HYPOGLOSSAL GLAND [glandula sublingualis (PNA, JNA, BNA)] — the pair big sialaden located in hypoglossal area under a mucous membrane of a mouth floor on a diaphragm of a mouth. It is for the first time described in 1679 by A. Rivinus. Is complex tubular gland with mixed, preferential mucous secretion (see).
Anatomy and histology
Item. has the form of the ellipse squeezed from sides. Front expanded end of the Item. there is at the level of a canine, back narrowed — at the level of the 3rd big molar (painter) of a mandible. Projection of the Item. on the surface of a face has the form of an oval. Longitudinal size of the Item. 1,5 — 3,0 cm, cross 0,4 — 1,0 cm, vertical 0,8 — 1,2 cm. Weight (weight) of the Item. the newborn has on average 0,42 g, at adult 5 g of the Item. lies in friable cellulose of a mouth floor (see. Roth, oral cavity ) also has no fascial bed. Its lateral surface borders on a body of the mandible (corpus mandibulae), medial — from hypoglossal and lingual (m. hyoglossus) and podborodochnoyazychny (t. genioglossus) muscles; between gland and both muscles there pass a deep artery and a vein of language (and. et v. profundae linguae), lingual nerve (n. lingualis), branches of a hypoglossal nerve (rami linguales of the item hypoglossi) and submaxillary channel (submandibular channel, T.; ductus submandibularis). Upper edge of the Item. raises a mucous membrane of a mouth floor, forming a hypoglossal fold (plica sublingualis), its bottom edge is included into an interval between maxillary and hypoglossal (m. mylohyoideus) and genioglossal muscles (tsvetn, the tab., Art. 112, fig. 1 and 2).
Item. it is covered with the thin capsule and it is divided into segments by friable connecting fabric. In segments there are tubular trailer departments of three types: mucous, proteinaceous and mixed. Mucous trailer departments consist of mukotsi-comrade. The proteinaceous (serous) trailer departments formed by serotsi-ta are very not numerous. The serotsita forming accumulations in the form of semilunums, so-called semilunums of Dzhanuntsi (fig. 1) enter into structure of the mixed trailer departments, except mukotsit. Channels of front group of segments connect to the big hypoglossal canal (duc tus sublingualis major), or bartholins a channel. This channel for the first time described at animals in 1685. K. Bar-tolin Jr., at the person — in 1698 A. Nuck. The big hypoglossal channel opens on a hypoglossal nipple (caruncula sublingualis) one opening with a submaxillary channel, the certain mouth has seldom. Length of a channel is 0,9 — 2,0 cm, internal to dia. 1,0 — 1,5 mm, gleam of the mouth less than 1 mm. According to S. N. Kasatkin, the big hypoglossal channel is changeable, it meets in 23,5% of cases. From average and back segments of the Item. small hypoglossal channels (ductus sublinguales minores) described in 1724 by A. F. Walther originate. Small channels open on a hypoglossal fold separate openings, the number to-rykh fluctuates from 4 to 30. Existence of a set of channels facilitates removal of a viscous secret of hypoglossal gland.
Blood supply of the Item. it is carried out by hypoglossal and podpodbo-rodochny arteries (aa. sublingualis et submentalis). A venous blood flows in lingual and facial veins (vv. lingualis et facialis). The lymph gathers in submaxillary limf, nodes (nodi lymphatici submandibulares).
Item. has the general sources of an innervation with submaxillary gland. Both glands are supplied with ferruterous branches of a submaxillary node (gangl, submandibulares in structure to-rykh are available sympathetic and parasympathetic fibers. In nek-ry cases on the course of the branches going to the Item., the separate hypoglossal node is formed (gangl, sublinguale). In an innervation of the Item. also the branch of a lingual nerve takes part.
Physiology and biochemistry Item. — see. Sialadens .
Methods of a research
Investigate the Item. by means of a X-ray analysis. In the presence of an independent hypoglossal channel carrying out artificial contrasting of gland is possible (see. Sialografiya ). For the purpose of identification of cystous education or a tumor of the Item. apply diagnostic puncture (see) with the subsequent tsitol, a research of punctate.
Patol, processes in the Item. are similar to those at defeat of other sialadens. On patol, the condition of gland specifies increase in hypoglossal folds, painful at an acute inflammation, painless at chronic, a dense consistence at a tumor and a soft consistence at cysts of the Item.
