88. Salivary glands Flashcards
List the four major salivary glands
- Parotid
- Mandibular
- Sublingual
- Zygomatic
The parotid gland is superficial to the …
Vertical ear canal and is triangular shaped
The parotid gland is bordered:
1. Rostrally by…
2. Caudally by…
3. Ventrally by…
4. Superficially by..
- Rostrally by the masseter muscle and the temporomandibular joint
- Caudally by the sternomastoideus and cleidocervicalis muscles
- Ventrally by the mandibular salivary gland
- Superficially by the parotidoauricularis and platysma muscles
The parotid gland is covered by a thin capsule that blends with deeper surrounding structures. Name 7 of these structures.
The intimate association of the parotid capsule and gland with surrounding structures creates a challenging dissection for complete removal of the parotid salivary gland.
- Facial nerve
- Maxillary artery
- Temporal artery
- Internal maxiallary vein
- External acoustic meatus
- Stylomastoid foramen
The stylomastoid foramen transmits the facial nerve, and the stylomastoid artery.
The parotid duct is formed by two or three converging ductules on the ventrorostral border of the gland.
1. Where does it travel?
2. Where does is open?
It travels over the lateral aspect and ventral third of the masseter muscle and opens into the oral cavity through a small papilla at the level of the upper fourth premolar.
Where is an accessory parotid gland found?
Accessory parotid gland in the form of glandular lobules
Dorsal to the parotid duct.
Where does the accessory parotid gland tissue empty into ?
Directly into the main parotid duct through several small communications.
What is the arterial supply to the parotid gland?
Parotid artery a branch of the external carotid artery.
Several other small branches from surrounding arteries also contribute to its perfusion.
Describe the location to identify the parotid artery
ID: the medial aspect of the parotid gland in the region *ventral *to the external ear canal
Name the venous return from the parotid gland
Superficial temporal and great auricular veins
The majority of the lymphatic flow from the parotid gland is directed toward which two lymph nodes.
- Parotid lymph node
- Medial retropharyngeal lymph node
Describe the location of the zygomatic gland
In reference to the globe and zygomatic arch
Located in the periorbital area just **ventral and rostrolateral **to the globe and medial to the zygomatic arch
How many major and minor ducts come from the zygomatic gland into the oral cavity?
One major
Four minor
Where does the zygomatic gland major duct open into the oral cavity?
Caudolateral aspect of the last upper molar
Typically the zygomatic papilla is approximately 1 cm caudal to the parotid salivary papilla.
True or false?
True
What artery supplies the zygomatic gland?
A branch of the infraorbital artery
Name the vein draining the zygomatic salivary gland
Deep facial vein
Name lymph node that zygomatic gland drain
Medial retropharyngeal lymph node
Mandibular and sublingual salivary gland are seperated by the sublingual muscle. True or false?
False
Intimately associated and thus considered anatomically as a pair.
These two glands share a common capsule and can initially look like a single gland
The mandibular salivary gland can be palpated.
True or false?
True
Large, palpable gland located caudomedial to the angle of the mandible
Describe the location of the mandibular salivary gland
In relation to veins, lymph nodes and anatomic land marks
It lies on the medial aspect of the **linguofacial and maxillary vein junction. The mandibular lymph nodes lie on its ventral surface and the medial retropharyngeal lymph node** and** larynx** on its **medial **surface.
Its cranial border abuts the primary portion of the sublingual salivary gland.
Where does the mandibular salivary duct exit on the gland?
On the glands medial surface.
Describe the course of the mandibular salivary duct
Continues rostrally, medial to the sublingual salivary gland and horizontal ramus of the mandible. Under the oral mucosa, it travels between the styloglossus and mylohyoideus muscles until it exits into the oral cavity
oral cavity: sublingual caruncle lateral to the lingual frenulum
Where does the mandibular salivary gland enter into the oral cavity?
Sublingual caruncle lateral to the lingual frenulum
Name the major blood supply to the mandibular salivary gland
Glandular branch of the facial artery
Other small arteries and veins may be present
Name the venous drainage from the mandibular salivary gland
Branch of the lingual vein
Other small arteries and veins may be present
Name the lymph nodes the mandibular salivary gland drains to
Retropharyngeal lymph nodes
The sublingual salivary gland is composed of monostomatic and polystomatic portions.
True or false?
Monostomatic glands deliver saliva to a distant site through a singular duct, whereas polystomatic glands produce saliva locally through multiple openings adjacent to the saliva-producing glands
True
Which portion of the sublingual salivary gland is found in the capsule shared by the mandibular salivary gland?
Largest and most caudal component of the monostomatic portion
It has a large portion that abuts the mandibular salivary gland and tapers to a triangular shape rostrally
Describe the sublingual salivary gland location external to the capsule
The gland continues rostrally in close association with the mandibular duct but is packaged in loose clusters of glandular tissue deep to the digastricus and mylohyoideus muscles
Sublingual salivary tissue caudal to the lingual nerve empties into the ……..duct and is considered a ……….stomatic salivary gland.
