Transcribed by Albert Cheng Salivary Gland Development and Structure by Dr.

Wishe
2014 SALIVARY GLANDS 3-03.ppt

4/8/14

Slide 10: SEROUS CELL C FIG. 15-5 MUCOUS CELL C FIG. 15-6 4th ED. [Dr. Wishe]has your round circular nucleus, theres your flat nucleus of the mucus. And both cells do have organelles. Slide 11: NANCI TC FIG. 11-33 SALIVARY GLAND ORGANIZATION So theres the general introduction in terms of the types of cells you are going to find associated with the major and the minor salivary glands. Now I like to discuss the functions of the salivary glands. Number 1, theyre going to maintain the integrity, the well being of the oral cavity. And if you have a deficiency in the amount of saliva being produced, youre gonna have problems with lubrication, swallowing, speaking etc. And this you can easily see when you talk to an elderly patient. So saliva provides a fluid environment, which lubrication takes place. You have a medium for swallowing and the food begins to solubilize, which means it begins to break downbecome more liquid and not so solid in nature. The saliva acts as a buffer. Its a buffer to acidity, temperature, or other stresses. And yes when youre eating a slice of pizza, its suppose to bring your temperature down but youre consuming the pizza so quickly that theres not enough time to drop the temperature so you dont burn your palate. But nevertheless, its still a buffer. The pH in terms of the oral cavity is around a 8, when you get to the stomach youre at a 3, and when you get to the small intestine it becomes more of a 8 again. So youre having a swit ch back between different pH environment. The saliva is protective in nature. One type of protection is to lubricate the oral cavity, it sort of gives you a mucus coating and thats your protection. When it comes to bacteria, it causes the bacteria to clump together and once the bacteria clump together, it becomes difficult to adhere to the tooth enamel. The other type of protection is against minor trauma, it acts as a barrier, protection against microbial toxins, resist wear and tear. And lets not forget the protective nature in terms of the presence of bacteria by causing the bacteria to clump together; thats an important function. The process of chemical digestion begins in the oral cavity and here you have your serous cells releasing enzymes, which begins the digestion of carbohydrates. So youll find enzymes like maltase which tends to break down carbohydrates to maltose and then your salivary amylase breaks down your C-12 sugar down to C-6 sugar like glucose. So the process of digestion of carbohydrates has just begun. Then we have the function of taste. Now your taste can distinguish between something that tastes good and things that dont taste good. If it doesnt taste good, you dont eat it. In terms of protection against the growth of mic roorganisms besides the mucus, we have other factors that play an important role. One is lysozyme and from the name you know its an enzyme. And when this enzyme is released by your serous cells, it tends to affect the bacterials membrane permeabilityit messes it up. And eventually leads to the death of the bacteria. Another substance called lactoferrin binds iron. And the significance of this is that certain bacteria require iron to survive and if you remove the iron from the oral cavity, these special groups of bacteria dont make it and die off. So youre really inhibiting bacterial growth again. Then theres another enzyme called lactoperoxidase and this enzyme actually goes into the bacterial cell and modifies bacterial enzymes so that bacterial growth is inhibited. Immunoglobulins have the same effect as mucus does, it causes the bacteria to clump together and then the bacteria are unable to stick to your enamel. Tooth integrity is something one doesnt normally think ofwhen primary dentin formation is co mplete, the tooth has erupted into the oral cavity. You have your clinical crown, the enamel is covering and protecting the tooth but the enamel is not fully mineralized. So what happens later on during the developmental process, the saliva contributes calcium to further mineralized the enamel tissue. Saliva can be used as a monitor just like blood. With regards to blood, the doctor takes a sample of blood, sends it to the lab, and you get a chemical printout of the various things in your blood like glucose, sodium, alkaline phosphatase etc. With the saliva, the problem is that you have to spit into a tube, collect enough saliva, and then thats sent out for analysis. Now you can detect certain things in saliva like if somebody is taking a psychoactive or anti-epileptic drug. You can detect certain environmental agents such as mercury, if youve been exposed to it. So youre able to make some sort of disease diagnosis and maybe itll lead to a treatment plan and prevention just like the blood test. Again youll have a spill over of hormones especially your sex hormones. If you have too much hormones in your

