Salivary gland

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Salivary gland
Blausen 0780 SalivaryGlands.png
The three main paired salivary glands.
Details
System Digestive system
Identifiers
Latin glandulae salivariae
MeSH D012469
TA98 A05.1.02.002
A05.1.02.013
TA2 2798
FMA 9597 95971, 9597
Anatomical terminology

The salivary glands in many vertebrates including mammals are exocrine glands that produce saliva through a system of ducts. Humans have three paired major salivary glands (parotid, submandibular, and sublingual), as well as hundreds of minor salivary glands. [1] Salivary glands can be classified as serous, mucous, or seromucous (mixed).

Contents

In serous secretions, the main type of protein secreted is alpha-amylase, an enzyme that breaks down starch into maltose and glucose, [2] whereas in mucous secretions, the main protein secreted is mucin, which acts as a lubricant. [1]

In humans, 1200 to 1500 ml of saliva are produced every day. [3] The secretion of saliva (salivation) is mediated by parasympathetic stimulation; acetylcholine is the active neurotransmitter and binds to muscarinic receptors in the glands, leading to increased salivation. [3] [4]

A proposed fourth pair of salivary glands, the tubarial glands, were first identified in 2020. They are named for their location, being positioned in front of and over the torus tubarius. However, this finding from one study is yet to be confirmed. [5]

Structure

Parotid glands

The two parotid glands are major salivary glands wrapped around the mandibular ramus in humans. [6] These are largest of the salivary glands, secreting saliva to facilitate mastication and swallowing, and amylase to begin the digestion of starches. [7] It is the serous type of gland which secretes alpha-amylase (also known as ptyalin). [8] It enters the oral cavity via the parotid duct. The glands are located posterior to the mandibular ramus and anterior to the mastoid process of the temporal bone. They are clinically relevant in dissections of facial nerve branches while exposing the different lobes, since any iatrogenic lesion will result in either loss of action or strength of muscles involved in facial expression. [8] They produce 20% of the total salivary content in the oral cavity. [7] Mumps is a viral infection, caused by infection in the parotid gland. [9]

Submandibular glands

The submandibular glands (previously known as submaxillary glands) are a pair of major salivary glands located beneath the lower jaws, superior to the digastric muscles. [6] The secretion produced is a mixture of both serous fluid and mucus, and enters the oral cavity via the submandibular duct or Wharton duct. [7] Around 70% of saliva in the oral cavity is produced by the submandibular glands, though they are much smaller than the parotid glands. [7] This gland can usually be felt via palpation of the neck, as it is in the superficial cervical region and feels like a rounded ball. It is located about two fingers above the Adam's apple (laryngeal prominence) and about two inches apart under the chin.

Sublingual glands

The sublingual glands are a pair of major salivary glands located inferior to the tongue, anterior to the submandibular glands. [6] The secretion produced is mainly mucous in nature, but it is categorized as a mixed gland. [8] Unlike the other two major glands, the ductal system of the sublingual glands does not have intercalated ducts and usually does not have striated ducts, either, so saliva exits directly from 8-20 excretory ducts known as the Rivinus ducts. [8] About 5% of saliva entering the oral cavity comes from these glands. [7]

Tubarial salivary glands

The tubarial glands are suggested as a fourth pair of salivary glands situated posteriorly in the nasopharynx and nasal cavity, predominantly with mucous glands, and its ducts opening into the dorsolateral pharyngeal wall. The glands were unknown until September 2020, when they were discovered by a group of Dutch scientists using prostate-specific membrane antigen PET-CT. This discovery may explain mouth dryness after radiotherapy despite the avoidance of the three major glands. However, these findings from just one study need to be confirmed. [10] [5] On the other hand, an interdisciplinary group of scientists disagree with this new discovery. They believe that an accumulation of minor salivary glands has been described. [11]

Minor salivary glands

Around 800 to 1,000 minor salivary glands are located throughout the oral cavity within the submucosa [12] of the oral mucosa in the tissue of the buccal, labial, and lingual mucosa, the soft palate, the lateral parts of the hard palate, and the floor of the mouth or between muscle fibers of the tongue. [13] They are 1 to 2 mm in diameter and unlike the major glands, they are not encapsulated by connective tissue, only surrounded by it. The gland has usually a number of acini connected in a tiny lobule. A minor salivary gland may have a common excretory duct with another gland, or may have its own excretory duct. Their secretion is mainly mucous in nature and have many functions such as coating the oral cavity with saliva. Problems with dentures are sometimes associated with minor salivary glands if dry mouth is present. [12] The minor salivary glands are innervated by the facial nerve (cranial nerve CN VII). [13]

Von Ebner's glands

Von Ebner's glands are found in a trough circling the circumvallate papillae on the dorsal surface of the tongue near the terminal sulcus. They secrete a purely serous fluid that begins lipid hydrolysis. They also facilitate the perception of taste through secretion of digestive enzymes and proteins. [12] The arrangement of these glands around the circumvallate papillae provides a continuous flow of fluid over the great number of taste buds lining the sides of the papillae, and is important for dissolving the food particles to be tasted.

