2. Saliva Flashcards by J L

Introduction

Why is saliva important
• Saliva functions primarily to prevent ____ of the oral mucosa and to provide ____ for the mastication and swallowing of ingested food. The senses of taste and, to a lesser extent, smell depend on an adequate supply of saliva.
• Saliva plays a very important role in maintaining proper oral ____. It accomplishes this task by washing away food particles, killing bacteria (lysozyme and IgA activity), and contributing to overall dental integrity.

dehydration
lubrication
hygiene

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Introduction

Salivary flow
  •  Normally ~\_\_\_\_L secreted per day
•  Amount of saliva varies with eating 
Generally ~\_\_\_\_mL/min
When stimulated can be \_\_\_\_ mL/min
•  Decreased saliva > \_\_\_\_
•  Excess saliva > \_\_\_\_

1-1.5
0.3-0.5
4-8
xerostomia
drooling

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Salivary Glands
• Major ____
____ ____
• Minor

submandibular
sublingual
parotid

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Introduction

Exocrine glands
• The major salivary glands are ____ glands: specialized secretory organs that contain a ____ ductular system through which they release their secretory products.

compound exocrine

branching

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Introduction

Exocrine glands
• The salivary glands are divided into ____, each of which are drained by a single ____.
• Within the lobules reside the secretory units of the gland. Each secretory unit is composed of an ____ and a ____.
• The acinus represents a cluster of 15 to 100 ____ cells that synthesize and secrete proteins into the lumen of the epithelial structure

lobules
intralobular duct
acinus
small intercalated
acinar

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Introduction

Exocrine glands
• Acinar cells from the salivary glands also secrete an ____, plasma-like fluid that accompanies the secretory proteins.
• In all, the final acinar secretion is a ____- rich product known as the ____ secretion.

isotonic
protein
primary

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Introduction

Acinar cells
Different salivary acinar cells secrete different proteins.
• The acinar cells of the parotid secrete a ____ (watery) product that contains an abundance of ____.
• Many acinar cells of the sublingual glands secrete a mucinous product that is composed primarily of ____ glycoproteins.
• The submandibular gland contains both ____-type and ____-type acinar cells.

serous
alpha-amylase
mucin
mucous
serous

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Introduction

Exocrine Glands
• Each acinar lumen is connected to the ____
end of an intercalated duct.
• Distally, the intercalated ducts fuse with other small ducts that coalesce to form the ____ that drains the lobule.
• The ducts not only provide a conduit for the transport of secretory proteins, but the epithelial cells lining the ducts also ____ the fluid and electrolyte composition of the primary secretion.
• Thus, the final exocrine gland secretion represents the combined product of two distinct epithelial-cell populations, the ____ cell and the ____ cell.

intercalated duct
intralobular duct
modify
acinar
duct

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Anatomy

Parotid gland
• The ____ of all the major salivary glands.
• ____ in shape, with up to 5 processes (or extensions).
• The gland’s capsule is from the ____.
• Approximately 75% of the parotid gland overlies the ____ muscle; the rest is ____.

largest
pyramidal
deep cervical fascia
retromandibular

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Anatomy

Parotid gland
• The facial nerve enters the parotid fossa by passing between the stylohyoid muscle and the posterior belly of the digastric muscle, then splits the gland into a ____ lobe and a ____ lobe that are connected by an ____.
• The deep lobe lies adjacent to the ____ space (note: pathology of the deep lobe will only be visible ____).
• Although it passes through the parotid gland, the facial nerve does not provide any ____ to it.

superficial
deep
isthmus
pharyngeal
intraorally
innervation

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Anatomy

Parotid duct
• Forms within the ____ lobe and passes from the anterior border of the gland across the masseter superficially, through the buccinator into the oral cavity opposite the ____.
• Also known as ____ duct

deep
second maxillary molar
stensen’s

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Anatomy

Arterial Supply of the Parotid Gland
• The external carotid artery: It ascends superiorly posterior to the ____ and deep to the posterior belly of the ____ muscle and the stylohyoid muscle to enter the ____ gland.
• Within the parotid gland, it gives branches to the gland: The ____ artery and the ____ artery.

mandible
digastric
parotid
posterior auricular
superficial temporal

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Anatomy
Venous Drainage of the Parotid Gland
• The retromandibular vein: Arises from the joining of the ____ and ____ veins within the parotid gland.

