From Big Medical Encyclopedia

SIALADENS [glandulae oris (PNA, JNA, BNA); synonym: glands of a mouth, T.] — the digestive glands allocating the specific secret which is a part of saliva in an oral cavity. Distinguish big — parotid, submaxillary, hypoglossal ii small sialadens — buccal, molar, gubnyyu, lingual a hard and soft palate (fig. 1).

Fig. 1. Diagrammatic representation of localization of the main sialadens of the person: 1 — molar glands; 2 — buccal glands: 3 — lip glands; 4 — front lingual gland; 5 — hypoglossal gland; 6 — submaxillary gland; 7 — a parotid gland; 8 — an additional parotid gland.

The comparative anatomy and embryology

At the animals living in water, gland of a mouth are developed poorly and presented by the simple pieces of iron producing slime. At land animals due to the need of moistening of a mucous membrane of a mouth of N of wetting of food of Page. are more developed. Amphibians have mucous lip, palatal, lingual and intermaxillary glands. Reptiles, besides, have hypoglossal glands, at birds hypoglossal and so-called angular glands are well developed. At mammals (except cetacea) in addition to numerous small Pages. there are big Pages., located outside an oral cavity.

In an embryogenesis of the person all glands of a mouth result from growing of cellular elements мно^ a gosloyny flat epithelium of a mucous membrane in the subject mesenchyma. Small Pages. develop from 3rd month of embryonic development, by 5th month output channels form, glands begin to function. Big Pages. develop from epithelial tyazhy, growing into the subject mesenchyma, to-rye in the course of growth share and form the branching channels and trailer departments. Laying of a parotid gland occurs on the 6th week, submaxillary — at the end of the 6th week of embryonic development. On 7 — several laying of hypoglossal glands appears 8th week, from to-rykh independent pieces of iron are formed; their trailer departments combine the general capsule and open in an oral cavity 10 — 12 separate openings.

Topography, anatomy

Depending on localization and the place of a confluence of output channels of Page. oral cavities are divided into glands of a threshold of an oral cavity and gland actually. Treat the first group molar (gll. molares), buccal (gll. buccales) and lip (gll. labia-les) glands, and also parotid gland (see), an output channel the cut opens in a threshold of an oral cavity on a mucous membrane of a cheek at the level of an upper second big molar. Submaxillary and hypoglossal glands, and also glands of language (gll. linguales), hard and soft palate (gll. palatinae) belong to glands actually of an oral cavity.

Big Pages. represent the lobular educations which are easily probed from a mucous membrane of a mouth (see. Parotid gland , Submaxillary gland , Hypoglossal gland ).

Small Pages. have diameter of 1 — 5 mm and are located with groups in a submucosa of a mouth (see. Roth, oral cavity ). The greatest number of small Pages. is located in a submucosa of lips, a hard and soft palate. Distinguish from small sialadens of language: Ebner's glands — branched tubular glands, channels to-rykh open in trenches of zhelobovaty nipples and between leaflike nipples of language; glands, channels to-rykh open in crypts of a lingual almond, and also front lingual gland (gl. lingualis ant.), representing accumulation of the pieces of iron opening 3 — 4 output channels on a lower surface of language and under it (a nunova of gland).


Page. represent the branched glands consisting from trailer, or secretory, departments and output channels. Each gland is covered with the connective tissue capsule with the layers of connecting fabric departing from it in body, in to-rykh there pass blood vessels and nerves. These layers divide gland into shares and segments, the basis to-rykh is formed by the branchings of a small output (intra lobular) channel passing into trailer (secretory) departments. Trailer departments of Page. consist of ferruterous, secretory cells (glandulotsit) and myoepithelial cells (myoepitheliocytes) located knaruzh from them. In glandulotsita there is a formation of a secret. On character of the allocated secret distinguish proteinaceous, or serous (a parotid gland and Ebner's glands), mucous (e.g., palatal glands) and mixed (submaxillary, hypoglossal, buccal, a lobby lingual, lip) glands. On the mechanism of department of a secret sialadens belong to merokrinovy (see. Glands ).

