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Salivary Gland Disorders Salivary Gland Disorders Bearbeitet von Eugene N Myers, Robert L Ferris 1. Auflage 2007. Buch. xvi, 518 S. Hardcover ISBN 978 3 540 47070 0 Format (B x L): 19,3 x 24,2 cm Gewicht: 1228 g Weitere Fachgebiete > Medizin > Chirurgie Zu Inhaltsverzeichnis schnell und portofrei erhältlich bei Die Online-Fachbuchhandlung beck-shop.de ist spezialisiert auf Fachbücher, insbesondere Recht, Steuern und Wirtschaft. Im Sortiment finden Sie alle Medien (Bücher, Zeitschriften, CDs, eBooks, etc.) aller Verlage. Ergänzt wird das Programm durch Services wie Neuerscheinungsdienst oder Zusammenstellungen von Büchern zu Sonderpreisen. Der Shop führt mehr als 8 Millionen Produkte. Chapter 1 Anatomy, Function, and Evaluation of the Salivary Glands 1 F. Christopher Holsinger and Dana T. Bui Contents Introduction . 2 Physiology of Salivary Glands . 11 Developmental Anatomy . 2 Evaluation of the Salivary Glands . 13 Parotid Gland . 2 History . 13 Anatomy . 2 Physical Examination . 13 Fascia . 3 Radiologic and Endoscopic Examination of the Salivary Glands . 14 Stensen’s Duct . 3 Neural Anatomy . 4 Autonomic Nerve Innervation . 4 Core Features Arterial Supply . 5 Venous Drainage . 6 • Embryology of the salivary glands and their as- Lymphatic Drainage . 6 sociated structures Parapharyngeal Space . 6 • Detailed anatomy of the parotid, submandibular, Submandibular Gland . 6 sublingual, and minor salivary glands, including nervous innervation, arterial supply, and venous Anatomy . 6 and lymphatic drainage Fascia . 6 • Histology and organization of the acini and duct Wharton’s Duct . 7 systems within the salivary glands Neural Anatomy . 7 • Physiology and function of the glands with re- Arterial Supply . 8 spect to the production of saliva Venous Drainage . 8 • Considerations when taking a patient’s history Lymphatic Drainage . 8 Sublingual Gland . 8 • The intra- and extraoral aspects of inspection and palpation during a physical examination Minor Salivary Glands . 9 Histology . 9 2 F. Christopher Holsinger and Dana T. Bui 1 Introduction life and extend posteriorly around the mylohyoid muscle into the submandibular triangle . These buds eventually The human salivary gland system can be divided into two develop into the submandibular glands . A capsule from distinct exocrine groups . The major salivary glands in- the surrounding mesenchyme is fully developed around clude the paired parotid, submandibular, and sublingual the gland by the third gestational month [8] . During the glands . Additionally, the mucosa of the upper aerodiges- ninth embryonic month, the sublingual gland anlage is tive tract is lined by hundreds of small, minor salivary formed from multiple endodermal epithelial buds in the glands . The major function of the salivary glands is to paralingual sulcus of the floor of the mouth . Absence of secrete saliva, which plays a significant role in lubrica- a capsule is due to infiltration of the glands by sublingual tion, digestion, immunity, and the overall maintenance of connective tissue . Intraglandular lymph nodes and ma- homeostasis within the human body . jor ducts also do not generally develop within sublingual glands . Upper respiratory ectoderm gives rise to simple tubuloacinar units . They develop into the minor salivary Developmental Anatomy glands during the 12th intrauterine week [17] . Recent work using murine models has shown the In the last 15 years, significant improvement has been complexity of the underlying molecular events orches- made in our understanding of the molecular basis of trating classical embryological findings . Development salivary gland development, supplanting and expanding of the salivary glands is an example of branching mor- classical teaching in the embryology and developmental phogenesis, a process fundamental to many developing anatomy . organs, including lung, mammary gland, pancreas, and Early work suggests that development of the salivary kidney [12] . Branching organs develop a complex arbo- glands begins during the sixth to eighth embryonic week rization and morphology through a program of repeti- when oral ectodermal outpouchings extend into the ad- tive, self-similar branching forks to create new epithelial jacent mesoderm and serve as the site of origin for major outgrowths . The developmental growth of a multicellular salivary gland growth . The development of major salivary organ such as a salivary gland is based on a set of interde- glands is thought to consist of three main stages [1, 8] . pendent mechanisms and signaling pathways . The result- The first stage is marked by the presence of a primordial ing expression of these pathways is dynamic, organized, anlage (from the German verb anlagen, meaning to lay a and changes correspondingly with each developmental foundation