Whartons Duct

Floor of the mouth in a submucosal plane. Beneath the mandible, a small motor nerve branches off and travels posteriorly from the lingual nerve to innervate the mylohyoid muscle. These fibers are usually sacrificed during surgical removal of the submandibular gland. Parasympathetic fibers are carried via the lingual nerve to the submandibular ganglion, and postsynaptic fibers exit along the course of the submandibular duct to innervate the gland. The hypoglossal nerve (CN XII) supplies motor...

List of Contributors

University of Pittsburgh Medical Center University of Pittsburgh School of Medicine Co-Director, Head and Neck Cancer Program University of Pittsburgh Cancer Institute Clinical Professor of Otolaryngology Louisiana State University Health Science Center New Orleans, Louisiana Pittsburgh Ear Associates, Allegheny General Hospital 420 East North Avenue, Suite 402 Pittsburgh, PA 15212 USA National and Kapodistrian University Consultant Head and Neck Oncologic Surgeon Department of...

Treatment and Prognosis

The differential diagnosis includes metastatic adeno-carcinoma from the prostate and metastatic ductal carcinoma of the breast. Immunoperoxidase staining for prostate-specific antigen aids in ruling out metastatic prostate carcinoma 38 . It is more difficult to exclude metastatic ductal carcinoma of the breast since, in rare instances, salivary duct carcinoma is positive for estrogen and progesterone receptors. Identifying areas of intra-ductal (in situ) tumor would serve to distinguish...

Clinical Features

Cystadenomas are rare benign cystic salivary tumors that resembles Warthin's tumor, though the clinicopathologic features of this tumor are different. In contrast to War-thin's tumor, there is actually a slight female predilection, and there is no association with smoking 179, 600 . The mean age at presentation is 57 years 80 . The major site of involvement is the parotid gland (45 ), though unlike Warthin's tumor, other cystadenomas can be in sites such as the lip and buccal mucosa 523 ....

Sublingual Gland

The smallest of the major salivary glands is the sublingual gland, weighing 2-4 g. Consisting mainly of mucous aci-nar cells, it lies as a flat structure in a submucosal plane within the anterior floor of the mouth, superior to the my-lohyoid muscle and deep to the sublingual folds opposite the lingual frenulum 11 . Lateral to it are the mandible and genioglossus muscle. There is no true fascial capsule surrounding the gland, which is instead covered by oral mucosa on its superior aspect....

Histology

All glands in general are derived from epithelial cells and consist of parenchyma (the secretory unit and associated ducts) and stroma (the surrounding connective tissue that penetrates and divides the gland into lobules). Secretory products are synthesized intracellularly and subsequently released from secretory granules by various mechanisms. Glands are usually classified into two main groups. Endocrine glands contain no ducts, and the secretory products are released directly into the...

Pathology of Salivary Gland Disease

Introduction Non-neoplastic Diseases Acute Sialadenitis Chronic Non-autoimmune Sialadenitis 37 Autoimmune Sialadenitis Special Considerations Necrotizing Sialometaplasia Subacute Necrotizing Sialadenitis 41 Sialadenosis Adenomatoid Hyperplasia Salivary Duct Cysts Lymphoepithelial Cysts Dysgenetic Polycystic Disease Benign Tumors Pleomorphic Adenoma Basal Cell Adenoma Canalicular Adenoma Myoepithelioma Warthin's Tumor Cystadenomas Lymphadenomas Oncocytoma and Oncocytosis Miscellaneous Rare...

Pathogenesis

Acute sialadenitis may involve any salivary gland, though the major salivary glands, particularly the parotid, are most commonly affected 399, 462 . Causes may be bacterial or viral. This entity typically presents unilaterally with localized erythema, swelling, and tenderness in the affected region. Purulent exudate can often be expressed from the excretory duct orifices. Acute viral sialadenitis, in contrast, Bacterial sialadenitis typically occurs as the result of salivary stasis and...

Physiology of Salivary Glands

Saliva production, the main function of the salivary glands, is crucial in the processes of digestion, lubrication, and protection in the body. Saliva is actively produced in high volumes relative to the mass of the salivary glands, and it is almost completely controlled extrinsically by both the parasympathetic and sympathetic divisions of the autonomic nervous system. Saliva plays a crucial role in the digestion of carbohydrates and fats through two main enzymes. Ptyalin is an a-amylase in...

Pathologic Features

Grossly the tumors are solitary, firm or rubbery, and well circumscribed ranging in size from 0.5 to 13 cm (median 2.5 cm). Recurrent tumors are frequently multiple and may be poorly demarcated. The cut surface var ies from tan to gray and is occasionally cystic 22, 404 . Microscopically multiple growth patterns occur, often within the same tumor. These have been categorized as solid, microcystic, papillary-cystic, and follicular with the solid and microcystic patterns being the most common...

Parotid Gland

The likelihood of a tumor having a certain histology varies with the gland involved. Even the rate of malignancy varies. For instance, a tumor in the submandibular gland is more likely malignant than one identified in the parotid The majority of lesions in the parotid gland are benign. Pleomorphic adenoma is the most frequent benign tumor encountered. Mucoepidermoid carcinoma is the most common malignancy but there are others as described elsewhere in this volume. No finding is considered to be...