saliva, something is wrong with the system. Lipids are produced and released in your oral cavity. But theres two groups of people: caries-resistant and caries-prone group. Each group has different lipids and concentrations. Caries susceptible group will have more lipids and the concentrations of the lipids will be greater. We already mentioned about the bleeding of the oral tissue, unlike bleeding on the skin, you get the formation of a wet-gelatinous clot which takes place much faster than the dry skin scab formation. But the gel-like clot will continue to ooze for hours or even a day or moreso you do have to be careful with that. We have epidermal growth factors present in saliva and just like in the rest of the body; it promotes healing and shortening clotting time. And then we briefly mentioned yesterday about the salivary glands of other animals such as the dog with the pantingthats the dogs AC system. And finally with the poisonous reptiles, the poison is actually released by the salivary glands. We can classify salivary glands in a number of ways. One is location. Is it in the vestibule or is it in the oral cavity proper? And we saw yesterday when we spoke about the vestibule, you find the labial glands associated with the lips, buccal glands associated with the cheek, your parotid glandthey all release their secretions in the vestibule. The rest of the glands release their secretions into the oral cavity proper such as the glands in the tongue, submandibular gland, sublingual gland, the floor of the mouth etc palate (hard and soft). We can classify glands according to size, major or minor And the major glands are of course your parotid, submandibular, and sublingual glands. The parotid tends to develop first like during weeks 4-6. The submandibular tends to come in during week 6 and the sublingual is the last to develop about weeks 8-12. The smaller minor glands also develop around weeks 8-12. With regards to the major glands, they secrete under some stimulus whether its chemical, thermal, or mechanical it doesnt matter. And all these glands are paired. Theyre divided into lobesthat makes them lobatedtheyre divided into lobules which makes them lobulated and the smallest subunit happens to be the alveoli. So theyre paired, lobated, lobulated alveolar glands. And all the major glands begin to develop as mixed glands, but in the adult the parotid gland is purely serous. The submandibular gland is mixed, mostly serous. The sublingual is mixed but mostly mucus. Thats why I started off with the discussion about serous versus mucus cells. The minor glands tend to continouously secrete. And a lot of the minor glands that you find associated with the tongue are now referred to as von Ebners glands. Thats an example of a minor gland. The diagram that you see on the screen is showing you different types of arrangement of the cells. First of all realize that for the most part, the major glands namely the parotid and submandibular are surrounded by a well-developed connective tissue. The connective tissue enters the glands forming connective tissue septa or trabeculae and the gland is now divided into lobes, lobules, and finally alveoli. And around the alveoli you tend to find these reticular fibers. However, the sublingual gland has a poorly-developed capsule, it doesnt need it because its buried in the floor of the oral cavity. So the connective tissue of the floor of the oral cavity is surrounding that particular gland. [Refer to picture below] When you look at this diagram, this is an example of a serous alveolus. You can see the nuclei are at the base are round and circular in nature. If you look at the apex of these cells, you see these little dots. Those are the serous zymogenic granules. So this structure represents the serous alveolus. The alveolus could consist of all mucus cellswe dont really have that illustrated over here but we have this situation illustrated. And thats where you have mucus alveolus essentially and thats this particular part and then youll notice something sitting on top of it. Like youre wear ing a baseball cap. This is called a serous demilune and these cells are serous cells. This combination of mucus alveoli with serous demilune on top, you have 2 types of secretions released. One the mucin into the lumen and two from the serous cells, the enzymes. They pass into the lumen and eventually into a narrow duct called the intercalated duct illustrated right over here. We will talk about the duct momentarily. A number of intercalated duct come together and they form this larger