Innervation of the tubarial glands: A hypothesis-driven anatomical review

The tubarial glands have been described as a macroscopic bilateral glandular complex in the posterolateral nasopharynx near the torus tubarius and the pharyngeal opening of the Eustachian tube. Since their recognition on prostate-specific membrane antigen-based imaging, their anatomical classification has remained debated, with converging histologic and macroscopic data supporting a dense, organized glandular entity that shares multiple features with minor mucous salivary glands while demonstrating distinctive drainage patterns. In contrast to the expanding anatomical and structural literature, the neural control of these glands has not been directly investigated. No tubarial-specific neural tracing studies, dedicated innervation immunophenotyping, or three-dimensional nerve-gland mapping investigations have been reported. Here, we develop an evidence-graded, falsifiable model of tubarial gland innervation by integrating classical autonomic neuroanatomy, microanatomical organization of the pterygopalatine fossa, and contemporary structural observations. We hypothesize that tubarial secretion is regulated by parasympathetic secretomotor drive via the greater petrosal nerve and pterygopalatine ganglion, sympathetic modulation via the superior cervical ganglion through the deep petrosal/vidian pathway, putative intrinsic mucosal microganglia within the nasopharyngeal lamina propria, and sensory-autonomic coupling via trigeminal afferents. This framework provides concrete predictions for validation using human tissue immunophenotyping, three-dimensional nerve mapping, and experimental tract-tracing models. Clarifying these circuits may refine the interpretation of regional dysfunction and guide future translational studies.