Nerve supply

Salivary glands are innervated, either directly or indirectly, by the parasympathetic and sympathetic arms of the autonomic nervous system. Parasympathetic stimulation evokes a copious flow of saliva.

Microanatomy

The gland is internally divided into lobules. Blood vessels and nerves enter the glands at the hilum and gradually branch out into the lobules.

Acini

Secretory cells are found in a group, or acinus. Each acinus is located at the terminal part of the gland connected to the ductal system, with many acini within each lobule of the gland. Each acinus consists of a single layer of cuboidal epithelial cells surrounding a lumen, a central opening where the saliva is deposited after being produced by the secretory cells. The three forms of acini are classified in terms of the type of epithelial cell present and the secretory product being produced - serous, mucoserous, and mucous. [17] [18]

Ducts

In the duct system, the lumina are formed by intercalated ducts, which in turn join to form striated ducts. These drain into ducts situated between the lobes of the gland (called interlobular ducts or secretory ducts). These are found on most major and minor glands (exception may be the sublingual gland). [17]

All of the human salivary glands terminate in the mouth, where the saliva proceeds to aid in digestion. The released saliva is quickly inactivated in the stomach by the acid that is present, but saliva also contains enzymes that are actually activated by stomach acid.

Gene and protein expression

About 20,000 protein-coding genes are expressed in human cells and 60% of these genes are expressed in normal, adult salivary glands. [19] [20] Less than 100 genes are more specifically expressed in the salivary gland. The salivary gland specific genes are mainly genes that encode for secreted proteins and compared to other organs in the human body; the salivary gland has the highest fraction of secreted genes. The heterogeneous family of proline-rich, human salivary glycoproteins, such as PRB1 and PRH1, are salivary gland-specific proteins with highest level of expression. Examples of other specifically expressed proteins include the digestive amylase enzyme AMY1A, the mucin MUC7 and statherin, all of major importance for specific characteristics of saliva.

Aging

Aging of salivary glands shows some structural changes, such as: [21] [22]

In addition, changes occur in salivary contents:

However, no overall change in the amount of saliva secreted is seen.

Function

Salivary glands secrete saliva, which has many benefits for the oral cavity and health in general. The knowledge of normal salivary flow rate (SFR) is extremely important when treating dental patients. [23] These benefits include:

The proteins (statherin and proline-rich proteins) within the salivary pellicle inhibit demineralization and promote remineralization by attracting calcium ions. [26]

Clinical significance

Micrograph of chronic inflammation of the salivary gland sialadenitis) Chronic sialadenitis.jpg
Micrograph of chronic inflammation of the salivary gland sialadenitis)

A sialolithiasis is a salivary stone that may cause blockage of the ducts, most commonly the submandibular ducts, causing pain and swelling of the gland. [33]

Salivary gland dysfunction is either a reduced (hyposalivation), or an increased (hypersalivation) production of saliva. Xerostomia, the symptom of dry mouth is often caused by hyposalivation and is associated with significant impairment of quality of life. [34] Following radiotherapy of the head and neck region, salivary gland dysfunction is a predictable side-effect. [34] Saliva production may be pharmacologically stimulated by sialagogues such as pilocarpine and cevimeline. [35] It can also be suppressed by so-called antisialagogues such as tricyclic antidepressants, SSRIs, antihypertensives, and polypharmacy. [36] A Cochrane review found there was no strong evidence that topical therapies are effective in relieving the symptoms of dry mouth. [37]

Cancer treatments including chemotherapy and radiation therapy may impair salivary flow. [37] [34] Radiotherapy can cause permanent hyposalivation due to injury to the oral mucosa containing the salivary glands, resulting in xerostomia, whereas chemotherapy may cause only temporary salivary impairment. [37] [34] Surgical removal of benign or malignant lesions may also impair function. [38]

