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Submandibular duct

The submandibular duct, commonly referred to as Wharton's duct, is the principal excretory duct of the submandibular salivary gland, a paired structure located in the anterior neck beneath the mandible, responsible for secreting approximately 70% of unstimulated saliva into the oral cavity.^[1] This duct measures about 5 cm in length and 1.5 mm in diameter, originating at the hilum of the submandibular gland, curving anteriorly and medially along the medial aspect of the mandible, passing between the mylohyoid and hyoglossus muscles, and crossing superior to the lingual nerve before opening at the sublingual caruncle on the floor of the mouth, lateral to the lingual frenulum.^[1]^[2] Its primary function is to transport mucinous saliva, which aids in oral lubrication, digestion initiation, and antimicrobial defense, through a submucosal plane in close relation to the hypoglossal nerve and sublingual gland.^[1]^[2] Clinically, the submandibular duct is notable for its predisposition to sialolithiasis, with 80-90% of salivary stones forming within it due to salivary stasis, viscous secretions, and its dependent anatomical position, potentially leading to obstruction, inflammation (sialadenitis), or infection if untreated.^[1] Surgical interventions, such as sialendoscopy or ductoplasty, may be required to address blockages, emphasizing the duct's vulnerability in salivary gland disorders.^[2] Imaging modalities like ultrasound, enhanced by sialogogues, are effective for visualizing the duct's patency and surrounding structures.^[2]

Anatomy

Gross anatomy

The submandibular duct, also known as Wharton's duct, is the principal excretory duct of the submandibular gland, primarily draining its mixed serous and mucous saliva into the oral cavity, while also receiving secretions from the sublingual gland via the ducts of Bartholin, which join it near its termination.^[3]^[4] It measures approximately 5 cm in length and has a diameter of 1-3 mm, featuring a thin wall that contrasts with the thicker structure of the parotid duct.^[4]^[5] The duct is present bilaterally as independent structures, one on each side of the midline.^[6] The duct originates at the hilum on the medial surface of the deep lobe of the submandibular gland, located within the submandibular triangle of the neck.^[5] It then courses anteriorly within the sublingual space, initially traveling along the superior surface of the mylohyoid muscle and between the mylohyoid and hyoglossus muscles.^[6] As it progresses, the duct forms a genu by curving superiorly around the posterior border of the mylohyoid, before directing anteriorly and passing between the sublingual gland superiorly and the genioglossus muscle inferiorly.^[5] It lies in the floor of the mouth, adjacent to the sublingual fold.^[4] Key spatial relationships include its position inferior to the lingual nerve, which crosses and loops over the duct twice during its path.^[6]^[5] The duct is situated superior to the hypoglossal nerve and the submandibular vessels.^[3] It terminates by opening at the sublingual papilla (or caruncle), a small elevation on the summit of the sublingual fold, located near the base of the lingual frenulum on either side of the tongue.^[4]^[6]

Microscopic anatomy

The submandibular duct, also known as Wharton's duct, is lined by a pseudostratified columnar epithelium near its origin from the submandibular gland, transitioning distally to stratified columnar and ultimately nonkeratinized stratified squamous epithelium as it approaches the oral cavity.^[7]^[8] This epithelial variation supports the duct's role in conducting saliva while adapting to the mechanical stresses of the oral environment. Occasional goblet cells may be present in the proximal pseudostratified regions, contributing minor mucinous secretions.^[8] The duct wall consists of fibroelastic connective tissue reinforced by longitudinal and circular smooth muscle fibers, which facilitate peristaltic propulsion of saliva through the lumen.^[9] These smooth muscle elements, identified via immunostaining for α-smooth muscle actin, are embedded within the surrounding stroma and provide contractile support without forming a distinct muscularis layer.^[9] The entire structure is enveloped by dense connective tissue stroma, which integrates the duct with adjacent sublingual space tissues. Unlike the parotid gland, which features prominent striated ducts for ion modification, the submandibular duct system includes shorter intercalated ducts lined by low cuboidal epithelium but lacks extensive striated ducts, reflecting the gland's mixed secretory profile.^[10] These intercalated ducts connect directly to the main excretory duct, bypassing the more elaborate ductal modifications seen in serous-dominant glands.^[11] The duct receives salivary contributions from the submandibular gland's acini, which are primarily mixed seromucous but predominantly serous (approximately 90-95%), with serous acini featuring zymogen granules for enzymatic secretion and minor mucous acini or demilunes providing viscous components.^[12]^[13] Myoepithelial cells, contractile elements surrounding the acini and intercalated ducts, aid in expelling secretions into the ductal network.^[7] Innervation of the submandibular duct and associated gland involves parasympathetic fibers from the chorda tympani branch of the facial nerve (via the lingual nerve), which synapse in the submandibular ganglion to stimulate serous and mucous secretion.^[14] Sympathetic innervation, derived from the superior cervical ganglion, modulates vasoregulation and may influence smooth muscle tone in the duct wall, though it primarily affects glandular blood flow.^[3]