Glandulotsita have conical shape with the pointed top and the expanded basis. Electronic microscopic examinations (see the Submicroscopy) showed that on side and basal surfaces of glandulotsit the plasmolemma forms ledges, folds and embolies in cytoplasm. Side surfaces have desmosomes (see) and the closing plates providing communication between cells. At apical edges microvillis, quantity vyyae-lyatsya to-rykh increases with increase in secretory activity of gland. In cytoplasm there are well developed endoplasmic reticulum (see), ribosomes (see) and Golgi's complex (see Golgi a complex).

Trailer departments of proteinaceous (serous) Pages. are formed a tonsil-lotsitami of a conical or pyramidal shape with basphilic cytoplasm and roundish kernels — so-called serotsitami-(serocytus). Between serotsita the thin, not having own walls, intercellular secretory tubules which are continuation of a cavity of trailer departments are located.

Trailer departments of mucous Pages. are formed by the glandulotsita having very light, badly painted cytoplasm with numerous vacuoles and a dark kernel — so-called mukotsita (mucocytus. The secret in mukotsita is formed in the form of granules of mucinogen, to-rye merge in the large drop of slime occupying an apical part of a cell, kernels at the same time are displaced to the basis of a cell and flattened.

Fig. 2. The diagrammatic representation of the mixed sialaden: 1 - proteinaceous trailer departments; 2 — the mixed trailer department; 3 — a polulunpa from proteinaceous secretory cells (a serous semilunum); 4 — mucous trailer department; 5 — an inserted channel; 6 — an ischerchenny channel.

In the mixed glands along with purely proteinaceous trailer departments there are mixed departments, both mucous, and proteinaceous cells are a part to-rykh. At the same time the central part of the mixed department is occupied by large light mukotsita, and more dark serotsita lie on the periphery of trailer department in the form of a semilunum — a so-called serous semilunum, or a semilunum of Dzhanuzzi — semilima serosa (fig. 2).

Myoepithelial cells (myoepitheliocytes) are located on a basal membrane of Page. knaruzh from glandulotsit, covering them the cytoplasmatic shoots, reduction to-rykh promotes removal of a secret from trailer departments and its advance along channels. Trailer departments pass into inserted channels (ductus intercalati) covered by a low cubic or flat epithelium. They are well developed in a parotid gland, shorter in submaxillary gland and almost completely are absent in hypoglossal. Inserted channels pass into ischerchenny canals (ductus striati), or Pflyuger's tubes covered by a high cubic epithelium, cytoplasm to-rogo has characteristic striation. Electronic microscopic examination allows to reveal two types of cells here: dark and light (more numerous). Attribute to Ischerchenny channels functions of removal of a secret and participation in processes of its concentration. There are data that cells of ischerchenny channels take part in production of gormonopodobny substances, in particular insulinopodobny protein. In mucous glands of ischerchenny channels is not present. Vnut-ridolkovy output channels proceed in interlobular, covered by a double-row epithelium, to-rye, merging, form the general output channel covered in final department by a multilayer flat epithelium.

Blood supply of Page. carry out branches of outside carotid arteries (see), flows blood in system of outside and internal jugular veins (see). Feature of circulatory system of Page. existence of a numerous arteriolovenulyar-ny and arteriovenous anastomosis is, on the Crimea blood from arteries and arterioles gets into veins and venules, passing a capillary bed that promotes redistribution of blood in iron.

The lymph flows in mental, submaxillary and deep cervical limf. nodes.

A parasympathetic innervation carry out an upper slyunootdelitelny kernel front and the lower slyunootdelitelny kernel glossopalatine nerves, a sympathetic innervation — an outside sleepy texture, branches of an upper cervical node of a sympathetic trunk take part in formation to-rogo.


Page. allocate in an oral cavity through system of output channels the secret containing digestive enzymes: amylase, proteinase, a lipase, etc. (see. Salivation ). Secret of all Pages., mixed in an oral cavity, forms saliva (see), edges are provided by formation of a food lump and the beginning digestion (see). There are data on incretory function of Page. and their bonds with hemadens.