Graft-versus-host disease after allogeneic bone marrow transplantation may manifest as dry mouth and many small mucoceles. [39] Salivary gland tumours may occur, including mucoepidermoid carcinoma, a malignant growth. [40]

Imaging

A sialogram is a radiocontrast study of a salivary duct that may be used to check its function, and for diagnosing Sjögren syndrome. [41]

Other animals

The salivary glands of some species are modified to produce proteins; salivary amylase is found in many bird and mammal species (including humans, as noted above). Furthermore, the venom glands of venomous snakes, Gila monsters, and some shrews, are actually modified salivary glands. [36] In other organisms such as insects, salivary glands are often used to produce biologically important proteins such as silk or glues, whilst fly salivary glands contain polytene chromosomes that have been useful in genetic research. [42]

See also

Related Research Articles

<span class="mw-page-title-main">Exocrine gland</span> Gland that secretes substances onto an epithelial surface by way of a duct

Exocrine glands are glands that secrete substances onto an epithelial surface by way of a duct. Examples of exocrine glands include sweat, salivary, mammary, ceruminous, lacrimal, sebaceous, prostate and mucous. Exocrine glands are one of two types of glands in the human body, the other being endocrine glands, which secrete their products directly into the bloodstream. The liver and pancreas are both exocrine and endocrine glands; they are exocrine glands because they secrete products—bile and pancreatic juice—into the gastrointestinal tract through a series of ducts, and endocrine because they secrete other substances directly into the bloodstream. Exocrine sweat glands are part of the integumentary system; they have eccrine and apocrine types.

<span class="mw-page-title-main">Saliva</span> Bodily fluid secreted by salivary glands

Saliva is an extracellular fluid produced and secreted by salivary glands in the mouth. In humans, saliva is around 99% water, plus electrolytes, mucus, white blood cells, epithelial cells, enzymes, and antimicrobial agents.

<span class="mw-page-title-main">Parotid gland</span> Major salivary gland in many animals

The parotid gland is a major salivary gland in many animals. In humans, the two parotid glands are present on either side of the mouth and in front of both ears. They are the largest of the salivary glands. Each parotid is wrapped around the mandibular ramus, and secretes serous saliva through the parotid duct into the mouth, to facilitate mastication and swallowing and to begin the digestion of starches. There are also two other types of salivary glands; they are submandibular and sublingual glands. Sometimes accessory parotid glands are found close to the main parotid glands.

<span class="mw-page-title-main">Submandibular gland</span> Human salivary gland

The paired submandibular glands are major salivary glands located beneath the floor of the mouth. In adult humans, they each weigh about 15 grams and contribute some 60–67% of unstimulated saliva secretion; on stimulation their contribution decreases in proportion as parotid gland secretion rises to 50%. The average length of the normal adult human submandibular salivary gland is approximately 27 mm, while the average width is approximately 14.3 mm.

<span class="mw-page-title-main">Sublingual gland</span> Major salivary glands in the mouth

The sublingual gland is a seromucous polystomatic exocrine gland. Located underneath the oral diaphragm, the sublingual gland is the smallest and most diffuse of the three major salivary glands of the oral cavity, with the other two being the submandibular and parotid. The sublingual gland provides approximately 3-5% of the total salivary volume.

<span class="mw-page-title-main">Digestive enzyme</span> Class of enzymes

Digestive enzymes take part in the chemical process of digestion, which follows the mechanical process of digestion. Food consists of macromolecules of proteins, carbohydrates, and fats that need to be broken down chemically by digestive enzymes in the mouth, stomach, pancreas, and duodenum, before being able to be absorbed into the bloodstream. Initial breakdown is achieved by chewing (mastication) and the use of digestive enzymes of saliva. Once in the stomach further mechanical churning takes place mixing the food with secreted gastric acid. Digestive gastric enzymes take part in some of the chemical process needed for absorption. Most of the enzymatic activity, and hence absorption takes place in the duodenum.

<span class="mw-page-title-main">Xerostomia</span> Medical condition

Xerostomia, also known as dry mouth, is a subjective complaint of dryness in the mouth, which may be associated with a change in the composition of saliva, or reduced salivary flow, or have no identifiable cause.

<span class="mw-page-title-main">Serous gland</span>

Serous glands secrete serous fluid. They contain serous acini, a grouping of serous cells that secrete serous fluid, isotonic with blood plasma, that contains enzymes such as alpha-amylase.