superficial temporal

maxillary

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Anatomy

Sensory Nerves of the Parotid Gland
• Sensory innervation is supplied by the ____ nerve (deep gland) and the ____ nerve (superficial gland and fascia).

auriculotemporal

great auricular

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Anatomy

Parasympathetic Innervation of the Parotid Gland
• The parasympathetic innervation to the parotid gland has a complex path. It begins with the ____ nerve (cranial nerve IX).
• This nerve synapses with the ____.
• The ____ nerve then carries parasympathetic fibers from the otic ganglion to the ____ gland.
• Parasympathetic stimulation causes an ____ in saliva production.

glossopharyngeal
otic ganglion
auriculotemporal
parotid
increase

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Anatomy

Sympathetic Innervation of the Parotid Gland
• Sympathetic innervation originates from the ____, part of the paravertebral chain.
• Fibers from this ganglion travel along the ____ artery to reach the parotid gland.
• Increased activity of the sympathetic nervous system ____ saliva secretion, via ____.

superior cervical ganglion
external carotid
inhibits
vasoconstriction

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Anatomy

Submandibular gland
- the ____ largest salivary gland
• It is located superior to the ____ muscle and is divided into superficial and deep lobes, by the ____ muscle. The ____ lobe comprises most of the gland.
• The superficial lobe is located in the ____ triangle and is surrounded by the investing layer of deep cervical fascia.

second
digastric
mylohyoid
superficial

submandibular

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Anatomy

Submandibular Gland
Anatomy

Deep portion of the submandibular gland lies in the oral cavity between the ____ muscle and the mandible and ends at the posterior border of the ____ gland.
The facial ____ crosses between the submandibular gland and the mandible, while the facial ____ normally lies superficial to the gland.
The submandibular duct lies along the ____ gland and empties into the oral cavity at the ____.

hyoglossus
sublingual
artery
vein
sublingual
sublingual papilla

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Anatomy

Submandibular Duct
• Also know as ____ Duct.
• The submandibular duct lies along the ____ gland and empties into the oral cavity at the ____.

wharton’s
sublingual
sublingual papilla

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Anatomy

Sublingual gland
• ____ of the 3 major salivary glands.
• Located in the oral cavity between the mucosa of the oral cavity and the ____ muscle.
• Creates a ____ fold in the floor of the oral cavity.
• Lies between the ____ of the mandible and the ____ muscle of the tongue.

smallest
mylohyoid
sublingual
sublingual fossa
genioglossus

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Anatomy

Sublingual ducts
• Numerous small ducts opening along the ____.
• ____ duct may be present – it is a common duct that drains the ____ part of the gland in the region of the sublingual papilla.

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sublingual gold
bartholin’s
anterior

Anatomy
Arterial Supply of the Submandibular & Sublingual Gland
• The gland receives its blood supply from the ____ arteries.

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facial and lingual

Anatomy
Venous Drainage of the Submandibular & Sublingual Gland
• The venous drainage is via the common ____ veins.

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facial and lingual

Anatomy
Parasympathetic Innervation of the Submandibular & Sublingual Gland

Parasympathetic innervation to the submandibular glands is provided by the ____ nucleus via the ____ branch of the ____ nerve synapsing on the ____.
Increased parasympathetic activity ____ the secretion of saliva.

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superior salvatory
chorda tympani
submandibular ganglion
promotes

Anatomy Sympathetic Innervation of the Submandibular & Sublingual Gland * Sympathetic innervation originates from the ____, where post-synaptic vasoconstrictive fibers travel as a ____ on the internal and external carotid arteries, facial artery and finally the ____ arteries to enter each gland. * Increased sympathetic drive reduces glandular ____ through vasoconstriction and decreases the ____ of salivary secretions, resulting in a more mucus and ____-rich saliva.

``` superior cervical ganglion plexus submental bloodflow volume enzyme ```

Anatomy Innervation of Major Glands Summary • Parasympathetics (Rest and Ruminate) -____ of salivary flow. -Superior and inferior salivatory nucleus in the dorsal pons giving general visceral efferent fibers to the ____ and ____ nerve, respectively. -CN VII via the ____, to the ____ ganglion, then to the ____ and sublingual glands. -CN IX via the ____ nerve, to the ____ganglion, then to the parotid gland via the ____ nerve. • Sympathetics (Fight or Flight) - ____ salivary flow, but stimulates protein rich saliva. - T1-T3 nerves to the ____, to carotid and ____ or lingual arteries.

stimulation facial glossopharyngeal ``` chorda tympani submandibular submandibular lesser petrosal otic auriculotemporal ``` slows superior cervical ganglion facial

Anatomy Minor salivary glands • Found throughout the oral cavity (buccal, labial, palate, lingual), except the ____ and ____. • Approximately 1000 glands. • Small lobules of secretory glands with ducts. • Located in the ____. • Innervated by the ____ nerve like the ____ and ____ glands.

anterior plate gingiva submucosa facial submandibular sublingual