Development

Embryonic origins

The submandibular duct originates during the 6th week of human gestation as an endodermal epithelial bud arising from the oral epithelium in the floor of the mouth, positioned posterior to the parotid gland primordium. This bud forms within the medial paralingual groove, invaginating into the underlying mesenchyme to initiate glandular development.^[15]^[16] Branching morphogenesis follows, with the initial solid epithelial cord elongating anteriorly and undergoing clefting to form primitive ductal structures. By 8-10 weeks of gestation, canalization occurs as microlumens develop through apoptosis within the epithelial cords, establishing the primitive duct lumen and connecting it to the developing submandibular gland bud. The gland's elongation aligns with the formation of the mylohyoid raphe, guiding its anterior extension toward the sublingual region.^[17]^[16]^[18] Interactions with the surrounding mesenchyme, particularly neural crest-derived ectomesenchyme, are crucial for inducing acinar differentiation and ductal patterning. This mesenchyme condenses around the epithelial bud, providing structural support and signaling cues that promote branching and stroma formation. By 12 weeks, a continuous ductal lumen is evident, and around 14 weeks, the submandibular duct anlage integrates with the sublingual gland primordium, forming shared ductal connections.^[15]^[18]^[19] Genetic factors, including fibroblast growth factor 10 (FGF10) and bone morphogenetic protein 4 (BMP4) signaling, drive bud outgrowth and patterning. FGF10, expressed in the mesenchyme, promotes epithelial proliferation and branching, while BMP4 regulates initial clefting and mesenchymal organization during these early stages.^[17]^[20]

Postnatal maturation

During infancy and early childhood, the submandibular duct lengthens in proportion to mandibular growth, adapting to the expanding floor of the mouth as the jaw develops. Acinar maturation within the associated submandibular gland progresses rapidly, with immature acini and ducts initially separated by abundant vascular connective tissue at birth; by six months, the glandular structure becomes more compact, and the relative volume of acini rises from 43% at birth to 64% by 6 months to 2 years, with the relative volumes of ducts and connective tissue decreasing during this period.^[21] These changes enhance mucous secretion capacity. Pubertal changes involve hormonal modulation, particularly by androgens, which bind to receptors in human salivary tissues and promote proliferation and differentiation of ductal and acinar cells, shifting the gland toward a more pronounced serous secretory profile.^[22] Concurrently, the duct diameter expands to 2-3 mm by adolescence, aligning with overall glandular hypertrophy and increased salivary demands during this growth phase.^[4] Cellular activity across glandular components peaks in young adulthood following these pubertal adaptations.^[23] With aging, progressive fibrosis and fatty infiltration accumulate in the submandibular gland and duct walls, diminishing tissue elasticity and elevating the risk of salivary stasis, which predisposes elderly individuals to obstructive complications.^[24] These changes correlate with acinar atrophy and overall hypofunction, though the duct's core architecture persists unless compounded by disease.^[25] Adaptive responses include ductal hypertrophy in cases of chronic irritation, such as recurrent sialadenitis, where repeated inflammation prompts epithelial thickening and lumen dilation to maintain flow.^[26] The duct also integrates dynamically with dentition development, adjusting its position in the floor of the mouth as primary and permanent teeth erupt, thereby influencing submandibular space configuration without compromising patency.