Damages Item. meet rather seldom. At a gunshot wound they are, as a rule, combined with injuries of bones of a facial skull. Besides, cases of damage of the Item meet. a disk in the course of preparation of teeth of a mandible under crowns, during operation for acute inflammatory processes in hypoglossal area, during removal of a salivary stone (see. Sialolithiasis ) from average or back departments of a submaxillary channel. It is possible to diagnose damage of gland at survey of a wound, in a cut ferruterous fabric is well visible. Patients are disturbed by pain at a conversation, meal. As a result of scarring of a wound outflow of a secret from channels of the Item. it can be broken that leads to emergence of a ranula — a retentsionny cyst (see. Cyst ).
Diseases Item. include reactive and dystrophic processes, an acute and chronic inflammation, cysts, tumors (see. Sialadens ).
Reactive and dystrophic diseases usually are not the isolated defeat of the Item.: they develop at systemic lesion of salivary and lacrimal glands — Mikulich's diseases (see. Mikulich syndrome ), all excretory glands — Shegren's syndrome (see. Shegrena syndrome ), and also at other autoimmune and endocrine diseases (see. Sialadens ). Item. at the same time increases in sizes, it is condensed, decrease in its function is observed further.
Inflammation of the Item. happens acute and chronic. Viruses of epidemic parotitis can be the cause of acute at an atypical current (see. Parotitis epidemic ), flu (see), etc. The disease begins sharply, is followed by fervescence. Gland is increased in sizes, at a palpation is sharply condensed, painful. Hypoglossal folds at the same time are thickened, the mucous membrane of an oral cavity is edematous (fig. 2). These phenomena remain 4 — 5 days, then infiltrate slowly resolves, and the state is normalized. On 2 — the 3rd day of a disease development of abscess is possible. Treatment is conservative, in case of abscess — operational. Hron, inflammation of the Item. it is observed rather seldom, usually happens bilateral and it is combined with defeat of parotid or submaxillary sialadens (see. Parotid gland , Submaxillary gland ). It is clinically shown by a swelling of the Item. In the absence of treatment of iron slowly increases, condensed, becomes hilly (fig. 3). Morbidity appears only at an aggravation of process. Treatment includes the general actions directed to increase in resistance of an organism locally apply novocainic blockade. Besides, treatment of associated diseases is necessary.
The most frequent patol, process in the Item. the retentsionny cyst is, edges arises at disturbance of outflow of a secret from the Item. The cover of a cyst consists of connecting fabric rich with blood vessels, bunches a cut get into connective tissue layers of segments of the Item. In peripheral departments of a cover of a cyst the extended cells like fibroblasts are located, very seldom on an inner surface of a cover are found one — two rows of cells of a cubic or multirow cylindrical epithelium. The first wedge, a symptom of a cyst — emergence of a swelling in hypoglossal area (a painless, soft or resilient-elastic consistence), edges, slowly increasing, can extend to the submaxillary area. During the thinning of a mucous membrane of a mouth floor in hypoglossal area there can come spontaneous opening of a cyst and its emptying. In this case it decreases in sizes or is not defined at all, but later a nek-swarm time (weeks, months) appears and increases again. Treatment of a cyst — operational: carry out vesicotomy (opening of a cyst and emptying) or delete a cyst together with the Item.
For removal of a cyst together with the Item. make a section in hypoglossal area. At allocation of a cyst and gland it is necessary to enter the probe or a catheter into the canal of submaxillary gland in order to avoid its traumatizing. Allocation of the Item. it is necessary to begin with a distal pole. In cases of localization of a part of a cyst below a maxillary and hypoglossal muscle B. D. Kabakov suggested to carry out operation in two stages. At the first stage, after a section of fabrics in submaxillary or submental area allocate a cover of a cyst to the narrowed its part at a maxillary and hypoglossal muscle. This isthmus (narrow part of a cyst) is tied up and crossed. The part of a cyst separated from surrounding fabrics is deleted. The wound is layer-by-layer sewn up, leaving the small graduate. At the second stage open a cyst from a mouth floor, widely excising the mucous membrane of hypoglossal area covering a cyst, and also a cover of a cyst. After that the wall of a cyst is sewed knotty seams with edges of a mucous membrane of hypoglossal area. The cavity of a cyst is tamponed.
See also Sialadens .
Bibliography: Kasatkin S. N. Anatomy of sialadens, Stalingrad, 1948; The Guide to surgical stomatology, under the editorship of A. I. Evdokimov, page 226, M., 1972, bibliogr.; Sazama JI. Diseases of sialadens, the lane from Czeches., Prague, 1971, bibliogr.; Solntsev A. M. and Kolesov V. S. Surgery of sialadens, Kiev, 1979, bibliogr.; Rauch S. Die Speicheldrusen des Menschen, Stuttgart, 1959.
I. F. Romacheva; V. S. Speransky (An., gist.).