``` Physiology Contribution to Salivary Flow • Submandibular- ____% • Sublingual- ____% • Parotid- ____% • Minor- ____% ```

60 5 30 5

``` Physiology Saliva Composition • ____% water • 1% organic/inorganic compounds Electrolytes Mucous Proteins/Enzymes ```

``` Physiology Serous Cells • ____, protein rich-rich fluid • Secrete enzymes ____ Lysozyme • ____ • Lactoferrin ```

watery amylase IgA

Physiology Mucous cells • Viscous product- ____ Highly ____ proteins Gel-like lubrication • Rich in ____ and glycoproteins (mucins) • Contains ____ Immunoglobulins Lactoferrin

mucin glycosylated carbohydrates lysozyme

``` Physiology Gland Secretion • Parotid- Mostly ____ • Submandibular- ____ serous and mucous • Sublingual- Mostly ____ • Minor- Mostly ____ ```

serous mixed mucous mucous

Physiology Exocrine glands • Salivary glands contain a rich supply of nerves and blood vessels. Postganglionic parasympathetic and sympathetic fibers contribute to the autonomic regulation of secretion. • The major agonists of salivary acinar secretion are ____ and ____, which are released from postganglionic parasympathetic and sympathetic nerve terminals, respectively.

acetylcholine | norepinephrine

Physiology Exocrine glands • The cholinergic receptor on the salivary acinar cell is the ____ glandular subtype. • The adrenergic receptors identified on these cells include both the ____ subtypes.

M3 | alpha and beta

Physiology Parasympathetic control • Parasympathetic nerves secrete ____ on acinar cells. • Binds to muscarinic receptors causing increased ____ into the cell via ____ pathway. • Increased ____ causes vesicles to fuse with the cell membrane, releasing contents into the lumen. • Calcium also causes release of ____ which ____ blood vessels and increased capillary permeability.

``` ACh calcium IP3/DAG calcium bradykinin vasodilates ```

Physiology Parasympathetic control • Clinically, some medications have ____ properties that are most commonly manifested as dry mouth. • Conversely, excessive salivation is induced by some ____ agents that can be found in certain ____ and nerve gases.

anticholinergic anticholinesterase insecticides

Physiology Sympathetic control • Activated by norepinephrine which leads to calcium ____ and protein ____. • Norepinephrine causes ____ and ____ fluid flow.

influx secretion vasoconstriction decreased

Physiology Primary secretion • The primary secretion of the salivary acinar cell is ____ and results largely from the basolateral uptake of ____ through Na/K/Cl cotransporters, working in conjunction with ____ pumps and basolateral ____ channels.

isotonic Cl- Na-K K+

Physiology Primary secretion • The ____ modify the composition of the isotonic, plasma- like primary secretion of the acinar cells. • As the fluid exits the salivary acinus, it passes through an intercalated duct, with typical intercalated duct cells. • Later, abundant mitochondria and infoldings of the basolateral membrane give the basal portion of the duct cells a characteristic ____ appearance—hence the term striated duct cell.

ducts | striated

Physiology Primary secretion • In general, salivary duct cells absorb ____+ and ____− and, secrete ____+ and ____-. • Because the epithelium is not very water permeable, the lumen thus becomes ____.

``` Na Cl K HCO3 hypotonic ```

Physiology Salivary electrolytes * ____ in the gland * ____ in the mouth * ____ in calcium and phosphate * Variable with flow: At low (basal) flow rates, Na+ and Cl− are ____ from the lumen and K+ is ____. At higher flow rates, the composition of the final secretory product begins to approach that of the plasma-like ____ secretion.