Function

Salivary transport

The submandibular duct facilitates the transport of saliva from the submandibular gland to the oral cavity primarily through secretory pressure generated by acinar cell secretion and contractions of myoepithelial cells surrounding the acini and intercalated ducts, aided by gravity and neural regulation.^[27]^[28] Smooth muscle fibers in the duct wall may contribute to modulating luminal pressure and flow dynamics.^[9] The submandibular gland produces saliva at rates up to approximately 0.5-1 mL/min during stimulation, which is delivered through the duct.^[27] These mechanisms help maintain forward momentum from the acinar ejection.^[29] Flow dynamics within the duct are influenced by its anatomical course and positional factors. In the upright position, gravity assists the downward flow from the gland to the sublingual caruncle, but the duct's tortuous path—approximately 5 cm long and curving around muscles like the mylohyoid—increases the potential for stasis compared to the straighter parotid duct.^[30] The duct wall includes layers of connective tissue with smooth muscle that contribute to these dynamics.^[9] The submandibular gland accounts for 60-70% of unstimulated salivary volume, producing a mixed seromucous fluid with a pH of 6.5-7.5 that is delivered via the duct.^[31]^[32] Parasympathetic stimulation, mediated by the facial nerve (via the chorda tympani), increases salivary flow rate and myoepithelial contraction to enhance ejection efficiency from the acini.^[27] Integration with sublingual drainage occurs as the submandibular duct often receives contribution from the major duct of Bartholin of the sublingual gland, while 8-10 minor ducts of Rivinus open separately into the floor of the mouth near the sublingual caruncle, enabling combined salivary output into the oral cavity.^[34]^[35]^[36]

Contribution to oral physiology

The submandibular duct, also known as Wharton's duct, plays a pivotal role in oral physiology by delivering saliva from the submandibular gland to the oral cavity, contributing approximately 70% of unstimulated salivary flow.^[1] This mixed saliva, rich in both serous and mucous components, supports essential functions such as digestion initiation, antimicrobial defense, and mucosal protection.^[3] By opening at the sublingual caruncle adjacent to the lingual frenulum, the duct ensures targeted deposition of saliva that maintains oral homeostasis.^[1] In aiding digestion, the saliva transported through the submandibular duct contains α-amylase, an enzyme secreted by serous acini that hydrolyzes starches into maltose and dextrins, beginning carbohydrate breakdown in the mouth.^[27] Additionally, bicarbonate ions in this saliva act as a buffer to neutralize acids from ingested food or gastric reflux, helping to protect enamel and soft tissues from erosion.^[3] These components collectively facilitate the initial stages of nutrient processing and prevent acidic damage, underscoring the duct's integral support for gastrointestinal preparation.^[37] The antimicrobial properties of submandibular saliva, delivered via the duct, are crucial for reducing the risk of dental caries and periodontitis. Key agents include lysozyme, which lyses bacterial cell walls; lactoferrin, which sequesters iron to inhibit microbial proliferation; and secretory IgA, which neutralizes pathogens by preventing their adhesion to mucosal surfaces.^[3] These factors create an inhospitable environment for oral bacteria, promoting a balanced microbiome and lowering infection susceptibility.^[38] For lubrication and protection, the mucous elements in the saliva coat the oral mucosa, reducing friction during swallowing and speech while maintaining hydration, particularly in the floor of the mouth.^[27] This viscous layer shields against mechanical trauma and desiccation, enhancing overall oral comfort. Furthermore, the duct's proximity to the lingual frenulum allows saliva flow to solubilize food particles, stimulating taste buds and enabling sensory feedback for flavor perception and dietary intake regulation.^[3]

