Salivary gland

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.<ref name="Edgar12">Template:Cite book</ref> Salivary glands can be classified as serous, mucous, or seromucous (mixed).

In serous secretions, the main type of protein secreted is alpha-amylase, an enzyme that breaks down starch into maltose and glucose,<ref>Template:Cite book</ref> whereas in mucous secretions, the main protein secreted is mucin, which acts as a lubricant.<ref name=Edgar12/>

In humans, 1200 to 1500 ml of saliva are produced every day.<ref name=":0">Template:Cite journal</ref> 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.<ref name=":0" /><ref>Template:Cite journal</ref>

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.<ref name=tub>Template:Cite news</ref>

Structure

Parotid glands

Template:Main The two parotid glands are major salivary glands wrapped around the mandibular ramus in humans.<ref name="Bialek_2006">Template:Cite journal</ref> These are largest of the salivary glands, secreting saliva to facilitate mastication and swallowing, and amylase to begin the digestion of starches.<ref name = "Nanco_2018">Template:Cite book</ref> It is the serous type of gland which secretes alpha-amylase (also known as ptyalin).<ref name="Holmberg_2014">Template:Cite book</ref> 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.<ref name="Holmberg_2014" /> They produce 25% of the total salivary content in the oral cavity.<ref name = "Nanco_2018" /> Mumps is a viral infection, caused by infection in the parotid gland.<ref name="Hviid_2008">Template:Cite journal</ref>

Submandibular glands

Template:Main 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.<ref name="Bialek_2006" /> The secretion produced is a mixture of both serous fluid and mucus, and enters the oral cavity via the submandibular duct or Wharton duct.<ref name = "Nanco_2018" /> Around 70% of saliva in the oral cavity is produced by the submandibular glands, though they are much smaller than the parotid glands.<ref name = "Nanco_2018" /> 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

Template:Main The sublingual glands are a pair of major salivary glands located inferior to the tongue, anterior to the submandibular glands.<ref name="Bialek_2006" /> The secretion produced is mainly mucous in nature, but it is categorized as a mixed gland.<ref name="Holmberg_2014" /> 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.<ref name="Holmberg_2014" /> About 5% of saliva entering the oral cavity comes from these glands.<ref name = "Nanco_2018" />

Tubarial salivary glands

Template:Expand section Template:Main 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.<ref>Template:Cite journal</ref><ref name=tub/> 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.<ref>Template:Cite journal</ref> The researchers examined the scans and confirmed the glandular tissue through dissection of cadavers, proposing that this structure could constitute a previously unrecognized major salivary gland.<ref>Template:Cite journal</ref> Their findings raised clinical interest, particularly in radiation oncology, as damage to these glands during radiotherapy for head and neck cancers might contribute to xerostomia (dry mouth), even when the known major salivary glands are spared.

Minor salivary glands

Around 800 to 1,000 minor salivary glands are located throughout the oral cavity within the submucosa<ref name="Ten Cate 2008">Template:Cite book</ref> 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.<ref name="Neck 2012, p. 157">Template:Cite book</ref> 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.<ref name="Ten Cate 2008" /> The minor salivary glands are innervated by the facial nerve (cranial nerve CN VII).<ref name="Neck 2012, p. 157"/>

Von Ebner's glands

Template:Main 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.<ref name="Ten Cate 2008" /> 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.

• Parasympathetic innervation to the salivary glands is carried via cranial nerves. The parotid gland receives its parasympathetic input from the glossopharyngeal nerve (CN IX) via the otic ganglion,<ref name="Frommer_1977">Template:Cite journal</ref> while the submandibular and sublingual glands receive their parasympathetic input from the facial nerve (CN VII) via the submandibular ganglion.<ref name="Ishizuka_2010">Template:Cite journal</ref> These nerves release acetylcholine and substance P, which activate the IP3 and DAG pathways respectively.
• Direct sympathetic innervation of the salivary glands takes place via preganglionic nerves in the thoracic segments T1-T3 which synapse in the superior cervical ganglion with postganglionic neurons that release norepinephrine, which is then received by β₁-adrenergic receptors on the acinar and ductal cells of the salivary glands, leading to an increase in cyclic adenosine monophosphate (cAMP) levels and the corresponding increase of saliva secretion. Note that in this regard both parasympathetic and sympathetic stimuli result in an increase in salivary gland secretions,<ref>Template:Cite book</ref> the difference lies on the composition of this saliva, once sympathetic stimulus results particularly in the increase of amylase secretion, which is produced by serous glands. The sympathetic nervous system also affects salivary gland secretions indirectly by innervating the blood vessels that supply the glands, resulting in vasoconstriction through the activation of α₁ adrenergic receptors, lessening the saliva's water content.

