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Salivary Gland Cancer

Understanding the Anatomy

In order to understand salivary gland cancer, you need a basic understanding of the anatomy of your head and neck. There are different types of salivary glands, including major and minor salivary glands. It is also important to understand where the major nerves that serve important functions are located since they, too, can become involved.

Major Salivary Glands Minor Salivary Glands
21_glands 14_minor_glands
The major salivary glands are called “major” because they are big, and each one has its own single tube (or duct) that leaves the gland and opens into the mouth to deposit saliva. There are three major salivary glands on each side of the face and neck: the parotid gland, submandibular gland and sublingual gland. In terms of cancer treatment, though, the sublingual gland is usually grouped with the minor salivary glands. The minor salivary glands are found all over the mouth and throat. They are called “minor” because they are much smaller, have no envelope around them and don’t have an organized outflow system leading up to a duct.

Here are the major salivary glands in greater detail, with a focus on the parotid gland.

THE MAJOR SALIVARY GLANDS: Parotid Salivary Glands
22 Salivary Gland Parotid08a_parotid_duct
The parotid gland, a major salivary gland, sits in front of the ear, one on each side. It extends from just below the cheekbone to the top of the vertical part of the jawbone, and it sits on top of the main muscle used for chewing (the masseter). The parotid gland tapers down at the bottom into what is called the “tail” of the gland. The duct, called Stenson’s duct, leaves the gland and pierces through fat and muscle to open into the mouth across from the second upper molar.This is the biggest salivary gland, and it produces the most saliva of any single salivary gland. It is also the most common site of tumors, malignant or benign. Actually, 80% of salivary gland cancers are in the parotid gland. However, of all lumps (or tumors) in the parotid gland, 80% are benign.2Califano J, Eisele DW. Benign salivary gland neoplasms. Otolaryngologic clinics of North America 1999;32:861.Also, even though the parotid gland is enclosed within an envelope of tissue, this tissue envelope actually develops late during the formation of the embryo, so lymph nodes get caught inside the envelope. In fact, the parotid gland is the only salivary gland to have lymph nodes within its envelope. This is important because cancer cells can travel through the lymphatic system to end up in one of these parotid lymph nodes. Therefore, a lump in the parotid gland can be a cancer that has spread from another part of the body into a lymph node within the parotid gland.The facial nerve is a long tube that begins in your brain stem, winds in and around the inner workings of your ear and comes out of the skull just behind the ear where it branches out three ways (including the nerve that allows some people to wiggle their ears on demand). It then extends into the middle of the parotid gland where it fans out into five more branches to supply the muscles of facial expression. The facial nerve artificially divides the parotid gland into two “lobes,” one superficial and one deep.
Submandibular Salivary Glands Sublingual Salivary Glands
23_submandibular

24_sublingual

The two submandibular glands are in the submandibular triangle, which is in the central area of the neck below the jawbone. The ducts of each submandibular gland, called Wharton’s ducts, open just under the tongue in the floor of the mouth. Each duct is about five centimeters long.The marginal mandibular branch, one of the branches of the facial nerve, runs in the envelope overlying this gland. This nerve moves the lower lip downwards on each side. Other nerves in close association with this gland include the hypoglossal nerve (which moves the tongue) and the lingual nerve (which supplies sensation and taste to the tongue and mouth region). These paired glands sit in the floor of mouth underneath the tongue. They meet in the midline. The ducts are called ducts of Rivinus, and they open directly into the mouth. Some of these ducts even unite and form the major ducts of Bartholin, which sometimes meet up with the submandibular duct.The lingual nerve is the main nerve to consider. It runs along the side of the gland until it gets to the front, and then it goes underneath the gland, where it runs with the submandibular duct until it goes up into the tongue.

These are the minor salivary glands:

THE MINOR SALIVARY GLANDS
14_minor_glandsYou have thousands of minor salivary glands all over your mouth and throat. They are most concentrated in a few places, including the junction of the hard palate with the soft palate, in the lips and along the inner lining of your cheeks. But they also exist on your tongue and even down into your throat. Minor salivary glands do not have envelopes around them, nor do they have specific ducts.
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30 Referenced with permission from The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Head and Neck Cancers V.2.2014. © National Comprehensive Cancer Network, Inc 2014. All rights reserved. Accessed June 18, 2014. To view the most recent and complete version of the guideline, go online to www.NCCN.org. NATIONAL COMPREHENSIVE CANCER NETWORK®, NCCN®, NCCN GUIDELINES®, and all other NCCN Content are trademarks owned by the National Comprehensive Cancer Network, Inc.