Clinical significance

Sialolithiasis

Sialolithiasis refers to the formation of calcified stones, or sialoliths, within the salivary glands and ducts, with the submandibular duct being the most common site due to its anatomical and physiological characteristics. These stones obstruct salivary flow, leading to inflammation and potential complications. Sialoliths in the submandibular duct most commonly develop in the hilar region, with a significant portion in the distal third near Wharton's papilla, where stasis promotes mineral deposition.^[39] The condition accounts for the majority of salivary gland obstructions, affecting individuals across all ages but more frequently in adults between 30 and 60 years.^[40] Approximately 80-90% of all sialoliths occur in the submandibular gland and its duct, attributed to the duct's long, tortuous path that promotes saliva stasis, the production of more alkaline and viscous mucinous saliva, and the gland's dependent position in the neck facilitating gravity-dependent pooling. This predisposition arises from the submandibular duct's gross anatomy, which favors reduced flow and mineral precipitation compared to other salivary ducts. Sialoliths form through a process of nucleation around a central nidus composed of organic debris, such as exfoliated epithelial cells, bacteria, and inflammatory exosomes, which serves as a scaffold for layered deposition of inorganic salts. The composition primarily consists of calcium phosphates, including hydroxyapatite and carbonate-apatite, intermixed with an organic matrix of glycoproteins, mucopolysaccharides, and cellular remnants.^[40]^[41]^[42] Symptoms of submandibular duct sialolithiasis often manifest as intermittent, meal-time related pain and swelling in the submandibular region due to acute obstruction and pressure buildup during salivary stimulation. Chronic cases may lead to ductal dilation, known as sialectasis, resulting in persistent gland enlargement, while secondary bacterial infection can cause acute sialadenitis with erythema, tenderness, and pus expression from the papilla.^[40]^[43]^[26] Diagnosis typically involves clinical palpation to detect the stone at the ductal orifice or along the floor of the mouth, often confirmed by expressing turbid saliva or visualizing the calculus intraorally. Risk factors include dehydration, which reduces salivary volume and flow, and medications such as anticholinergics that inhibit secretion, alongside tobacco use that promotes inflammation and debris accumulation.^[40]^[43]^[26] Management begins with conservative measures, including hydration to increase salivary flow, gentle massage of the gland, and sialogogues like lemon drops to stimulate secretion and potentially dislodge small stones (<5 mm). For persistent or larger sialoliths, interventional approaches such as sialendoscopy allow minimally invasive visualization and basket retrieval or fragmentation under direct endoscopic guidance. Intraoral removal via duct incision is employed for accessible distal stones, while impacted proximal calculi may require surgical marsupialization of the duct to the oral mucosa, preserving gland function when possible. These treatments achieve success rates exceeding 85% in resolving obstruction without resorting to gland excision.^[40]^[44]^[45]

Congenital and acquired obstructions

Congenital obstructions of the submandibular duct primarily manifest as imperforate duct or atresia, a rare developmental anomaly resulting from failed canalization during embryogenesis. This condition leads to salivary retention and cyst formation in the floor of the mouth, often presenting in neonates as a unilateral, bluish, cystic swelling along the duct's course, accompanied by feeding difficulties, excessive drooling, and distress.^[46] It exhibits a male predominance (approximately 73% of cases) and is typically unilateral (75%), with fewer than 50 documented cases in the medical literature, underscoring its rarity.^[47] Diagnosis is often clinical, supported by imaging such as MRI, which reveals a dilated tubular structure without connection to the oral cavity.^[48] Management of congenital imperforate submandibular duct focuses on restoring salivary flow while preserving gland function, typically through marsupialization of the cyst and sialodochostomy or ductoplasty to create a patent opening. These procedures are minimally invasive, performed intraorally, and yield high success rates with low recurrence, allowing rapid resumption of normal feeding.^[49] Probing and dilation may be employed in milder cases, though surgical intervention is preferred to prevent complications like secondary infection or ranula formation.^[50] Acquired obstructions arise from non-developmental causes, most commonly ductal strictures or stenosis due to chronic inflammation from bacterial sialadenitis, where pathogens such as Staphylococcus or Streptococcus ascend from the oral cavity, leading to fibrosis and narrowing.^[51] Trauma, including intubation injury or prior oral surgery, can also induce fibrotic strictures, while less frequent etiologies include allergic reactions (up to 27% of cases), autoimmune conditions (up to 17%), and post-radiation effects.^[52] These strictures account for 5-10% of submandibular duct obstructions, often presenting with recurrent painful swelling exacerbated by meals, xerostomia, foul taste, and chronic submandibular enlargement.^[51] Complications may include abscess formation or salivary fistula if untreated. Anatomical variations, such as bifid duct openings or accessory ducts, can predispose to acquired blockages by altering flow dynamics and increasing stagnation risk.^[53] For management, initial treatment of inflammatory causes involves antibiotics and supportive measures like hydration and sialagogues to promote drainage.^[54] Interventional approaches include sialendoscopy for dilation and stenting (success rates of 25-60% in submandibular cases), balloon dilatation, or corticosteroid irrigation to reduce fibrosis.^[51] In refractory instances, surgical options such as duct relocation or partial gland excision may be necessary, prioritizing gland preservation in over 90% of cases.^[55]