Pathological anatomy

Dystrophic changes in Page. are often combined with disturbance of their functions. Proteinaceous dystrophies (see. Proteinaceous dystrophy ) are characterized by muddy swelling of ferruterous cells (granular dystrophy) and a hyalinosis of intersticial fabric (see. Hyalinosis ). Granular dystrophy of ferruterous cells is observed at sialadenitis (see), cachexias (see), and also at poisoning with the salts of heavy metals (mercury, lead, etc.) which are emitted with saliva and damaging ferruterous cells. The hyalinosis of intersticial fabric leads to a thickening of interlobular partitions, the hyalin can be found in walls of small vessels and in basal membranes of trailer (secretory) departments of Page. At the general amyloidosis (see) in walls of vessels and basal membranes amyloid is occasionally laid. Fatty dystrophy of ferruterous cells (see. Fatty dystrophy) is observed at infectious diseases (diphtheria, tuberculosis) and hron.serdechno-vascular diseases. Lipomatoz of Page. it is expressed in growth between their segments to fatty tissue (see Lipomatoz). Overdevelopment of fatty tissue in the thickness of Page. meets at the general obesity (see) and senile atrophy of Page.

Carbohydrate dystrophies (see) are observed at a diabetes mellitus and are characterized by emergence of inclusions glycogen (see) in cytoplasm of ferruterous cells.

Necrosis of Page. meets seldom and there is a hl. obr. at purulent slept dinites.

Frustration krovo-and lymphokineses in the Village. have no independent value in the overall pathoanatomical picture. They represent only local manifestations of the general circulatory disturbances proceeding in the form of venous hyperemia (see). The arterial hyperemia is observed, as a rule, at local inflammatory processes in the Village. and at disturbance of an innervation. Hemorrhages in the Village. are noted at diseases of blood, injuries and nek-ry inf. diseases (naira., belly and sypny typhus).

Acute nonspecific inflammatory process in the Village. — with the adenitis fell — results from implementation of the activators of a virus pla of a bacterial infection getting into gland through an output channel and also a hematogenous or lymphogenous way. Distinguish a diffusion form of an inflammation of Page. and limited (in the form of abscess). Chronic nonspecific fell down an adenitis can arise initially less often as an outcome of an acute inflammation of Page. At hron. inflammation of Page. decrease in sizes, get a dense consistence. Infiltration of a stroma and parenchyma of glands by lymphoid elements, an atrophy of trailer (secretory) departments and the expressed sclerosis of a stroma is microscopically noted.

Defeat of Page. at tuberculosis it is shown in the form of hemilesion and results for the second time from lympho-and hematogenous dissimination. Development of tuberculosis of Page. begins with defeat regional limf, nodes of gland, in the subsequent its parenchyma and a stroma are involved in process. In the Village. find the miliary hillocks or small small knots which are exposed to a caseous necrosis. Fusion of caseous masses with formation of tubercular abscess is sometimes noted, at Krom there can be fistular courses. At gistol. a research find tubercular hillocks of a usual structure (see Tuberculosis), at fusion of fabric nesnetsifichesky inflammatory changes join.

Defeat of Page. at syphilis meets seldom. Inflammatory changes are found only in the secondary and tertiary periods of a disease and can have diffusion or limited character. At diffusion inflammatory infiltration (most often in the secondary period) Page. is surprised throughout, abscessing and a necrosis of certain sites of gland quite often develops. Limited forms of defeat are characterized by a sclerosis and an atrophy of Page. Histologically in the Village. find the changes corresponding to a picture of a specific inflammation at syphilis (see).

Actinomycosis of Page. can initially develop, as a result of penetration of actinomycetes into gland on the course of channels, or for the second time, at distribution of inflammatory process from surrounding Pages. soft tissues. Primary actinomycosis (see) proceeds slowly, with periodic aggravations. In the Village. dense, limited infiltrate comes to light, to-ry in the subsequent spreads to all gland with formation of multiple abscesses. The secondary actinomycosis has less accurate symptomatology in connection with development of diffusion inflammatory process in surrounding fabrics. Specific inflammatory changes at an actinomycosis of Page. are characterized by development of granulyatsionny fabric with small pustules and the expressed signs of scarring. In inflammatory infiltrate quite often find druses of actinomycetes, to-rye at localization in output channels can be a basis for formation of salivary stones.

From parasitic diseases of Page. extremely seldom cases of an echinococcosis meet. At this Page. are surprised for the second time, and macro - and microscopic changes in them are similar to that at defeat of other bodies (see. Echinococcosis ).

