SUBMAXILLARY GLAND [glandula submandibularis (PNA, JNA), glandula submaxillaris (BNA), submandibular gland, T.] — a big sialaden, second-large after parotid, located on a neck, under a diaphragm of a mouth, in submaxillary area.
Anatomy and histology
Submaxillary gland — pair body, has the uploshchenno-roundish, ovoid or ellipsoidal form, its length at adult 3,5 — 4,5 cm, width of 1,5 — 2,5 cm, thickness of 1,2 — 2 cm. The weight (weight) of gland at the newborn on average 0,84 g, at adult 10 — 15 g. At advanced age of iron is exposed to a sclerosis and its weight decreases. Item. is located in the niche limited lateralno to a body of the mandible (corpus mandibulae), medially — maxillary and hypoglossal (m. mylohyoideus) and hypoglossal and lingual (m. hyoglossus) with muscles; from below it is covered by skin, hypodermic cellulose, a hypodermic muscle of a neck (platysma) and a superficial plate of a cervical fascia (lamina superficialis fasciae cervicalis). In front of iron borders on a front abdomen of a biventral muscle (venter ant. m. digastrici), behind — with a back abdomen of a biventral muscle (venter post. m. digastrici) and a shi-lo-hypoglossal muscle (m. stylohyoideus), below approaches a big horn of a hypoglossal bone (cornu majus osis hyoidei). Shoot of the Item. gets into a crack between maxillary and hypoglossal and podjyazychnoyazychny muscles and can reach hypoglossal gland (gl. sublingualis). Projection of the Item. on the surface of a face and neck has the form of a rhombus. A superficial plate of a cervical fascia, being split, covers gland, forming its capsule (saccus gl. submandibularis). Item. unlike a parotid gland with the capsule it is connected rykhlo and easily from it it is allocated. In the capsule of the Item. enter a facial artery (a. facialis) and in nek-ry cases a facial vein (v. facialis). The artery bends around gland from above or behind and lays down in a furrow on its medial surface, sometimes going deep into fabric of gland. The facial vein passes on the lateral surface of gland (tsvetn. fig. 1). Near the Item. there are also submental artery and a vein (and. et. v. submentales). On a surface of the Item. nodes are located submaxillary limf (Submandibular limf, nodes, T.; nodi lymphatici submandibulares). Podchelyustnoy Canal (submandibular channel, T.; ductus submandibularis) in 1656 T. Barton for the first time described. The channel leaves the forefront of the Item. and, having rounded the rear edge of a maxillary and hypoglossal muscle, goes over it at first between geniohypoid and hypoglossal and lingual muscles, then on the medial surface of hypoglossal gland, under a mucous membrane of a mouth floor in hypoglossal area and opens on a hypoglossal nipple (caruncula sublingualis) nearby or together with a big hypoglossal channel. Length of a submaxillary channel is 40 — 60 mm, internal to dia. 2 — 3 mm, in the mouth a channel are narrowed to 1 mm. Podchelyustnoy Canal, as a rule, direct, seldom the arc-shaped or S-shaped. Almost in half of cases from above and from below from it additional segments of the Item are located. On a sialogram-ma in a side projection the submaxillary channel and its branchings are projected on a body and a corner of a mandible.
Blood supply of the Item. it is carried out by ferruterous branches of a facial artery: its verkhneperedny part — a submental artery (a. submentalis), and a nizhneperedny part — a lingual artery (a. lingualis). Venous outflow is carried out in the veins of the same name. The lymph flows in submaxillary and lateral deep cervical limf. nodes.
Submaxillary gland is innervated as well as hypoglossal gland (see).
Item. is complex trubchatoalveolyarny gland with the mixed serous and mucous secretion. It consists of the segments divided by layers of connecting fabric, in to-rykh there pass vessels and nerves. In segments there are serous and mixed (serous and mucous) trailer departments. Serous trailer departments have the same structure, as well as in to a parotid gland (see). They possess the short inserted and long, strongly branching ischerchenny channels. The mixed trailer departments consist of two types of cells — mukotsit and serotsit. Mukotsita larger, occupy the central parts of trailer departments, serotsita are on the periphery, forming the serous semilunums, so-called semilunums of Dzhanuzzi characteristic of the mixed trailer departments. Outside from serous semilunums myoepithelial cells lie. Intra lobular channels of the Item. pass in interlobular, then interlobar, and the last merge to the submaxillary canal.
Physiology and biochemistry Item. — see. Sialadens .
Methods of a research
For definition of character patol, process apply sounding of channels, a sialometriya (measurement of quantity of the secret which is allocated from a channel in unit of time), tsitol. a research of a secret (see. Saliva ), X-ray analysis, pan-tomography (see) with artificial contrasting of channels, or a pantomosialografiya (fig. 1), a termoviziografiya (see. Termografiya ), an ultrasonic biolocation (see. Ultrasonic diagnosis ) and scanning (see).