duct known as your striated, secretory duct. And then the secretory duct from a number of different area join up and form your excretory duct which carries the secretion to the oral cavity. Slide 12: C FIG 15-8 PAROTID GLAND 4th ED. Heres a picture of your parotid gland. What youre seeing is the subdivision into lobules. So for instance, this is a lobulethats another lobule. You can tell there are spaces between lobules. If we had a better section, you would see connective tissue surround each lobule. As you look at each lobule, you see 2 different things. You see these dark cells which are the serous cells and then you see these light cells, you might think theyre mucus cells but theyre actually adipose CT. With the parotid gland as well as with the other major glands, as you get older, the # of secreting cells tend to decrease and you will get the appearance of more adipose cells. This particularly happens within the parotid gland. There are ducts in here and theyre a little hard to see. But here for instance, a longitudinal section through a ductheres a tiny cross section through a duct. The intercalated and secretory ducts tend to be in the lobule proper

surrounded by your serous cells. Whereas you look in this region, this duct is buried in a lot of connective tissue. This duct is more in the excretory grouping. Slide 13: DVD HUMAN PAROTID GLAND Another picture of the human parotid gland. You can tell there is a lot more adipose tissue in this picture than the previous one. This had to come from an older person where the tendency is to have an increase in adipose cells. Any of the dark cells represent your serous cells. Now youre able to see in this particular area, ducts and these are all within the lobules. So the ducts in the lobules are either the intercalated or secretory ducts. And heres a pretty small duct, looks like simple cuboidal epitheliumso that would be an example of intercalated duct Slide 14: NANCI TC FIG. 11-34 PAROTID GLAND 7th ED. Another picture of your parotid gland which does not have that many adipose cells. So you see basically all your serous alveoli and right over here buried/surrounded by the serous alveoli happen to be sections through secretory ducts. Slide 15: DVD HUMAN PAROTID HP Here we have a high power through the parotid gland. And we might as well at this particular point discuss the duct since we have a clear-cut view. So the first duct to receive the salivary secretion happens to be this duct. And you can see a little round structureyou can tell by the round nuclei that theyre really simple cuboidal cellsso thats your example of intercalated ducts lined either by simple squamous or simple cuboidaland theyre generally not too conspicuous. The secretory duct is illustrated right over here. The epithelium tends to be more of a simple columnar type of epithelium. Its pretty conspicuousthey stand out. We cant see it in this picture but if you were to look at the base of these cells, you would see basal striations and I have a picture somewhere along the lines showing that. These basal striations represent accumulations of mitochondria. It is a secretory duct that releases certain products like taking back sodium, getting rid of potassium, in essence youre getting a creation of a buffer by these ducts and this buffer is released into the duct system and combines with the rest of the saliva Slide 16: NANCI TC FIG. 11-33 SALIVARY GLAND ORGANIZATION 7th ED. The excretory ducts are small and they get larger and larger. The main excretory duct of the parotid gland is Stensons duct and it opens into the oral cavity opposite the maxillary molar. You should know the name of the ducts and glands etc. This shows us another cell typethese cells. They sort of look like octopus if you will. Theyre called myoepithelial cells or basket cells. You can find these cells associated with other glands as well. The function of these cells is to squeeze the glands just like the smooth muscle does in the muscularis mucosa. By squeezing the gland, it causes it to release their secretory products whether its mucus or enzyme it doesnt matter. Slide 17: NANCI TC FIG. 11-20 SEM MYOEPITHELIAL CELLS 7th ED. Heres a picture of your myoepithelial cells. As youre looking at the top, these are the basket cells with their leg-like processes. In essence, if any of you saw the first Alien move, the critter attacked one of the astronautscovered his facethe cell had a body and all the processes coming offvery similar to that. Slide 18: NANCI TC FIG 11-19 MYOEPITHELIAL CELL 7th ED. This shows you the myoepithelial cells which have muscle like properties but it is an epithelial cell. So its elongated with processes, centrally placed elongated nucleus. This cell is attached to the secreting cell whether its serous or