Hypertrophy of Page. is response on patol. the processes proceeding in an organism. Increase in Page. it is observed at endocrine diseases (e.g., at a diffusion toxic craw, a hypothyroidism), cirrhosis and usually results from reactive growth of intersticial fabric that leads to an intersticial sialadenitis. The hypertrophy of intersticial fabric is observed also at Mikulich's syndrome (see. Mikulich syndrome ). In fiziol. conditions hypertrophy of Page. it is noted at pregnancy and in a puerperal period. Sometimes after removal of one of pair glands on the opposite side the vicarious hypertrophy develops.

Atrophy of Page. it is characterized by reduction of their sizes. Atrophic changes are observed at disturbance of an innervation of Page., age involution, and also at difficulty of outflow of a secret of gland with the subsequent atrophy of a parenchyma. Growth of connecting fabric with a thickening of interlobular partitions, reduction of the sizes of glandulotsi-t and emphasized lobation of Page is histologically noted.

Postmortem changes in the Village. come early (in 3 — 4 hours) that is connected with the self-digesting effect of enzymes of saliva. Macroscopically glands get a reddish shade and are softened. At patogistol. a research in ferruterous cells destructive changes while intersticial fabric keeps structure much longer are defined.

Methods of inspection include, except the general methods (poll, survey, a palpation, etc.), such special methods as sounding of channels, a sialometriya (see Salivation), tsitol. a research of a secret, an ultrasonic biolocation (see. Ultrasonic diagnosis), a termovizio-grafiya (see Termografiya), scanning (see), a sialografiya (see), a pan-tomography (see), a pnevmosubman-dibulografiya (see), a tomography computer (see).


Malformations of Page. meet extremely seldom, there are instructions on an allotopia, inborn lack and a hypertrophy of Page. In the absence of all big Pages. develops xerostomia (see).

Damages big Pages. are noted at wound of parotid, submaxillary, hypoglossal areas. The injury can lead to a rupture of a parenchyma and channels of gland. Owing to an injury of Page. there are a defect of a parenchyma, a stenosis and an atresia of an output channel, sialosyrinxes. Treatment is operational, consists in formation of the mouth of a channel at an atresia, plastic closing of a sialosyrinx (see. Sialosyrinxes ). Salivary fistula of a parotid channel after operation often recurs.

Fig. 3. Sialogramma of the left parotid gland at acute abetsediruyushchy parotitis: 1 — the abscess cavity filled with radiopaque substance; 2 — a parotid channel.

Diseases. Most often in the Village. inflammatory processes develop. Distinguish an acute and chronic inflammation. Reason of an acute inflammation of Page. there can be viruses of epidemic parotitis (see Parotitis epidemic), flu (see) or the mixed bacterial flora getting into gland at inf. diseases, after operations, especially on an abdominal cavity, a lymphogenous way or kontaktno from the phlegmonous centers in adjacent areas (see. Parotitis ), and also activators tuberculosis (see), actinomycosis (see), syphilis (see). For an acute inflammation of Page. emergence of a painful swelling in the respective area, disturbance of overall health, fervescence, release of pus from the mouth of a channel, abscessing (fig. 3) is characteristic.

Hron. the inflammation arises against the background of reactive and dystrophic changes of Page. Contagiums are implemented into glands through channels, a lymphogenous or hematogenous way. Hron. inflammation of Page. can proceed with formation of concrements in channels of glands (see. Sialolithiasis ). Main signs hron. inflammations of Page. are a long current patol. process (years) with periodic aggravations, swelling of sialadens and disturbance of secretion of saliva.

Treatment of patients with acute and aggravated hron. inflammation of Page. it is directed to removal of the acute phenomena by means of pharmaceuticals. Opening of abscess in the field of gland is made taking into account anatomic features (see. Parotid gland, Submaxillary gland, Hypoglossal area). Carry out the actions directed to recovery of function of gland. At hron. a sialadenitis the treatment increasing nonspecific resistance of an organism, warning aggravations of process is shown (see Parotitis, the Sialadenitis). Removal of gland is shown at unsuccessfulness of conservative treatment. Treatment of an actinomycosis, tuberculosis and syphilis of Page. carry out by the rules accepted for these infections.