Diagnostic imaging

Ultrasound and sialography

Ultrasound serves as a primary, non-invasive imaging modality for evaluating the submandibular duct, utilizing high-resolution linear transducers with frequencies of 7-15 MHz to visualize the duct and surrounding structures.^[56] The normal submandibular duct appears as a thin, hypoechoic tubular structure measuring less than 3 mm in diameter, though it is often not visible under routine conditions without compression or salivary stimulation; dilation manifests as anechoic tubular enlargement exceeding this threshold, commonly due to obstruction.^[57]^[56] Sialoliths are detected as hyperechoic foci with posterior acoustic shadowing, while masses may present as hypoechoic or heterogeneous lesions altering ductal contour.^[58] The examination is performed with the patient supine, neck extended, and head turned away from the side of interest, using a high-frequency probe placed in the submandibular region along the mylohyoid muscle to trace the duct from the gland hilum to the oral orifice.^[59] Ultrasound demonstrates sensitivity of 77-94% and specificity of 95-100% for detecting sialoliths in the submandibular duct, making it a reliable first-line tool, though it is operator-dependent and less effective for deep intraparenchymal structures.^[60]^[61] Sialography remains a conventional radiographic technique for detailed assessment of the submandibular ductal system, involving cannulation of the ductal orifice at the sublingual caruncle followed by injection of iodinated contrast medium under fluoroscopic guidance to opacify the ductal tree.^[62] This procedure delineates the normal branching pattern of the duct and its tributaries, revealing abnormalities such as strictures (as focal narrowings), filling defects from calculi, or irregular contours indicative of inflammation or neoplasm.^[63] It is considered the historical gold standard for identifying subtle ductal obstructions, with sensitivity around 87% for sialoliths and high accuracy for strictures, though it requires expertise in cannulation to avoid complications like contrast extravasation or allergic reactions.^[64]^[51] Contraindications include acute sialadenitis, as injection can exacerbate infection, and iodine allergy; post-procedure films assess contrast drainage to evaluate functional patency. Compared to ultrasound, sialography provides superior intraductal detail but is invasive and involves radiation exposure, limiting its routine use.^[63]

Advanced modalities

Computed tomography (CT) serves as an advanced imaging modality for detailed assessment of the submandibular duct in complex cases, particularly when sialolithiasis or inflammatory complications are suspected. Non-contrast CT excels at identifying sialoliths due to their high density, with sensitivity for detecting calculi in the submandibular system reaching up to 96%. Contrast-enhanced CT further delineates glandular inflammation and abscesses, providing high specificity (100%) for sialolithiasis while visualizing associated soft-tissue changes not apparent on non-contrast scans. With spatial resolution typically achieving 0.5-1 mm voxel sizes in head and neck protocols, CT enables precise evaluation of ductal walls and stone localization, including those smaller than 2 mm. Magnetic resonance imaging (MRI) offers superior soft-tissue contrast for submandibular duct evaluation, utilizing T1-weighted sequences for anatomical detail and T2-weighted sequences to highlight fluid-filled structures. MR sialography, a non-invasive technique employing heavily T2-weighted single-shot fast spin-echo sequences, leverages endogenous saliva as a natural contrast to visualize the entire ductal system, including primary and secondary branches, with up to 100% depiction of branches in stimulated conditions. This method proves particularly useful for detecting mass effects from tumors or ranulas, such as ductal displacement or strictures, without the need for exogenous contrast or ductal cannulation. Emerging techniques enhance diagnostic precision in challenging scenarios. Sialendoscopy provides direct intraluminal endoscopic visualization of the submandibular duct, allowing real-time assessment of the 4-6 cm Wharton duct and its genu, with applications in stone retrieval and stenosis dilation using miniature scopes (0.8-1.3 mm diameter). Diffusion-weighted MRI facilitates differentiation of infections by quantifying apparent diffusion coefficient (ADC) values; for instance, submandibular sialadenitis shows ADC values of approximately 0.97 × 10⁻³ mm²/s, aiding distinction from neoplasms or normal tissue. These advanced modalities support critical applications, including preoperative planning for sialadenectomy, where CT or MRI assesses lymphadenopathy and adjacent structure involvement to guide gland-preserving or excisional approaches. They also detect invasive neoplasms, such as adenoid cystic carcinoma, which presents as an infiltrating submandibular mass with heterogeneous T2 signal and perineural spread on MRI. Key advantages include multiplanar reformatting in both CT and MRI for comprehensive ductal mapping, alongside MRI's radiation-free profile, which is especially advantageous in pediatric patients to minimize long-term risks.