The main symptoms specifying on patol, process in submaxillary gland is dysfunction (reduction, increase, a delay, and also a qualitative change of the secret which is allocated from a channel), increase in the sizes of gland (fig. 2). At reduction of secretion patients feel dryness in an oral cavity (see. Xerostomia ); the delay of allocation of a secret is shown by so-called salivary colic (the pricking, arching pains in the field of gland developing during food), at increase in secretion there is hypersalivation (see. Salivation ).
Damages Item. are observed seldom. According to E. E. Babitskoy, in the period of the Great Patriotic War damage of the Item. with formation of outside salivary fistulas (see) it was observed in 2% of cases of wounds of all sialadens. Cases of damage of a submaxillary channel by a disk meet during preparation of teeth under crowns. Wound of the Item. and its channel can lead to formation of defect of a parenchyma, a stenosis or a full obliteration of a submaxillary channel. A sign of disturbance of passability of a submaxillary channel is swelling of the Item., especially during food. Localization and a damage rate of gland or its output channel are established with the help sialografiya (see). Apply bougieurage to elimination of narrowing of a channel the special probe. Impassability of a channel in front departments is eliminated in the operational way. At the same time otpreparovyvat the central end of a channel, split it longwise throughout 1 — 1,5 cm from the place of fusion and hem to a mucous membrane of hypoglossal area.
Reactive and dystrophic changes Item. arise at nek-ry diseases: Mikulich's diseases (see. Mikulich syndrome ), Shegren's syndrome (see. Shegrena syndrome ), adenosis of incretion, collagenic diseases (see), etc.
Acute inflammatory diseases of the Item. (see. Sialadenitis ) arise at implementation to P. zh Canal. a foreign body, napr, a peel from fruit, blades, at phlegmon of submaxillary and hypoglossal areas (owing to distribution of process of surrounding fabrics), at the atypical course of epidemic parotitis (see. Parotitis epidemic ). In these cases the disease proceeds sharply, with deterioration in overall health, fervescence, release of pus from a channel, pains and swelling of the Item.; purulent fusion of the Item is not excluded. In a complex to lay down. procedures at an acute sialadenitis include administration of medicines (antibiotics, a bacteriophage, proteolytic enzymes) in canals of gland, novocainic blockade of area of gland. At virus defeat irrigation of a mucous membrane of an oral cavity is recommended by interferon.
Hron, inflammation of the Item. generally proceeds as a calculous sialadenitis (see. Sialolithiasis ). The sialadenitis is less often observed not calculous hron: intersticial (so-called inflammatory tumor of Kyutt-ner or defeat of the Item. at Mikulich's disease) and parenchymatous (at Shegren's syndrome). Sialodochitis of the Item. meets less than parotid gland, can be bilateral. Patients complain of periodically appearing swelling in submaxillary area, the pricking, arching pains in the field of gland during food, allocation to an oral cavity of saltish saliva. The disease proceeds for years with periodic aggravations, in time to-rykh severe pains and a purulent discharge from a channel are observed. For diagnosis hron, a sialodochitis of the Item. apply a sia-lografiya (fig. 3) or a pantomosia-lografiya. At a calculous sialadenitis — treatment operational (see the Sialolithiasis). At not calculous sialadenitis and a sialodochitis treatment is directed to increase in resilience of an organizkhm, and also to elimination of associated diseases.
Rather seldom in the Item. the retentsionny cysts arising owing to an atresia of salivary channels meet. The atresia of salivary channels can be inborn or is caused by an injury or inflammatory process. Treatment operational: the cyst is deleted together with the Item.
Defeat of the Item. by tumoral process it is observed considerably less than okolounshy (see. Sialadens ).
During removal of the Item. make a section 7 — 8 cm long parallel to bottom edge of a body of the mandible, otstupya from it on 2 cm. Cut skin, hypodermic cellulose, a hypodermic muscle of a neck, a superficial plate of own fascia of a neck, open the capsule of gland, tying up at the same time a facial vein. Item. easily separates from fabrics of a bed. At department of an inner surface of the Item. allocate and tie up a facial artery. In the field of an upper pole of the Item. allocate and tie up an output channel and repeatedly tie up a facial artery. If gland is deleted concerning inflammatory process, then it is not necessary to go beyond its capsule not to damage a facial nerve (a regional branch of a mandible). The wound is sewn up layer-by-layer, leaving the graduate for 24 hours.
Bibliography: Zedgenidze G. A. Radiodiagnosis of diseases of sialadens, L., 1953, bibliogr.; Kasatkin S. N. Anatomy of sialadens, Stalingrad, 1948; With and z and m of a JI. Diseases of sialadens, the lane from Czeches., Prague, 1971, bibliogr.; Solntsev A. M. and Kolesov V. S. Surgery of sialadens, Kiev, 1979, bibliogr.; Burch R. J. a. Woodward H. W. Differential diagnosis and surgery of the submaxillary gland, J. oral Surg., v. 18, p. 470, 1960; Rauch S. Die Speicheldriisen des Menschen, Stuttgart, 1959; Schulz H. G. Das Ront-genbild der Kopfspeicheldriisen, Lpz., 1969, Bibliogr.
I. F. Romacheva; V. S. Speransky (An., gist.).