In physiology, serous fluid or serosal fluid is any of various body fluids resembling serum, that are typically pale yellow or transparent and of a benign nature. The fluid fills the inside of body cavities. Serous fluid originates from serous glands, with secretions enriched with proteins and water. Serous fluid may also originate from mixed glands, which contain both mucous and serous cells. A common trait of serous fluids is their role in assisting digestion, excretion, and respiration.

<span class="mw-page-title-main">Ranula</span> Medical condition

A ranula is a mucus extravasation cyst involving a sublingual gland and is a type of mucocele found on the floor of the mouth. Ranulae present as a swelling of connective tissue consisting of collected mucin from a ruptured salivary gland caused by local trauma. If small and asymptomatic further treatment may not be needed, otherwise minor oral surgery may be indicated.

<span class="mw-page-title-main">Submandibular duct</span> Duct in the salivary gland

The submandibular duct is one of the salivary excretory ducts. It is about 5 cm long, and its wall is much thinner than that of the parotid duct. It drains saliva from each bilateral submandibular gland and sublingual gland to the sublingual caruncle in the floor of the mouth.

<span class="mw-page-title-main">Sialadenitis</span> Medical condition

Sialadenitis (sialoadenitis) is inflammation of salivary glands, usually the major ones, the most common being the parotid gland, followed by submandibular and sublingual glands. It should not be confused with sialadenosis (sialosis) which is a non-inflammatory enlargement of the major salivary glands.

<span class="mw-page-title-main">Sialolithiasis</span> Medical condition

Sialolithiasis is a crystallopathy where a calcified mass or sialolith forms within a salivary gland, usually in the duct of the submandibular gland. Less commonly the parotid gland or rarely the sublingual gland or a minor salivary gland may develop salivary stones.

<span class="mw-page-title-main">Serous demilune</span>

Serous demilunes, also known as Crescents of Giannuzzi or Demilunes of Heidenhain, are cellular formations in the shape of a half-moon on the mixed submandibular and sublingual salivary glands.

<span class="mw-page-title-main">Duct (anatomy)</span> Channel leading from a bodily gland or organ

In anatomy and physiology, a duct is a circumscribed channel leading from an exocrine gland or organ.

<span class="mw-page-title-main">STATH</span> Protein-coding gene in humans

Statherin is a protein in humans that is encoded by the STATH gene. It prevents the precipitation of calcium phosphate in saliva, maintaining a high calcium level in saliva available for remineralisation of tooth enamel and high phosphate levels for buffering.

<span class="mw-page-title-main">Carbonic anhydrase VI</span> Enzyme found in humans

Carbonic anhydrase 6 is an enzyme that in humans is encoded by the CA6 gene. It is also called 'gustin' because of its presence in saliva, and lower-than-normal levels of salivary zinc in individuals with hypogeusia.

<span class="mw-page-title-main">Salivary gland disease</span> Medical condition

Salivary gland diseases (SGDs) are multiple and varied in cause. There are three paired major salivary glands in humans: the parotid glands, the submandibular glands, and the sublingual glands. There are also about 800–1,000 minor salivary glands in the mucosa of the mouth. The parotid glands are in front of the ears, one on side, and secrete mostly serous saliva, via the parotid ducts, into the mouth, usually opening roughly opposite the second upper molars. The submandibular gland is medial to the angle of the mandible, and it drains its mixture of serous and mucous saliva via the submandibular duct into the mouth, usually opening in a punctum in the floor of mouth. The sublingual gland is below the tongue, on the floor of the mouth; it drains its mostly mucous saliva into the mouth via about 8–20 ducts, which open along the plica sublingualis, a fold of tissue under the tongue.

<span class="mw-page-title-main">Human digestive system</span> Digestive system in humans

The human digestive system consists of the gastrointestinal tract plus the accessory organs of digestion. Digestion involves the breakdown of food into smaller and smaller components, until they can be absorbed and assimilated into the body. The process of digestion has three stages: the cephalic phase, the gastric phase, and the intestinal phase.

<span class="mw-page-title-main">Salivary microbiome</span> Biological contents of human saliva

The salivary microbiome consists of the nonpathogenic, commensal bacteria present in the healthy human salivary glands. It differs from the oral microbiome which is located in the oral cavity. Oral microorganisms tend to adhere to teeth. The oral microbiome possesses its own characteristic microorganisms found there. Resident microbes of the mouth adhere to the teeth and gums. "[T]here may be important interactions between the saliva microbiome and other microbiomes in the human body, in particular, that of the intestinal tract."

References

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