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.<ref name="Fehrenbach and Popowics_2026">Template:Cite book</ref><ref>Template:Cite journal</ref>

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).<ref name="Fehrenbach and Popowics_2026" />

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.<ref>Template:Cite web</ref><ref>Template:Cite journal</ref> 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:<ref name=Vissink96>Template:Cite journal</ref><ref name=Kim94>Template:Cite journal</ref>

• Decrease in volume of acinar tissue
• Increase in fibrous tissue
• Increase in adipose tissue
• Ductal hyperplasia and dilation<ref name=Vissink96 />

In addition, changes occur in salivary contents:

• Decrease in concentration of secretory IgE <ref name=Vissink96 />
• Decrease in the amount of mucin

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.<ref>Template:Cite journal</ref> These benefits include:

• Protection: Saliva consists of proteins (for example; mucins) that lubricate and protect both the soft and hard tissues of the oral cavity. Mucins are the principal organic constituents of mucus, the slimy viscoelastic material that coats all mucosal surfaces.<ref name="pmid6801238">Template:Cite journal</ref>

• Buffering: In general, the higher the saliva flow rate, the faster the clearance and the higher the buffer capacity, hence better protection from dental caries. Therefore, people with a slower rate of saliva secretion, combined with a low buffer capacity, have lessened salivary protection against microbes.<ref>Template:Cite web</ref>

• Pellicle formation: Saliva forms a pellicle on the surface of the tooth to prevent wearing. The film contains mucins and proline-rich glycoprotein from the saliva.

The proteins (statherin and proline-rich proteins) within the salivary pellicle inhibit demineralization and promote remineralization by attracting calcium ions.<ref>Template:Cite web</ref>

• Maintenance of tooth integrity: Demineralization occurs when enamel disintegrates due to the presence of acid. When this occurs, the buffering capacity effect of saliva (increases saliva flow rate) inhibits demineralization. Saliva can then begin to promote the remineralization of the tooth by strengthening the enamel with calcium and phosphate minerals.<ref>Template:Cite web</ref>

• Antimicrobial action: Saliva can prevent microbial growth based on the elements it contains. For example, lactoferrin in saliva binds naturally with iron. Since iron is a major component of bacterial cell walls, removal of iron breaks down the cell wall, which in turn breaks down the bacterium. Antimicrobial peptides such as histatins inhibit the growth of Candida albicans and Streptococcus mutans. Salivary immunoglobulin A serves to aggregate oral bacteria such as S. mutans and prevent the formation of dental plaque.<ref>Template:Cite web</ref>

• Tissue repair: Saliva can encourage soft-tissue repair by decreasing clotting time and increasing wound contraction.<ref>Template:Cite journal</ref>

• Digestion: Saliva contains amylase, which hydrolyses starch into glucose, maltose, and dextrin. As a result, saliva allows some digestion to occur before the food reaches the stomach.<ref>Template:Cite web</ref>

• Taste:<ref>Template:Cite book</ref> Saliva acts as a solvent in which solid particles can dissolve and enter the taste buds through oral mucosa located on the tongue. These taste buds are found within foliate and circumvallate papillae, where minor salivary glands secrete saliva.<ref>Template:Cite journal</ref>

Clinical significance

Micrograph of chronic inflammation of the salivary gland sialadenitis)

Template:Main 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.<ref>Template:Cite journal</ref>

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.<ref name=Riley17>Template:Cite journal</ref> Following radiotherapy of the head and neck region, salivary gland dysfunction is a predictable side-effect.<ref name=Riley17 /> Saliva production may be pharmacologically stimulated by sialagogues such as pilocarpine and cevimeline.<ref>Template:Cite journal</ref> It can also be suppressed by so-called antisialagogues such as tricyclic antidepressants, SSRIs, antihypertensives, and polypharmacy.<ref name="VB">Template:Cite book</ref> A Cochrane review found there was no strong evidence that topical therapies are effective in relieving the symptoms of dry mouth.<ref name=Furness11>Template:Cite journal</ref>

Cancer treatments including chemotherapy and radiation therapy may impair salivary flow.<ref name=Furness11 /><ref name=Riley17/> 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.<ref name=Furness11/><ref name=Riley17 /> Surgical removal of benign or malignant lesions may also impair function.<ref>Template:Cite journal</ref>

Graft-versus-host disease after allogeneic bone marrow transplantation may manifest as dry mouth and many small mucoceles.<ref>Template:Cite journal</ref> Salivary gland tumours may occur, including mucoepidermoid carcinoma, a malignant growth.<ref>Template:Cite journal</ref>

Imaging

A sialogram is a radiocontrast study of a salivary duct that may be used to check its function, and for diagnosing Sjögren syndrome.<ref>Template:Cite journal</ref>

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.<ref name="VB"/> 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.<ref>Template:Cite journal</ref>

See also

• Serous demilune
• Sialome

External links

• Salivary gland at the Human Protein Atlas
• Illustration at merck.com Template:Webarchive
• Illustration at .washington.edu Template:Webarchive
• Template:EMedicine
• Medical Encyclopedia Medline Plus: Salivary gland