History

Early descriptions

The earliest recorded observations of salivary gland swellings date to ancient Greece, where Hippocrates (c. 460–370 BCE) described suppurative and non-suppurative inflammation of the glands, akin to mumps, in Epidemiae Book I.^[65] Galen (c. 129–216 CE) advanced this understanding by identifying three pairs of salivary glands—the parotids, submaxillaries (submandibular), and those under the tongue—in works such as Nerve Dissection, likening them to sponges that filter and clean the blood, though he provided no details on their ducts.^[65] During the Renaissance, Andreas Vesalius (1514–1564) offered the first systematic illustrations of the submandibular gland in De Humani Corporis Fabrica Libri Septem (1543), depicting its position in Book II and using the term "salivary gland" explicitly, which implied an associated ductal structure without describing it directly.^[65]^[66] The definitive description of the submandibular duct emerged in the mid-17th century through Thomas Wharton (1614–1673), who, in his comprehensive Adenographia sive Glandularum Totius Corporis Descriptio (1656), traced the duct's path from the submandibular gland, along the floor of the mouth, to its opening at the sublingual caruncle, based on dissections of human cadavers and animal specimens such as oxen and sheep.^[67]^[66] Wharton's work established the duct's independence from lymphatic vessels and earned it the eponym Wharton's duct.^[65] Contemporaneously, Nicolaus Stensen (1638–1686) contributed to salivary anatomy in De Glandulis Oris et Novis Earundem Vasis (1661), where he examined the submandibular and sublingual glands alongside his primary focus on the parotid duct, reinforcing the glandular-ductal framework through observational dissections.^[66]^[65] Wharton's targeted elucidation of the submandibular duct, however, stood as the foundational independent account.^[67]

Modern nomenclature

The nomenclature for the duct draining the submandibular salivary gland has evolved significantly from the 19th to the 21st century, transitioning from eponymous and historical terms to more descriptive anatomical designations while retaining some traditional labels for clarity in clinical and histological contexts. In the mid-19th century, the eponym "Wharton's duct" became standardized in major anatomical references, reflecting the duct's recognition as the primary excretory pathway from the submandibular gland to the oral cavity. This term, honoring Thomas Wharton's earlier description, appeared prominently in the first edition of Gray's Anatomy (1858), where it was described as the conduit opening near the lingual frenulum, aiding in the integration of salivary anatomy into systematic medical education.^[68]^[3] By the late 19th century, histological advancements further refined understanding of the duct's structure within the salivary system. Jacob Henle's Handbuch der systematischen Anatomie des Menschen (1872 edition) incorporated the submandibular duct into detailed descriptions of salivary gland histology, emphasizing its epithelial lining and role in mixed seromucous secretion, which helped establish it as a key component of the excretory apparatus rather than an isolated vessel.^[69] In the 20th century, particularly following World War I, surgical literature emphasized pathological nomenclature tied to the duct, with Vilray P. Blair's 1923 publication on infections of salivary glands and ducts advancing techniques for parotid and submandibular pathologies, including sialography to visualize ductal strictures and stones. Blair's work standardized terms like "ductal pyogenic infection" in oral-maxillofacial surgery texts, bridging anatomy and clinical intervention. By the mid-20th century, the preferred term shifted toward "submandibular duct" in descriptive contexts, as seen in radiological and surgical references, to prioritize positional accuracy over eponyms.^[70]^[71] Contemporary nomenclature in the 21st century favors descriptive terms such as "submandibular excretory duct" in some histological and imaging guidelines, reflecting a broader movement away from eponyms to enhance international consistency, as proposed in reviews clarifying salivary gland terminology. The World Health Organization's classifications of salivary gland tumors (updated in the 2000s and 2010s) employ these descriptive labels for ductal involvement in neoplasms and anomalies. Recent genomic research has linked FGFR2 mutations to submandibular ductal malformations, as demonstrated in 2018 mouse models of Apert syndrome showing impaired gland development and ductal hypoplasia, informing molecularly precise terminological distinctions in congenital disorders.^[72]^[73]^[74] The etymological roots underscore this evolution: "submandibular" derives from Latin sub- (beneath) and mandibula (jaw), denoting the gland's inframandibular location, while "duct" stems from ductus (a leading or conducting channel), emphasizing its functional role in saliva transport.^[4]^[75]