mucous doesnt matterits attached by desmosomes because as this cell squeezes, you dont want the cells to slide all over the place. So you want the cell anchored and when this cells contract, its pushing cell 1 and cell 2 squeezing them causing them to release their secretions into the lumen of the alveolus. Thats an important cell in terms of secretory products. Slide 19: NANCI TC FIG. 11-6 SALIVARY GLAND DUCT SYSTEM 7th ED. This is a general representation. It shows you alveoli down here, could be mucous/serous doesnt matter. And then the secretions go into your intercalated ducts and eventually a number of your intercalated ducts join up to form your secretory/striated salivary ducts. Why 3 names? Well originally it was called a salivary duct. No one really knew anything about the duct. Later they found that there were mitochondria in the

basebasal striationso they called it striated duct. And then they found out that this cell releases products like bicarbonate ions so its a secretory duct. All of the name do begin with the letter S. And all the secretory ducts get together and form the small excretory duct and finally your main excretory duct. Since were talking about parotid, it happens to be Stensons duct. Keep in mind the parotid gland is the largest of all your glands, but it only produces about 25% of the saliva and in the mature human adult, it strictly enzyme serous zymogenic in nature. Slide 20: C FIG. 15-11 DUCT SYSTEM 4th ED. Heres another picture showing us the duct system. Heres a serous alveolitheres your mucus alveoli with a serous demilune. And again the secretion pass into these intercalated ducts and then finally into your striated secretory ducts. And what youre seeing up here is the main excretory duct opening into the oral cavity Slide 21: TC FIG. 15-26 STRIATED DUCT OLDER ED. Good picture, not colorful but it illustrates the presence of your basal striations. So you look underneath the nucleus region, you see little linesthose are the basal striationsthey represent accumulation of mitochondriacourse to produce a buffer, you do need energy. Slide 22: NANCI TC FIG. 11-29 STRIATED DUCT 7th ED. This just shows us what a cell of the striated duct looks like. It has your usual organelles and nucleus. And again here are the secretory products of the cell and its going to be released in the apex. You have mitochondria giving you energy, in fact a lot of mitochondria. And again all these cells are attached to each other by your desmosomes Slide 23: NANCI TC FIG. 11-26 SUBMANDIBULAR GLAND 7th ED. Now were into the submandibular gland which is your 2 nd major salivary gland in terms of size. Its a mixed gland but mostly serous secretions and if you look at most of these cells, they appear dark probably a little basophilic, that represents the serous cells. Now from this power, its a little difficult to see your mucous cells but if you look right over heretheres some light staining cells. If you look in this region, theres some light staining cellsthose are the mucous cells. Remember 85% of the cells are serous and 15% are mucous in nature. And you can see all sorts of ducts in the lobules. Basically, your intercalated/striated ducts. And here theres a lot of connective tissue outside the lobule and heres where you would find your excretory ducts. Slide 24: TC SUBMANDIBULAR GLAND OLDER ED. Picture of the submandibular gland. You can very easily see the dark-staining serous cells. And there are some fat cells here in this region. In terms of mucous cells, those are lighter staining cells and in some cases you will see a dark-staining capthats your serous demilune. Heres another one. Slide 25: DVD SUBMANDIBULAR GLAND HP Heres a even better picture. The way whoever this was taken fromits evident you have a lot of mucous cells so its not characteristics of the submandibular gland. Heres a mucuos alveolus with its sero us demilune. Just think of it like a baseball cap or French beret sitting on top of the mucous alveolus. So in essence, you have serous alveoli, mucous alveoli, and mucous alveoli with a serous demilune. Thats the 3 organization of this secretory cell. Parotid ONLY has serous alveoli Slide 26: NANCI TC FIG. 11-23 SUBMANDIBULAR GLAND Branching Intercalating Ducts 7th ED. Another picture and what youre seeing basically are the serous cells in your submandibular gland. This area right in here is showing you very nicely your interconnection of intercalated ducts. Slide 27: NANCI TC FIG 11-27 SUBMANDBILAR GLAND Striated Ducts 7th ED. Higher power of your submandibular gland. You know these are serous cells. They look granular, somewhat eosinophilic in nature although they should also be basophilic because theyre active in terms of protein synthesis. Were just focusing on some of the ducts.

