11/6/2014 Andrew H. Murr, MD Professor and Chairman Roger Boles, MD Endowed Chair in Otolaryngology Education Department of Otolaryngology- Head and Neck Surgery Salivary Gland and Duct Anatomy UCSF Sialendoscopy/Salivary Duct Surgery Course November 6, 2014 University of California, San Francisco Salivary Gland and Duct Anatomy Function of Salivary Glands • Parotid Gland and Stensen’s Duct • Food digestion • Submandibular Gland and Wharton’s Duct – Lubrication • Sublingual Gland and Duct System – Clearance • Minor Salivary Glands • Tooth protection • Taste • Antimicrobial function 1 11/6/2014 Embryology Duct Ultrastructure Parotid Gland • Ectoderm origin – Surrounded by mesenchyme • 6-8 weeks of life • Originate at duct orifice – Parotid develops around and between facial nerve • Salivary tissue becomes encapsulated –*Parotid encapsulates last: only in parotid- lymphatic system is contained within parotid tissue prior to encapsulation Parotid Gland Parotid Gland • Largest and 1 st to • Tail develop • Accessory parotid • Serous acinar cells – 20% – Purely serous – seromucinous • Parotid fascia • Borders – Lateral Skin – Medial Parapharyngeal space – Superior Zygomatic arch – Posterior EAC – Inferior Styloid/carotid/jugular – Anterior Masseter 2 11/6/2014 Parotid Gland Parotid Gland Hollinshead • Arterial supply • Nerve Supply – External carotid – Parasympathetic • Maxillary • IX- preganglionic • Superficial temporal – LSP (ovale) to otic • Transverse facial ganglion • Postganglionic • Venous drainage – Auriculotemporal – Retromandibular – Sympathetic • Maxillary • Superior cervical ganglion • Superficial temporal – Via external carotid – External jugular plexus – Internal jugular Surgical Nerves Facial Nerve Hollinshead • Facial nerve • Greater Auricular 3 11/6/2014 LSD: Stenosis LSD Classification Marchal, F et al., Salivary stones and stenosis, A comprehensive classification. Rev Stomatol Chir Maxillofac 2008; 109: 233-236 Marchal, F et al., Salivary stones and stenosis, A comprehensive classification. Rev Stomatol Chir Maxillofac 2008; 109: 233-236 • Lithiasis Lithiasis • S0 no stenosis • Stenosis • L0 no stones • S1 diaphragmatic • Dilation • L1 floating stone • S2 Unique (main) • L2 fixed stone totally • S3 Diffuse (main) visible • S4 Generalized – A. <8 mm – B. >8 mm • L3 fixed stone partially visibile – A palpable – B non-palpable LSD: Dilations Marchal, F et al., Salivary stones and stenosis, A comprehensive classification. Rev Stomatol Chir Maxillofac 2008; Stensen’s Duct 109: 233-236 • D0 none • Diameter: 3 mm • D1 unique • Length: 6 cm • D2 multiple • Papilla: .5 mm • Main 1.4 mm • D3 generalized • Primary • Secondary • Tertiary • Terminal 4 11/6/2014 Endoscopic Duct Anatomy Endoscopic Duct Anatomy Main Primary Secondary Tertiary Transillumination Stensen’s Duct • Key points in the duct – Papilla – Buccinator – Masseter – Accessory – Intra-parotid 5 11/6/2014 Stensen’s Duct Kiringoda R, Eisele DW, Chang JL. A comparison of parotid imaging characteristics and sialendoscopic findings in obstructive salivary disorders. Laryngoscope. 2014 Jun 16. doi: 10.1002/lary.24787. [Epub ahead of print] PubMed Papilla PMID: 24932900. Masseter Kiringoda R, Eisele DW, Chang JL. A comparison of parotid imaging Submandibular Gland characteristics and sialendoscopic findings in obstructive salivary disorders. Laryngoscope. 2014 Jun 16. doi: 10.1002/lary.24787. [Epub ahead of print] PubMed PMID: 24932900. 6 11/6/2014 SMG Submandibular Gland • Submandibular triangle • Arterial Supply – Level 1 – Facial artery – Borders: • Mandible • Venous drainage • Digastric – Facial vein • Mylohyoid • Hayes-Martin Maneuver – Superficial lobe » Above mylohyoid • Nerve supply – Deep lobe – Parasympathetic • Seromucinous • VII (nervous intermedius) to Chorda Tympani • Lingual nerve via submandibular ganglion – Sympathetic- superior cervical ganglion Wharton’s Duct Eisele and Chang, Laryngoscope, 2012 • ~ 4 mm • 5 cm in length • Papilla 7 11/6/2014 Papilla [fom] Medial/Below/Above [neck] Combs et al, Int. J of OMFS 2009 Wharton’s Duct Wharton’s Duct Hollinshead 8 11/6/2014 Imaging Sublingual Gland • Unencapsulated • B/t mylohyoid and geniohyoid/genioglossus • Within sublingual space • Mucous secreting • Ducts of Rivinus – 8-10 ducts opening into FOM • Bartholin Duct which joins Wharton’s Duct Sublingual Duct(s) Ranula 9 11/6/2014 OHNS Faculty and Residents Thank you! 10.