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Duct of Rivinus | Radiology Reference Article | Radiopaedia.org
Aug 30, 2025 · The duct of Rivinus, also known as the minor sublingual duct, drains saliva from the sublingual gland into the floor of the mouth.Missing: integration | Show results with:integration<|separator|>
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The Sublingual Gland - Structure - Vasculature - TeachMeAnatomy
Secretions drain into the oral cavity by minor sublingual ducts (of Rivinus) ... Drainage then follows the submandibular duct out through the sublingual papillae.Missing: integration | Show results with:integration
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Physiology, Pathology and Regeneration of Salivary Glands - PMC
They will then acquire smooth muscle characteristics and locate in direct contact with the acinar structure to regulate the release of secretion [11]. Inner ...2. Salivary Gland Anatomy... · 3. Chemistry Of Secretion... · 4. Salivary Gland DisordersMissing: propulsion | Show results with:propulsion
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Oral Microbial Ecology and the Role of Salivary Immunoglobulin A
A group of salivary proteins, lysozyme, lactoferrin, and peroxidase, act in conjunction with other components of saliva to limit the growth of bacteria or kill ...
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Sialolithiasis - StatPearls - NCBI Bookshelf - NIH
Sialolithiasis is a benign condition involving the formation of stones within the ducts of the major salivary glands: parotid, submandibular, and sublingual ...Missing: composition | Show results with:composition
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Current opinions in sialolithiasis diagnosis and treatment - PMC - NIH
The most common localization is the submandibular gland where 92% of calculi are found, the duct being more frequently affected than the parenchyma. The parotid ...Missing: prevalence | Show results with:prevalence
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Identification of biological components for sialolith formation ...
Jul 28, 2023 · This study is aimed to identify the biological components of sialolith, which show different ultrastructures and chemical compositions from other stones, ...
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Contemporary Review of Submandibular Gland Sialolithiasis ... - NIH
Aug 18, 2022 · Other risk factors commonly attributed to salivary gland stone formation include dehydration and smoking, use of diuretics and anticholinergic ...
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Sialendoscopy for salivary stones: principles, technical skills and ...
Initial treatment of obstructive sialadenitis is usually conservative with hydration, salivary flow stimulation, antiinflammatory medication and antibiotics ...
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Intraoral microscopic‐assisted sialolithotomy for management ... - NIH
Mar 4, 2024 · Sialendoscopy has become the standard treatment for sialolithiasis; however, larger submandibular calculi may require an incisional technique.
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Developmental Anomalies of Salivary Glands - Frontiers
Jul 2, 2019 · Parotid gland produces almost exclusively serous saliva, while submandibular and sublingual glands produce both serous and mucous secretions ( ...
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[PDF] A Systematic Review - B-ENT
Apr 16, 2025 · ABSTRACT. Congenital submandibular duct atresia (CSMDA) is a rare congenital oral lesion that appears as a cystic swelling along the course ...Missing: incidence | Show results with:incidence
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Congenital abnormalities of the submandibular duct - PubMed
The diagnosis of congenital anomalies of the submandibular gland and duct can be made on physical examination. Magnetic resonance imaging can be helpful.Missing: incidence symptoms
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Treatment of imperforate submandibular duct: A systematic literature ...
This systematic review aimed to characterize treatments and outcomes for management of imperforate submandibular ducts while describing 2 new cases.
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Sialodochostomy as treatment for imperforate submandibular duct
The preferred treatment for ranula is a complete excision of the cyst with or without removal of the adjacent salivary gland, as there is high potential for ...
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Salivary duct stenosis: diagnosis and treatment - PMC
This review article aims to give an overview on the epidemiology, diagnostics and current state of the art of the treatment of salivary duct stenoses.
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Etiology of Salivary Duct Stenosis (Parotid Duct Stricture
Dec 28, 2020 · Salivary duct stenosis is a common cause of obstructive sialadenitis - with a stricture defined as a narrowing in the duct sufficient to ...
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Submandibular Gland Duct Strictures - Ento Key
Feb 24, 2020 · The vast majority of submandibular strictures are idiopathic. One explanation is that diminished salivary flow eventually causes atrophy of the ...
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Sialadenitis - Symptoms, diagnosis and treatment - BMJ Best Practice
Jul 19, 2022 · Sialadenitis is the inflammation and enlargement of one or several major salivary glands. It most commonly affects parotid and submandibular glands.
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Etiology, diagnosis, and surgical management of obstructive salivary ...
