Applied Basic Science

Saliva has an important role in starting the digestive process. It is also involved in maintaining good dental and periodontal health. It is produced by a series of glands in the mouth and pharynx. The major salivary glands are the parotid, submandibular and sublingual glands (Figure 35.1). The facial nerve runs through the parotid gland and is at risk in parotid surgery. Minor salivary glands are scattered throughout the mouth, tongue and soft and hard palates. Salivary enzymes, mainly amylase, are produced. The parotid gland produces saliva which leaves the gland by the parotid duct (also known as Stensen’s duct) to enter the mouth opposite the second molar tooth. The duct forms a small papilla in the buccal mucosa through which saliva can be seen to pass when the mouth is inspected while massaging the gland. The submandibular gland secretes saliva through the submandibular duct (Wharton’s duct) under the tongue on either side of the sublingual frenulum (see Figure 26.1b). The sublingual ducts secrete saliva through smaller individual ducts in the floor of the mouth (up to 20) and via the Wharton’s ducts.

Examination and Investigations

For examination of the neck see Chapter 28. Salivary gland pathology will often present with enlargement of one or more glands. The differential diagnosis includes other causes of neck swellings such as enlarged lymph nodes. When testing for enlargement of the submandibular gland it is useful to put your finger in the patient’s mouth and see if you can feel the enlarged submandibular gland against another finger placed just under the mandible (bimanual palpation). Submandibular stones can also be felt in this way. Bimanual palpation can also be used to palpate the parotid papilla and duct for stones and masses in the anterior part of the parotid gland. No examination of the parotid glands is complete without evaluation of the facial nerve function by examining the muscles of facial expression.

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