The salivary glands pdf - Head and Neck

630

CHAPTER 11

The Head and Neck

Muscles of the Soft Palate

T A B L E 1 1 . 9

Tenses soft palate

Tensor veli palatini

Muscle

Origin

Insertion

Nerve Supply

Action

Spine of sphenoid,

auditory tube

With muscle of other

side, forms palatine

aponeurosis

Nerve to medial pterygoid

from mandibular nerve

Levator veli palatini

Petrous part of temporal

bone, auditory tube

Palatine aponeurosis

Pharyngeal plexus

Raises soft palate

Palatoglossus

Palatine aponeurosis

Side of tongue

Pharyngeal plexus

Pulls root of tongue

upward and backward,

narrows oropharyngeal

isthmus

Palatopharyngeus

Palatine aponeurosis

Posterior border of

thyroid cartilage

Pharyngeal plexus

Elevates wall of pharynx,

pulls palatopharyngeal

folds medially

Musculus uvulae

Posterior border of hard

palate

Mucous membrane of

uvula

Pharyngeal plexus

Elevates uvula

communication

between nasal

and mouth

cavities

palatal process

of maxilla

superior concha

middle
concha

inferior
concha

tongue

nasal

cavity

palatal process

of maxilla

mouth

cavity

nasal
cavity

mouth
cavity

primary

palate

palatal
processes
of the
maxilla

nasal septum

primary

palate

primary palate

formation of

secondary palate

incisive

foramen

future

hard

palate

soft
palate

uvula

nasal septum

FIGURE 11.82

molar tooth (Fig. 11.72).

the mouth upon a small papilla opposite the upper second

the lateral surface of the masseter. It enters the vestibule of

the anterior border of the gland and passes forward over

The parotid duct emerges from

deep lobes.

superficial

mastoid muscle. The facial nerve divides the gland into

mandible (Fig. 11.85), and in front of the sternocleido

the external auditory meatus, behind the ramus of the

posed mostly of serous acini. It lies in a deep hollow below

The parotid gland is the largest salivary gland and is com

The different stages in the formation

The formation of the palate and the nasal septum (coronal section). B.

of the palate.

The Salivary Glands

Parotid Gland

and

Basic Anatomy

631

FIGURE 11.83

Different forms of cleft palate: cleft uvula

bilateral cleft lip and jaw

, total bilateral cleft palate and cleft lip

cleft lip

, total unilateral cleft palate and

cleft soft and hard palate

(A),

(B)

(C)

(D), and

(E).

FIGURE 11.84

Cleft hard and soft palate. (Courtesy of R.

glion, and the auriculotemporal nerve.

tympanic branch, the lesser petrosal nerve, the otic gan

sopharyngeal nerve. The nerves reach the gland via the

Parasympathetic secretomotor supply arises from the glos

Nerve Supply

Chase.)

across the masseter about a fingerbreadth below the zygo

Parotid Duct Injury

The parotid duct, which is a comparatively superficial struc-

ture on the face, may be damaged in injuries to the face or

may be inadvertently cut during surgical operations on the

face. The duct is about 2 in. (5 cm) long and passes forward

matic arch. It then pierces the buccinator muscle to enter the

mouth opposite the upper second molar tooth.

C L I N I C A L N O T E S

facial skin. By this means, a stimulus intended for saliva

Eventually, these fibers reach the sweat glands in the

out and join the distal end of the great auricular nerve.

secretomotor fibers in the auriculotemporal nerve grow

nerves. During the process of healing, the parasympathetic

by damage to the auriculotemporal and great auricular

on the skin covering the parotid. This condition is caused

gland. When the patient eats, beads of perspiration appear

times develops after penetrating wounds of the parotid

usually highly invasive and quickly involves the facial nerve,

Parotid Salivary Gland and Lesions of the Facial

Nerve

The parotid salivary gland consists essentially of superficial

and deep parts, and the important facial nerve lies in the inter-

val between these parts. A benign parotid neoplasm rarely, if

ever, causes facial palsy. A malignant tumor of the parotid is

causing unilateral facial paralysis.

