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Incidence and histology of human accessory parotid glands.

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THE ANATOMICAL RECORD 236:586-590 (1993)
Incidence and Histology of Human Accessory Parotid Glands
HIDETOSHI TOH, JUN KODAMA, JINICHI FUKUDA, BARRY RITTMAN,
AND IAN MACKENZIE
Second Department of Oral Anatomy, Fukuoka Dental College (H.T., J.K.), Department
of Dentistry and Oral Surgery, School of Medicine (J.F.), Fukuoka University,
Fukuoka, Japan; University of Texas Health Science Center, Dental Branch, Houston,
Texas (B.R., I.M.)
ABSTRACT
The parotid glands of 228 Japanese human cadavers were
examined to determine the incidence and histological features of accessory
parotid glands. The incidence was found to be 56% with no differences
between right and left sides or between sexes. Thirty parotid glands and
their associated accessory glands were examined histologically: eight of
these accessory glands were found to be mixed secretory glands (i.e., containing both serous and mucous acini).Thus, the pattern of differentiation
of a significant fraction of accessory glands differs from that of the main
parotid gland: it appears that mixed acini, present in the early stages of
development, persist into later life, and their presence may be related to
tumors developing at these sites. o 1993 Wiley-Liss, Inc.
Key words: Accessory parotid glands, Japanese, Adult human
Since the end of the last century, many reports have
described the anatomical and histological features of
the normal human parotid gland (Jonnesco and Juvara, 1896; Testut and Jacobs, 1905); and the presence
of accessory parotid glands, which are collections of
salivary tissue separate from the main gland and located on the anterior portion of the masseter muscle, is
well established (Ogawa, 1918; Batsakis, 1988; Ellis et
al., 1991). Studies of accessory parotid glands have reported their incidence t o range from 21% (Frommer,
1977)to 69% (Toh et al., 1984)and have described their
histology (Frommer, 1977; Toh et al., 1984; Takeda et
al., 1985). Human accessory parotid glands are generally regarded as serous in nature, but Zimmermann
(18981, Akiyoshi (1929), and Takeishi (1966) have indicated the presence of both mucous and serous acini in
the newborn parotid, and Toh et al. (1984) and Takeda
et al. (1985) have reported that accessory parotid
glands in the adult may also contain both mucous and
serous acini. The presently described work investigated a series of 228 pairs of Japanese human parotid
glands to provide better data concerning the incidence
and histologic features of accessory parotid glands.
MATERIALS AND METHODS
The accessory parotid glands studied were derived
from dissection of 107 male and 121 female Japanese
cadavers (Table 1). From the 128 cadavers showing the
presence of accessory glands, 30 main parotid glands,
together with the accessory parotid glands, were removed and the glandular capsule carefully stripped
free, keeping the facial nerve and blood vessels intact.
Specimens were refixed in 10% neutral formalin, processed to paraffin wax for sectioning at 6 pm, and
stained for examination by light microscopy with hematoxylin-eosin, with Azan trichrome (Cason, 19501,
and with mucicarmine (Lillie, 1965).
0 1993 WILEY-LISS, INC.
RESULTS
Morphology
Figure l a illustrates the common appearance of a
human accessory parotid gland as a small gland separated from the main parotid gland and lying above the
parotid duct. The accessory glands are usually round or
ellipsoidal in shape (Fig. lb,c) but occasionally may be
triangular (Fig. Id) or of indeterminate shape (Fig. le).
Seven of the glands examined showed very small “ricelike” accessory glands lying on or above the duct (Fig.
If) and at the buccinator side of the anterior border of
the masseter muscle without being covered by the buccal fat pad (Fig. 2). Generally, accessory parotid glands
lie on the masseter muscle, with the zygomatic and
buccal branches of the parotid plexus of the facial nerve
being found both within the lobes and overlying them
as a net-like covering (Fig. 3). Branches of the transverse facial artery are usually buried in the lobes of the
accessory glands and there is a clear boundary between
the main parotid gland and the accessory glands. The
“rice-like” glands showed no consistent relationship to
either the parotid plexus of the facial nerve or the
transverse facial artery.
incidence
Table 2 shows the incidence of accessory parotid
glands. Of the 228 cadavers examined, 32 cadavers
(14%) showed accessory parotid glands on both sides,
52 (23%)on the left side only, and 44 (19%)on the right
side only. The incidence of accessory parotid glands in
males was 55% and glands were present on both sides
in 13%, on the left side only in 21%, and an the right
Received August 27, 1992; accepted December 22, 1992.
Address reprint requests to Dr. Ian C. Mackenzie, University of
Texas Health Science Center, Dental Branch, P.O. Box 20068, Houston, TX 77225.
ACCESSORY HUMAN PAROTID GLANDS
TABLE 1. Age and sex distribution
Age
30-39
40-49
50-59
60-69
70-79
80-89
90-99
2100
Total
Male
Female
3
16
45
37
5
107
Total
1
0
1
3
6
22
34
63
17
1
79
100
121
228
22
1
Fig. 1. Illustrations of the variable morphology of accessory parotid
glands (arrows). a: Typical accessory parotid gland, male aged 84
years. b: Round shape, female aged 77 years. c: Ellipsoidal shape,
female aged 83 years. d: Triangular shape, female aged 83 years. e:
587
side only in 21% of the cadavers. The incidence in females was 57%,with the presence on both sides at 15%,
the left side only 25% and the right side only 17%.
