. Salivary secretion increases either by :
 Taste of food within 20-30 seconds (Innate reflex)
 By sight ,smell or thought of food (Conditioned reflex)
78

79. Factors altering Salivary Flow:
 Unstimulated – Submandibular
 Stimulated – Parotid 2/3rd
 Acidic food – Max stimulation
 Sweet food – Least stimulation
79

80. Factors altering Salivary Flow:
 Psychic factors
 Circadian rhythm
 Diurnal variation
 Age
 Drugs
 Tricyclic antidepressants
 Phenothiazines
 Depression and anxiety states
 Dehydration, hemorrhage
80

81. Factors altering Salivary Flow:
 Salivary Gland diseases
 Radiation sialadenitis
 Autoimmune sialadenitis
 HIV infection
 Iron overload
 Sarcoidosis
 Amyloidosis
 Cystic fibrosis
81

82. Effect of Drugs on Salivary Flow:
 Sympathomimetic drugs like adrenaline and ephedrine stimulate salivary
secretion
 Parasympathomimetic drugs like Ach, pilocarpine, muscarine and physostigmine
increase the secretion of saliva
 Histamine stimulates salivary secretion
 Sympathetic depressants like ergotamine and dipheniramine abolish salivary
secretion
 Parasympathetic depressants like atropine and scopolamine inhibit the
secretion of saliva
 Anaesthetics like chloroform and ether stimulate the reflex secretion of saliva
 However, deep anaesthesia decreases salivary secretion due to central
inhibition
82

83. Factors altering Salivary composition:
 Flow rate
 Source of secretion
 Type of stimulus
 Diurnal variation
 Diet
 Drugs – flow dependant components
 Hormones – mineralocorticoids, ovulation
83

84. Factors altering Salivary composition:
 Disease states
 Sialadenitis
 Radiation damage
 Sjorgen’s syndrome
 Cystic fibrosis
 HTN
 DM
 Alcoholic cirrhosis
 Aldosteronism
 Chronic pancreatitis
84

85. Applied Physiology:
1. Hyposalivation :
 Reduction in salivary secretion
 2 types, temporary and permanent
 Temporary – Emotional conditions like fear, Fever, or Dehydration
 Permanent
 Sialolithiasis
 Congenital absence or hypoplasia of salivary glands
 Bell’s palsy
85

86. Applied Physiology:
2. Xerostomia :
 Dry mouth/Pasties/Cottonmouth
 Due to hyposalivation or aptyalism
 Causes :
1. Dehydration due to Renal failure
2. Sjogren’s syndrome
3. Post Radiotherapy
4. Trauma to gland or ducts
5. Side effect of some drugs
6. Shock
7. After smoking marijuana
86

87. Applied Physiology:
3. Hypersalivation:
 Excess secretion of saliva
 Physiological condition – Pregnancy
 Pathological hypersalivation is called Ptyalism, Sialorrhoea, Sialism or Sialosis
 Occurs in following conditions :
 Tooth decay or neoplasm of mouth or tongue
 Disease of oesophagus, stomach or intestine
 Neurological disorders like cerebral palsy and mental retardation
 Cerebral Stroke
 Parkinsonism
 Nausea and vomiting
87

88. Applied Physiology:
4. Drooling :
 Uncontrolled flow of saliva with inability to retain saliva in the mouth
 Occurs in following conditions :
 During teeth eruption in children
 Upper respiratory tract infection or nasal allergies in children
 Dysphagia
 Tonsillitis
 Peritonsillar abscess
88

89. Applied Physiology:
5. Paralytic secretion of Saliva :
 Iatrogenic/Traumatic severance of parasympathetic nerve supply
 Leads to increase in salivary secretion for 3 weeks, later it diminishes
finally stopping at about 6th week
 The increased secretion of saliva after cutting the PS nerve fibres is
called Paralytic secretion
 It is due to the release of large amounts of adrenaline from adrenal
medulla after denervation
 Cutting of the sympathetic Nerve supply does not influence paralytic
secretion
89

90. Applied Physiology:
6. Augmented Secretion of Saliva:
 If the nerves supplying salivary glands are stimulated twice, the amount
of saliva secreted by the 2nd stimulus is more than due to the 1st stimulus
 It is because, the 1st stimulus increases excitability of acinar cells, so
that when the 2nd stimulus is applied, the salivary secretion is
augmented
90

91. Conclusion:
 Knowledge of anatomy and physiology of salivary glands is
essential to distinctly identify various associated conditions and
salivary gland pathologies
 Precise anatomical knowledge is also essential to plan out our
treatment strategies and alter the patient’s lifestyle for the
better
91

92. References:
 Inderbir Singh; Human Embryology; 10th edition; 96,178
 Moore, Persaud, Torchia ; The Developing Human; 9th edition; 179
 Inderbir Singh; Textbook of Anatomy; 5th edition Volume 3; 781
 B D Chaurasia; Human Anatomy; 6th edition Volume 3; 106-112 , 133-8
 K Sembulingam; Essentials of Medical Physiology; 4th edition; 197-203
 A K Jain ; Textbook of Physiology; 4th edition Volume 1; 201-4
 Antonio Nanci; Tencate’s Oral Histology; 8th edition; 253-71
 G S Kumar; Orban’s Oral Histology and Embryology; 13th edition, 291-306
 Somen Das; A manual on clinical surgery; 8th edition; 359-63
 K Rajgopal Shenoy; Manipal Manual of Surgery; 4th edition; 302-8
 http://www.britannica.com/science/gland
 http://www.ncbi.nlm.nih.gov/pubmed/12904600
 https://shortnotesinplasticsurgery.wordpress.com/2013/12/17/40-surgery-of-the-
parotid-gland/
 http://www.google.com/images 92

93. Thank you and Good
day..
93