Parotid Gland Infections

The parotid gland may become acutely inflamed as a result of

retrograde bacterial infection from the mouth via the parotid

duct. The gland may also become infected via the blood-

stream, as in mumps. In both cases, the gland is swollen; it is

painful because the fascial capsule derived from the invest-

ing layer of deep cervical fascia is strong and limits the swell-

ing of the gland. The swollen glenoid process, which extends

medially behind the temporomandibular joint, is responsible

for the pain experienced in acute parotitis when eating.

Frey’s Syndrome

Frey’s syndrome is an interesting complication that some-

production produces sweat secretion instead.

C L I N I C A L N O T E S

Submandibular Gland

of the mouth on the side of the tongue. The submandibular

deep part of the gland lies beneath the mucous membrane

superficial and deep parts by the mylohyoid muscle. The

body of the mandible (Fig. 11.86) and is divided into

and mucous acini. It lies beneath the lower border of the

The submandibular gland consists of a mixture of serous

632

CHAPTER 11

The Head and Neck

superficial

temporal vein

posterior

auricular vein

external jugular vein

angle of mandible

sternocleidomastoid

masseter

buccinator

orbicularis oris

parotid duct

accessory part of

parotid gland

zygomatic arch

temporalis

superior constrictor of pharynx

carotid sheath

internal jugular vein

glossopharyngeal nerve

accessory nerve

hypoglossal nerve

stylopharyngeus

styloid process

stylohyoid

posterior auricular artery

posterior belly

of digastric

mastoid process

skin

facial nerve

sternocleidomastoid

parotid lymph nodes

great auricular nerve

superficial part of parotid gland

deep part of parotid gland

masseter

ramus of mandible

formation of
retromandibular vein

medial pterygoid

division of external

carotid artery

stylomandibular ligament

fibrous capsule

fascial capsule

auriculotemporal nerve

styloglossus

internal carotid artery

vagus nerve

parotid gland

FIGURE 11.85

Parotid gland and its relations.

Horizontal

Lateral surface of the gland and the course of the parotid duct.

section of the parotid gland.

Basic Anatomy

633

super ficial part of submandibular gland

deep part of submandibular gland

tongue

submandibular duct

opening of submandibular duct

central incisor tooth

sublingual gland

mylohyoid

body of mandible

anterior belly of digastric

hyoid bone

fibrous band

posterior belly of digastric

stylohyoid

mouth cavity

styloglossus

vestibule

buccinator

inferior alveolar nerve

muscles of tongue

fibrous septum

genioglossus

geniohyoid

mylohyoid

anterior belly of digastric

submandibular duct

sublingual gland

mylohyoid

deep part of submandibular gland

FIGURE 11.86

gland.

ganglion. The postganglionic fibers pass directly to the

nerve via the chorda tympani, and the submandibular

Parasympathetic secretomotor supply is from the facial

Nerve Supply

(Fig. 11.72).

which is situated at the side of the frenulum of the tongue

of the mouth. It opens into the mouth on a small papilla,

gland and runs forward beneath the mucous membrane

duct emerges from the anterior end of the deep part of the

the ducts of the submandibular salivary glands.

Coronal section (anterior to B) through the sublingual salivary glands and

deep parts of the submandibular salivary glands.

lateral view

Submandibular and sublingual salivary glands (

). B. Coronal section through the superficial and

Submandibular Salivary Gland: Calculus Formation

the condition. Examination of the floor of the mouth will reveal

is reduced in size or absent between meals, is diagnostic of

the mandible, which is greatest before or during a meal and

glands. The presence of a tense swelling below the body of

culus formation. This condition is rare in the other salivary

The submandibular salivary gland is a common site of cal-

C L I N I C A L N O T E S

(continued)

634

CHAPTER 11

The Head and Neck

Sublingual Gland

glion. Postganglionic fibers pass directly to the gland.

nerve via the chorda tympani, and the submandibular gan

Parasympathetic secretomotor supply is from the facial

Nerve Supply

summit of the sublingual fold (Fig. 11.72).