``` isotonic hypotonic high absorbed secreted primary ```

Physiology Central control • Both ____ input and ____ input to the salivatory nuclei can regulate the parasympathetic signals transmitted to the glands. • Taste and tactile stimuli from the tongue are transmitted to the ____, where their signals can excite the ____ nuclei and stimulate salivary gland secretion. • Central impulses triggered by the sight and smell of food also excite the salivatory nuclei and can induce ____ before food is ingested. (Ivan Pavlov conditioned dogs to salivate at the sound of a bell).

local central brainstem salivatory salivation

Physiology Digestive function - ____ for bolus formation • a-amylase (ptyalin)- from ____ cells. • Lingual lipase- from ____ glands (surrounding the circumvallate and foliate papilla). • Dissolves food, liquid medium allowing interaction with taste buds.

lubrication serous von ebner's

Physiology Protective function • Lubrication to ease swallowing, protection from trauma • Remineralization ____ with calcium and phosphate (statherins) ____ bind calcium allowing high levels in saliva • Dilution of heat/cold/toxins/bacteria • Buffering pH ____ Bicarbonate Prevents ____ of enamel (critical pH of ____)

``` supersaturated PRPs 6.2-7.4 demineralization 5.5 ```

Physiology Protective function • Antimicrobial ____- binds iron and is antibacterial ____- kills bacteria, muramidase cleaving NAM/NAG ____-inhibits bacterial growth by disrupting glycolytic pathway ____- particle accumulation, antiviral ____- antimicrobial/antiviral, blocks attachment of microbes to mucosa ____- antimicrobial/antifungal, binds cell membranes

``` lactoferrin lysozyme peroxidase agglutinin secretory IgA histatins ```

Clinical Correlations Tumors of the Parotid Gland • 80% of parotid tumors are ____. The most common benign tumor is a ____. • When examining the patient, tumors of the superficial lobe will appear to obstruct view of the ____. Tumors of the deep lobe will appear as ____ swelling adjacent to the lateral pharyngeal space. • If you see facial nerve palsy and a mass – concern for ____ should be high. • The most common parotid gland malignancy is ____.

``` benign pleomorphic adenoma earlobe intraoral malignancy mucoepidermoid carcinoma ```

Clinical Correlations Frey’s Syndrome * Caused by regeneration of the ____ autonomic fibers in an abnormal fashion, innervating the sweat glands near the parotid gland after a parotidectomy. * Symptoms include ____ and ____ in the distribution of the auriculotemporal nerve during eating. * Diagnosis is via ____ test–creates a ____ spot over the gustatory sweating area. * Treatments include tympanic ____ (severing the parasympathetic component) and the topical anticholinergic ____ (Robinul).

``` auriculotemporal sweating redness minor's starch iodine dark neurectomy glycopyrrolate ```

Clinical Correlations Submandibular Sialolithiasis • A calculus or sialolith is a calcified deposit which can block the lumen of a duct. • The ____ duct is the most susceptible to calculi out of all the salivary ducts; accounting for approximately 80% of cases. • This is thought to be due to the ____ length of the duct (5cm), ascending secretory pathway and nature of salivary secretion. • The submandibular glands and the patency of the ducts can be examined by a ____. A calculus may present radiographically as a stricture or complete occlusion of the duct.

submandibular torturous sialogram

Clinical Correlations Mucocele of Minor Salivary Glands • A mucocele (aka mucous retention cyst, mucous extravasation cyst) is a clinical term that refers to two related phenomena: Mucus ____ phenomenon Mucus ____ cyst * The mucocele has a ____ translucent color, and is more commonly found in ____ and young adults. * Although the term cyst often used to refer to these, mucoceles are not true cysts because there is no ____ lining.

``` extravasation retention bluish children epithelial ```

Clinical Correlations • A ranula is a type of mucocele (mucous cyst) that occurs in the ____ of the mouth inferior to the tongue. • It is the most common disorder associated with the ____ glands due to their higher mucin content in secretions compared to other salivary glands. • Ranulas can be caused by trauma to the delicate ____ gland ducts causing them to rupture, with mucin then collecting within the connective tissues to form a cyst. • Mucin from the gland or ducts may collect inferiorly beneath mylohyoid and present as a ____ in the neck (a cervical/ plunging ranula). Rarely, this collection can course posteriorly into the ____ space.

``` floor sublingual sublingual swelling parapharyngeal ```

2. Saliva Flashcards

(50 cards)