This paper presents a review on the four main etiologies of salivary gland obstruction, appropriate diagnostic workup, and medical and surgical management of ...Missing: acquired | Show results with:acquired
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Standards for the assessment of salivary glands – an update - PMC
Ultrasound is currently the most useful technique for salivary gland imaging. The glands are routinely evaluated for their size, shape as well as ...
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High-resolution real-time ultrasonography of the submandibular ...
It is possible to define the entire gland and portions of its duct, which measures less than 3 mm in diameter. Adjacent structures are easily seen and are ...
[55]
Submandibular Sialolithiasis: The Roles of Radiology in its ... - NIH
In addition, the submandibular duct is longer and the gland has an antigravity flow.[2] It should be noted that stone formation in the salivary glands is ...Missing: dynamics tortuous path
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Point-of-care Ultrasound Diagnosis of Acute Sialolithiasis with ... - NIH
Place the high-frequency, linear probe in the submandibular region underneath the body of the mandible and scan along the mylohyoid muscle, anterior to the ...
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How Reliable Is Sonography in the Assessment of Sialolithiasis? | AJR
Jun 21, 2013 · The overall sensitivity, specificity, accuracy, and positive and negative predictive values of sonography in the detection of calculi were 77%, ...
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Accuracy of Ultrasonography and Computed Tomography ... - PubMed
Objective To determine the accuracy of the 2 most utilized imaging modalities in obstructive sialadenitis secondary to sialolithiasis-computed tomography ...<|control11|><|separator|>
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Salivary Duct Intervention - PMC - PubMed Central - NIH
Conventional sialography is performed by obtaining control radiographs, then manually injecting a small quantity of iodinated contrast medium into the salivary ...
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Salivary gland calculi – contemporary methods of imaging - PMC - NIH
Thirty per cent of the calculi are located near the opening of the submandibular duct, and 20% in its medial part [1,8,12]. Sjögren's syndrome and sarcoidosis ...
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Sialoendoscopy, sialography, and ultrasound: a comparison of ... - NIH
Sialography, which is characterized by examination of the duct with contrast medium, is nowadays considered obsolete in many cases [5, 6]. However, it remains ...Missing: fluoroscopy | Show results with:fluoroscopy
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Uma breve história da cirurgia das glândulas salivares - SciELO
He described and recognized the salivary glands and gave them their correct importance in his Atlas "De Humani Corporis Fabrica Libre Septem" in 1543; he ...
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The historical evolution of the understanding of the submandibular ...
Next, we look at the discovery and description of the submandibular gland's duct by Thomas Wharton (1614-1673) in his landmark book, Adenographia sive ...
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Thus, we can say that the real human anatomy that we have been developing since then dates from Vesalius. Whatever precedes Vesalius can be considered as an ...
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Anatomy : descriptive and surgical : Gray, Henry, 1825-1861
May 23, 2011 · Anatomy : descriptive and surgical. by: Gray, Henry, 1825-1861. Publication date: 1858. Topics: Human anatomy, Anatomy. Publisher: London : J.W. ...Missing: Wharton's duct
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Handbuch der systematischen Anatomie des Menschen.
Nov 23, 2015 · Handbuch der systematischen Anatomie des Menschen. Bd. 3, Abth. 1. Knochenlehre. 3. Aufl. 1871. Abth. 2. Bänderlehre. 2. Aufl. 1872.Missing: salivary glands
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https://archive.org/details/anatomydescripti1858gray
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Vilray P. Blair, his surgical descendants, and their roles in plastic ...
Blair's efforts in the early part of this century helped to develop plastic surgery as a distinct surgical subspecialty in the United States. His prowess as a ...Missing: salivary gland 1920s<|separator|>
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Diagnosis and Treatment of Diseases of the Salivary Glands
4. V.P. Blair, E.C. Padgett. Pyogenic Infection of Parotid Glands and Ducts. Arch. Surg, 7 (July 1923) ...
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Clarification of the terminology of the major human salivary glands
Jun 6, 2014 · The most appropriate terminology for the major human salivary glands would be: (1) the parotid gland, entirely serous, should be called compound acinar glands.
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Salivary gland pathologies: evolution in classification and ...
Jul 13, 2023 · The following review examines all changes from the first World Health Organization (WHO) Classification of salivary gland pathologies from 1972 to fifth ...Missing: IAOMS IFHWS 2000s
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Maldevelopment of the submandibular gland in a mouse model of ...
Sep 25, 2018 · Maldevelopment of SMGs due to a gain-of-function mutation in FGFR2. Increase in the number of macrophages in SMGs of Ap mice.
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SUBMANDIBULAR Definition & Meaning - Merriam-Webster
The meaning of SUBMANDIBULAR is of, relating to, situated in, or performed in the region below the lower jaw. How to use submandibular in a sentence.