At various patol. processes of the general character: general diseases of connecting fabric, diseases of the digestive device, a nervous system, closed glands, etc., in the Village. reactive and dystrophic processes develop, to-rye are expressed in increase in Page. or disturbance of their function. Treatment of reactive and dystrophic processes in the Village. it is directed to improvement of a trophicity of gland, stimulation of salivation, elimination of a basic disease. At systematic treatment process in the Village. it is stabilized, depression of function of Page is sometimes possible. If necessary carry out antiinflammatory therapy (novocainic blockade of area of gland, Dimexidum, etc.), and also the actions directed to increase in nonspecific resistance of an organism.

Reactive processes in the Village. at pregnancy, a lactation are expressed in swelling of glands, they are reversible and after a certain period pass.

Tumors. Majority of tumors of Page. has an epithelial origin, not epithelial tumors make no more than 2,5% of new growths of Page. Tumors develop preferential in big sialadens: parotid and submaxillary, it is extremely rare in hypoglossal. Small sialadens are surprised approximately in 12% of cases, at the same time tumors can arise in any anatomic part of an oral cavity, but are most often localized on a hard palate, on border of a soft and hard palate, in the field of an alveolar shoot of an upper jaw.

The international histologic WHO classification subdivides tumors of sialadens into 4 groups: epithelial (adenomas, mucoepidermoid tumors, acinous and cellular tumors, carcinomas), not epithelial, not classified tumors, related states (the disease of not tumoral nature clinically similar to a tumor). Distribution of tumors by the kliniko-morphological principle is in practice reasonable. Distinguish benign tumors, among to-rykh allocate epithelial — polymorphic adenoma, or an enclavoma, an adenolymphoma (see), oxyphilic adenoma, other types of adenomas (see Adenoma) and not epithelial — a hemangioma, a lymphangioma, fibroma, a neurinoma, a lipoma, etc.; mestnodestruiruyushchy tumors (acinous and cellular tumor). Distinguish epithelial from malignant tumors — a mucoepidermoid tumor, a cyst-denoidnuyu a carcinoma, or to tsilind-rum, an adenocarcinoma, epidermoid cancer, undifferentiated cancer and not epithelial — sarcoma, a limforetikulyarny tumor, etc.; the malignant tumors which developed in an enclavoma (ozlo-kachestvlenny polymorphic adenoma); secondary (metastatic) tumors.

New growths of Page. occur equally often at men and women, 30 years are aged more senior.

Among high-quality epithelial new growths more than 87% make polymorphic adenomas, or enclavomas (see). Tumors of Page. usually are located in a parenchyma, but can be superficial, sometimes defeat happens bilateral. Klnnicheski the benign tumor represents painless education with a smooth or krupnobugristy surface, a plotnoelastichesky consistence. Benign tumors have the well-marked capsule, only at an enclavoma the capsule on certain sites can be absent, in this case tumoral fabric prilezhit directly to a parenchyma of gland. Usually the tumor is found by the patient when it reaches the sizes 15 — 20 mm. At long existence of a tumor its sizes can be considerable.

From not epithelial tumors of others meet a hemangioma (see) and a lymphangioma more often (see). In most cases they are found already at early children's age in the form of the swelling changing the form and the sizes during the pressing and tension.

The acinous and cellular tumor is observed approximately at 1,6% of patients with tumors of Page., it is localized in a parotid gland, clinically does not differ from benign tumors, signs of infiltrative growth are established only at microscopic examination.

For malignant tumors of Page. pains in the field of gland, infiltration of skin over a tumor, the regional and remote metastasises are characteristic.

Mucoepidermoid tumor (see) it is localized preferential in a parotid gland and S.Zh. Klien makes from 2 to 12% of all tumors, the current in many respects depends on degree of a differentiation of cells. Distinguish well, moderately and м^Гло-дифференцированные tumors. Clinically it is difficult to distinguish well differentiated mucoepidermoid tumor from an enclavoma. The malignant current is observed at a third of patients.