Slide 28: TC FIG. 15-30 TYPICAL GLAND OLDER EDITION We saw that 2 times already. I just wanna point out in this picture where we have serous demilune. This part of the cell looks zig zaggy. The enzymes are released between the cells and they flow into the lumen of alveolus. So you have a double release of two separate products Slide 29: TC FIG. 15-22 SUBLINGUAL GLAND OLDER VERSION Now were into the last major gland, the sublingual gland which is mostly mucous. There are no serous alveoli at all. They have mucous alveoli or mucous alveoli capped by serous demilune and then the serous demilunes still make up a minor component. And since youre dealing with mucous alveoli, their lumens are larger in nature. Slide 30: DVD SUBLINGUAL GLAND As you look at this picture, you dont see really dark -staining cells. For the most part, you see mostly lightstaining cells, the mucous cells. There are some ducts within the lobule, but as you read the book and check out the references, the sublingual gland may have NO intercalated ducts or completely reduced in number. It may have NO secretory/striated ducts or completely reduced in number. That means the main duct system of the sublingual gland happens to be the excretory duct Slide 31: C FIG. 15-7 LOCATION OF SALIVARY GLANDS 4th ED. Here again you see the picture of the major salivary gland. [Back to slide 28, refer to picture below] Let me quickly draw you this picture, thats the ventral surface of the tongue. Heres your lingual frenulum. And down here happens to be your sublingual fold or caruncle and thats where your sublingual gland is actually located in the floor of the oral cavity. Thats why it doesnt have a capsule because its covered by the capsule of the floor of the oral cavity. Anyway, on each side of this lingual frenulum, you will find Whartons duct which is the major excretory duct of the submandibular gland. And then next to it, you will find Bartholins duct which is the main duct of the sublingual gland. And then as you look at this area, youre gonna find a whole bunch of little ducts (8 -12) and those are called Rivinian ductsthe minor ducts. It turns out the sublingual gland had a dual origin so thats why we have major and minor glands with ducts sort of like the pancreas having a dual origin. Keep in mind that the amount of saliva can change thats being produced. Bacterial infections can have this. Viruses, herpes, it reduces the production of saliva. Sometimes you get blockage of the ducts. And blockage of Stensons duct is fairly common and then the duct swells up and becomes inflamed. What you have to do is remove the debris thats caught in the duct and then the normal color comes back and the inflammation goes down and the gland functions properly. If you get calcium deposits in the ducts, Dr. Spielman will talk about this, you get the structures called sialoliths. In essence, its an accumulation of calcium organized into stones like gall stones and kidney stones. You can get cyst forming and lets not forget xerostomia and this is a side effect of age to some extent but its really a side effect of different medications youre taking. And I mentioned anti histamine yesterday and youre not sick or anything, you cant breathe, youre taking the anti -histamine to unclog your nasal passages but it has the effect of drying out the oral cavity. If you breathe through the mouth, it gets dried out. Diabetes has an effect on the gland, it decreases secretions from the gland. As a result, you have increase plaque formation. Pro blems with the adrenal glandsadrenal diseaseremember the adrenal glands which we havent really discussed is involved with metabolism of proteins, carbs, and fats. So when you have adrenal disease, youre going to also alter the electrolytes that are in the body. Sjorens syndrome is another condition youll hear a lot of. In essence, you have an invasion of your lymphocytes, destruction of the epithelial cells etc. Xerostomia, this was caused by the reduction in the amount of saliva and way back when in the tropical jungle, the natives use to chew on this plant called pilocarpine when its hot out and the pilocarpine gave them an increase in saliva keeping their oral cavity moist. So one of the items that could be given to a patient is pilocarpine. Its al so used for heart conditions etc but it stimulates your salivary glands to produce more saliva. Keep in mind if youre getting cancer treatment/chemotherapy, youre gonna have a decrease in salivary function as well as everything else. And when they give you these types of treatment with special X-rays, they try sparing techniques so they dont destroy the whole salivary glands. [Back to slide 31] This is really the last slide. Again, we started off with this slide. But for todays conclusions

Slide 32: But for todays conclusions we haveit shows you the position of the tonsils. Theres the body of the tongueposterior 1/3 or root of the tongue. Theres your lingual tonsils. And between your two arches which you can see when you look in the mirror, the palatine tonsils. Then higher up are the pharyngeal tonsils. In essence, the presence of these 3 tonsils make up the ring of Waldeyer which is protective in nature for you.