(8 to 20 in number) open into the mouth on the

gual ducts

sublin

mucous acini, with the latter predominating. The

frenulum of the tongue (Fig. 11.86). It has both serous and

(sublingual fold) of the floor of the mouth, close to the

The sublingual gland lies beneath the mucous membrane

nasal part
of pharynx

oral part of
pharynx

laryngeal part of
pharynx

FIGURE 11.87

Sagittal section through the nose, mouth,

(Fig. 11.89).

tubal elevation

ridge of which is called the

the elevated

auditory tube,

lateral wall is the opening of the

the soft palate and the posterior pharyngeal wall. On the

The pharyngeal isthmus is the opening in the floor between

(Fig. 11.89).

pharyngeal tonsil

lymphoid tissue called the

(Fig. 11.87). In the submucosa of the roof is a collection of

This lies above the soft palate and behind the nasal cavities

the oral pharynx, and the laryngeal pharynx.

The pharynx is divided into three parts: the nasal pharynx,

Table 11.10.

and actions of the pharyngeal muscles are summarized in

The details of the origins, insertions, nerve supply,

sphincteric part, the cricopharyngeus.

propulsive part of the inferior constrictor and the lower

area on the posterior pharyngeal wall between the upper

Killian’s dehiscence

pharynx and act as a sphincter.

horizontally around the lowest and narrowest part of the

(Fig. 11.88). The fibers of the cricopharyngeus pass

muscle

cricopharyngeus

from the cricoid cartilage, is called the

The lower part of the inferior constrictor, which arises

outside the lower part of the middle constrictor (Fig. 11.88).

of the superior constrictor and the inferior constrictor lies

the middle constrictor lies on the outside of the lower part

The three constrictor muscles overlap each other so that

of the occipital bone of the skull down to the esophagus.

extends from the pharyngeal tubercle on the basilar part

yngeal wall to be inserted into a fibrous band or raphe that

The three constrictor muscles extend around the phar

direction.

whose fibers run in a somewhat longitudinal

geus muscles,

salpingopharyn

stylopharyngeus

direction, and the

pharynx, and larynx to show the subdivisions of the pharynx.

and

is the

Interior of the Pharynx

Nasal Pharynx

Sublingual Salivary Gland and Cyst Formation

The sublingual salivary gland, which lies beneath the sub-

lingual fold of the floor of the mouth, opens into the mouth

by numerous small ducts. Blockage of one of these ducts is

believed to be the cause of cysts under the tongue.

C L I N I C A L N O T E S

absence of ejection of saliva from the orifice of the duct of the

superior, middle, and inferior constrictor muscles

The muscles in the wall of the pharynx consist of the

brane is also continuous with that of the tympanic cavity.

larynx. By means of the auditory tube, the mucous mem

(choanae), the opening into the mouth, and the inlet of the

Here, it is replaced by the posterior openings into the nose

musculomembranous wall, which is deficient anteriorly.

gus opposite the 6th cervical vertebra. The pharynx has a

lower, narrow end becoming continuous with the esopha

shaped, its upper, wider end lying under the skull and its

The pharynx is funnel

laryngeal parts.

nasal, oral,

mouth, and the larynx (Fig. 11.87) and may be divided into

The pharynx is situated behind the nasal cavities, the

a result of a pathologic condition of the scalp, face, maxillary

affected gland. Frequently, the stone can be palpated in the

duct, which lies below the mucous membrane of the floor of

the mouth.

Enlargement of the Submandibular Lymph Nodes

and Swelling of the Submandibular Salivary Gland

The submandibular lymph nodes are commonly enlarged as

sinus, or mouth cavity. One of the most common causes of

painful enlargement of these nodes is acute infection of the

teeth. Enlargement of these nodes should not be confused

with pathologic swelling of the submandibular salivary gland.

The Pharynx

and

Muscles of the Pharynx

(Fig.

fibers run in a somewhat circular

11.80A), whose