Tsistadenoidny carcinoma, or tsilindroma (see), makes up to 13% of new growths of Page., meets generally in small Pages., is more rare — in big. Allocate three options of a structure of a tumor defining the course of a disease: cribrosa, characterized by rather long current, solid, differing in the rapid progressing current, and mixed, on a clinical current intermediate. A wedge, manifestations of a tsistadenoidny carcinoma in small Pages. are defined by localization of process; in a parotid gland it is shown as an enclavoma or is followed by pains and paralysis of mimic muscles. Unlike other malignant tumors it is characterized preferential hematogenous metastazirovaiiy. Metastasises in regional limf, nodes are observed in 8 — 9% of cases.

Adenokartspnoma, epidermoid and undifferentiated cancer (see) are observed at 12% of patients with tumors of Page., and the adenocarcinoma meets more often others. Two thirds of these tumors arise in parotid and submaxillary glands. Process has the progressing character. The tumor is found as a dense, painless node or infiltrate in iron, without clear boundary. Afterwards there are moderate pains, to-rye then become intensive, irradiating. An early symptom at localization of a tumor in a parotid gland is paralysis of mimic muscles. Infiltration quickly extends to the fabrics and bodies surrounding a tumor, metastasises develop regional, usually on the party of defeat. Innidiation in the remote bodies is observed less than at the cylinder ohm.

Cancer in an enclavoma meets, according to different researchers, to 30% of cases. Than is longer there are enclavomas, that a high probability of their malignancy. In an enclavoma the sites of invasive growth and cellular changes inherent to cancer appear. Develops characteristic for defined gistol. like cancer a wedge, a picture. Since usually tumors have the big sizes, with the begun infiltrative growth they very quickly become inoperable.

Malignant not epithelial tumors of Page. meet seldom, generally in a parotid gland. Clinically they are shown as well as other malignant tumors of Page., but along with it have all properties of similar tumors of other localizations. At a limforetikulyarny tumor of a parotid gland the facial nerve is not involved in process.

In the Village. metastasises of malignant tumors of other localizations, most often a melanoma and a carcinoma cutaneum of the person and the head, bodies of an oral cavity and upper respiratory tracts meet.

Diagnosis of tumors of Page. includes a complex of actions, the purpose to-rykh is definition of character and degree of a zlokachestvennost of process. The presurgical diagnosis is based on data of clinical, cytologic and radiological researches. Results gistol are most reliable. the researches received during the studying of biopsy or operational material.

The treatment of tumors of a parotid gland combined or operational — cm. Parotid gland. The mixed, acinous and cellular tumors of submaxillary gland are subject to operational treatment — removal of gland together with a submaxillary fascial case (see. Submaxillary gland). Other benign tumors of submaxillary gland, and also tumor hypoglossal and small sialadens enukliirut, vascular tumors sometimes subject previously to radiation therapy (see) for the purpose of reduction of their sizes.

Treatment of malignant tumors of Page. combined. The first stage of treatment in the absence of metastasises in regional limf, nodes includes preoperative (for 3 — 4 weeks before operation) a remote gamma therapy on area of primary tumor in a total focal dose 4000 is glad (40 Gr), at the second stage make operation — fascial futlyarnoye excision of cervical cellulose together with a tumor. At widespread tumors and a recurrence the resection of a mandible and excision of fabrics of a mouth floor is shown. At metastasises to the radiation zone it is necessary to include the respective areas of a neck in cervical limf, nodes. Malignant tumors of small Pages., localized in an oral cavity and a Highmore's bosom, it is necessary to treat by the same principle, as cancer of these areas (see. Paranasal sinuses ; Mouth, oral cavity). In the absence of indications to radical operational treatment radiation therapy can be used.

The forecast at benign tumors of Page. favorable. A recurrence after treatment of enclavomas is rare. The forecast at malignant tumors of Page. adverse. A recurrence and metastasises in regional limf, nodes after use of the combined method of treatment arise approximately at 40 — 50% of patients. Five-year survival does not exceed 25%. Results of treatment of malignant tumors of submaxillary gland it is much worse, than a parotid gland.

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G. M. Mogilevsky (stalemate. An.), A. I. Pa-ches, T. D. Tabolshyuvskaya (PMC.), I. F. Ro-macheva (pathology), G. S. Semenov (An., gist., embr.).