Histologic Features
The 30 parotid and accessory parotid glands that
were stained with hematoxylin-eosin and with Trichrome stain showed the presence of serous cells and
fat cells. However, right accessory parotid glands, unlike the main parotid glands, showed characteristic
mucous cells with light cytoplasm and nuclei com-
Indeterminate gland, female aged 66 years. f: Rice-like shape, male
aged 71 years. D: duct; F: facial artery; N: facial nerve; 0: obicularis
oculi; P: parotid gland; Z zygomaticus minor and major.
H. TOH ET AL.
588
Fig. 2. A deeply lying accessory parotid gland (arrow) a t the buccinator side of the anterior border of the masseter muscle. Female aged
89 years.
pressed toward the base (Fig. 4a). The cytoplasm of
these cells showed strong staining with mucicarmine,
further evidence of their mucous nature. The mixed
nature of the accessory parotid glands was also indicated by the presence of serous demilunes and goblet
cells in the striated duct epithelium (Fig. 4b).
DISCUSSION
The reported incidence of accessory parotid glands
ranges from 21% (Frommer, 1977) to 69% (Toh et al.,
1984) and is generally regarded to be below 50%. The
high percentage found in the present and previous
studies by this group is believed to be the result of
detailed examination of a greater number of samples.
In particular, the existence of “rice-like” accessory
glands at the front edge of the masseter muscle close to
the fat pad must be taken into account when studies of
the incidence of accessory parotid glands are undertaken.
The anterior processes of parotid glands are described in older textbooks (Testut and Jacobs, 1905;
Jonnesco and Juvara, 1896,) as lobes protruding to the
front edge of the masseter muscle. Ao and Okada
(1965) and Toh et al. (1984) noted that more than half
of the accessory parotid glands were either round or
triangular in shape and that all showed anastomosis of
the zygomatic and buccal branches of the facial nerve
buried within them. Most accessory parotid glands
showed a net-like covering by this nerve.
The rapid embryonic development of the anterior
processes of the parotid gland may influence the size
and distribution of the developing facial nerve. During
development the parotid plexus of the facial nerve
branches extensively and the parotid duct lies under
the anastomosis of its buccal branch. According to McCormack et al. (1945),there is usually anastomosis between the zygomatic and buccal branches of the facial
nerve on the fat pad a t the anterior edge of the masseter muscle with only 13% of facial nerves lacking
anastomosis of the zygomatic and buccal branches.
Gasser (1970) reported the presence of accessory parotid glands in the 8-week human fetus (27 mm CR
length): these were considered to be extensions of the
main gland and might therefore be expected to have a
similar cellular composition, i.e., to be serous in na-
Fig. 3. Accessory parotid glands (arrows) surrounded by a rich network of the parotid plexus of the
facial nerve. a: Male aged 78 years. b Male aged 91 years,
TABLE 2. Frequency of the accessory parotid glands
Subjects
M
F
Totals
N
R
(%I
107
121
228
23
21
(21)
(17)
(19)
44
L
22
30
52
(%I
Both
(%)
(21)
(25)
(23)
14
18
(13)
(15)
(14)
32
Total 70
55
57
128
ACCESSORY HUMAN PAROTID GLANDS
589
Fig. 4. Photomicrographs of accessory parotid glands showing mucous (MA) and serous (SA) acini,
several intralobular striated ducts (D), fat cells (F), and serous demilunes (arrows). a Female aged 85
years. H & E stain. b: Male aged 77 years. Mucicarmine stain.
ture. However, the present study confirms previous reports of the presence of mixed acini both in the adult
(Zimmermann, 1927; Du Plessis, 1957; Evans and
Cruikshank, 1970; Iwata et al., 1977; Komori et al.,
1979; Toh et al., 1984; Takeda et al., 1985) and in the
terminal portion of newborn human accessory parotid
glands (Zimmermann, 1898). According to Taga and
Sesso (1979), the rat parotid gland also has mixed acini
during its early development.
The surgical anatomy of accessory parotid glands is
of importance in several clinical situations. For example, failure of removal of involved accessory glands
may be associated with recurrence of neoplastic lesions
(Ellis et al., 1991) or sialadenitis (Ferguson and McDonald, 1978). Further, the cellular composition of the
accessory glands may differ from that of the main
gland and this too could be of clinical significance;
more work is needed to clarify the extent to which
mixed acini persist from the fetal stage of development
and about the cells of origin of salivary tumors (Batsakis et al., 1989). However, the most common epithelial tumors arising in the salivary glands of children
are benign pleomorphic adenomas and mucoepidermoid carcinomas (Kamori, 1977; Greer et al., 1983; Ellis et al., 1991), and the mixed acini persisting from the
early stages of development could influence the patterns of development of such tumors.
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