or to prepare) and the formation of branched stage . The sonic hedgehog (Shh) signaling plays an es- duct buds due to repeated epithelial cleft and bud devel- sential role during craniofacial development [13] . Other opment . Ciliated epithelial cells form the lining of the pathways, including the fibroblast growth factor family of lumina, while external surfaces are lined by ectodermal receptors and associated ligands, have also been shown to myoepithelial cells [2] . The early appearance of lobules play a crucial role [28] . and duct canalization occur during the second stage . Primitive acini and distal duct regions, both containing myoepithelial cells, form within the seventh month of Parotid Gland embryonic life . The third stage is marked by maturation of the acini and intercalated ducts, as well as the dimin- Anatomy ishing prominence of interstitial connective tissue . The first of the glands to appear, during the sixth ges- The paired parotid glands are the largest of the major sali- tational week, is the primordial parotid gland . It develops vary glands and weigh, on average, 15–30 g . Located in from the posterior stomodeum, which laterally elongates the preauricular region and along the posterior surface of into solid cords across the developing masseter muscle . the mandible, each parotid gland is divided by the facial The cords then canalize to form ducts, and acini are formed nerve into a superficial lobe and a deep lobe (Fig . 1 .1) . at the distal ends . A capsule formed from the ambient The superficial lobe, overlying the lateral surface of the mesenchyme surrounds the gland and associated lymph masseter, is defined as the part of the gland lateral to the nodes [14] . Small buds appear in the floor of the mouth facial nerve . The deep lobe is medial to the facial nerve lateral to the tongue during the sixth week of embryonic and located between the mastoid process of the temporal Anatomy, Function, and Evaluation Chapter 1 3 Fig. 1.1: The parotid gland and the facial nerve branching bone and the ramus of the mandible . Most benign neo- Fascia plasms are found within the superficial lobe and can be removed by a superficial parotidectomy . Tumors arising The deep cervical fascia continues superiorly to form the in the deep lobe of the parotid gland can grow and extend parotid fascia, which is split into superficial and deep laterally, displacing the overlying superficial lobe with- layers to enclose the parotid gland . The thicker superfi- out direct involvement . These parapharyngeal tumors cial fascia is extended superiorly from the masseter and can grow into “dumbbell-shaped” tumors, because their sternocleidomastoid muscles to the zygomatic arch . The growth is directed through the stylomandibular tunnel deep layer extends to the stylomandibular ligament (or [5] . membrane), which separates the superficial and deep The parotid gland is bounded superiorly by the zygo- lobes of the parotid gland . The stylomandibular ligament matic arch . Inferiorly, the tail of the parotid gland extends is an important surgical landmark when considering the down and abuts the anteromedial margin of the sterno- resection of deep lobe tumors . In fact, stylomandibular cleidomastoid muscle . This tail of the parotid gland ex- tenotomy [22] can be a crucial maneuver in providing tends posteriorly over the superior border of the sterno- exposure for en bloc resections of deep-lobe parotid or cleidomastoid muscle toward the mastoid tip . The deep other parapharyngeal space tumors . The parotid fascia lobe of the parotid lies within the parapharyngeal space forms a dense inelastic capsule and, because it also covers [10] . the masseter muscle deeply, can sometimes be referred to An accessory parotid gland may also be present lying as the parotid masseteric fascia. anteriorly over the masseter muscle between the parotid duct and zygoma . Its ducts empty directly into the parotid duct through one tributary . Accessory glandular tissue is Stensen’s Duct histologically distinct from parotid tissue in that it may contain mucinous acinar cells in addition to the serous The parotid duct, also known as Stensen’s duct, secretes acinar cells [6] . a serous saliva into the vestibule of the oral cavity . From 4 F. Christopher Holsinger and Dana T. Bui 1 the anterior border of the gland, it travels parallel to the terminal branch can be located distally and traced retro- zygoma, approximately 1 cm below it, in an anterior di- grade across the parotid gland to the main trunk of the rection across the masseter muscle . It then turns sharply facial nerve . The facial nerve can also be identified at the to pierce the buccinator muscle and enters the oral cavity stylomastoid foramen by performing a mastoidectomy if opposite the second upper
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