Sublingual salivary tissue caudal to the lingual nerve empties into the sublingual duct and is considered a monostomatic salivary gland.
Sublingual salivary gland: The polystomatic salivary tissue consists of small clusters of glandular tissue rostral to the lingual nerve that typically empty directly into the oral cavity.
True or false?
True
The major sublingual salivary duct courses where?
Alongside the mandibular duct
The major sublingual salivary duct usually exits where?
At the sublingual caruncle just caudal to the mandibular duct.
The monostomatic portion of the sublingual salivary gland receive blood supply from where?
The glandular branch of the facial artery
The polystomatic portion of the sublingual salivary gland receive blood supply from where?
The sublingual branch of the lingual artery
Name sublingual salivary gland venous drainage
Satellite veins
Lymphatics from the sublingual salivary gland drain to the?
Medial retropharyngeal lymph nodes
What are minor salivary glands?
Small collections of salivary tissue surrounding the oral cavity that drain their secretions directly into the oral cavity to keep it moist
Name SIX minor salivary glands
- Buccal
- Labial
- Lingual
- Tonsillar
- Palatine
- Molar
Salivary gland disease is rarely reported with the minor salivary glands.
Open-mouth view in an anaesthetised cat. What is circled?
The membranous molar pad (circled) containing the molar gland, lingual to the molar tooth
Name functions of saliva
(six)
- Lubricate ingesta - facilitate packaging of a food bolus for its passage down the oesophagus
- Thermoregulation (evaporative cooling)
- Oral cavity cleansing
- Buffering of weak acids
- Reduction of oral bacterial growth
- Protection of surface epithelium in the oral cavity
Salivary α-amylase in dogs and cats plays a significant role in carbohydrate digestion.
True or false?
False.
Unlike in other species, salivary α-amylase in dogs and cats does not play a significant role in carbohydrate digestion.
Describe the pathway of saliva from the acinus to the major excretory ducts
Saliva travels from the acinus to the** intercalated ducts**, then to the intralobular ducts, interlobular ducts, lobular ducts, and finally the major excretory ducts
The acinus, or the terminal salivary gland unit, produces saliva that travels into the intercalated ducts. These ducts coalesce to form the intralobular ducts, which flow into interlobular ducts, lobular ducts, lobar ducts, and finally the major excretory ducts.
What are the two types of cells found in most salivary glands?
Histologically, most salivary glands consist of a combination of serous and mucus-producing cell
Define acinus in the context of salivary glands
The acinus is the terminal salivary gland unit that produces saliva
Parotid? Mandibular? Sublingual? Zygomatic?
Which glands produce more serous secretions?
Parotid and Mandibular
Evaluation of the location and viscosity of the aspirated fluid may therefore provide clues in identifying the offending gland.
Which glands produce mucus secretions?
Higher propotion of mucus
Sublingual and Zygomatic
Evaluation of the location and viscosity of the aspirated fluid may therefore provide clues in identifying the offending gland.
Saliva undergoes two phases before excretion into the oral cavity. What happens in phase 1?
Phase one: begins with production of saliva within the acinus. The acinar cells absorb Na+ , which helps to draw water in, creating sodium-rich saliva. After the saliva flows into the collecting ducts
Saliva undergoes two phases before excretion into the oral cavity. What happens in phase 2?
Phase two begins, with active reabsorption of Na+ and secretion of HCO3 − and K+. This process occurs mainly in the** intralobular duct epithelium**, which is formed by tall columnar epithelial cells
Saliva excreted into the oral cavity is rich in …………
**HCO3 − and K+ **
Which nervous system provides the majority of nervous control of the salivary glands?
Autonomic nervous system
Split into the parasympathetic and sympathetic
Stimulation of the parasympathetic nervous system increases production of saliva by which two methods?
- Vasodilation of the blood supply
- Stimulation of cyclic guanosine monophosphate (cGMP)
cGMP directly upregulates the activity of the acinar cell
Parasympathetic supply travels mainly via which nerves?
For salivary excretion
- Facial
- Mandibular
True or false: Sympathetic stimulation of the salivary gland causes major inhibition in sallivary flow.
False: Sympathetic stimulation of the salivary glands causes minor inhibition in salivary flow, after an initial increase from contraction of the myoepithelial cells
Sialadenosis cause is typically….
noninflammatory, nonneoplastic, bilateral swelling of the salivary gland
Non surgical salivary gland disease
Unknown
The cause is unknown
Sialadenosis more commonly affects which gland?
Mandibular salivary gland
Clinical signs: retching, gulping, lip smacking, hypersalivation and weight loss…whats the possible diagnosis?
In canines
Sialadenosis
True of fasle: Sialadenosis affected glands are enlarged and typically painful
False. Affected glands are enlarged and typically nonpainful
Describe histological changes to sialadenosis affected glands
Affected glands show minimal to no changes.
Abnormalities of the ….. are occasionally identified in conjuction with sialadenosis
Part of the gastrointestinal tract
Eosophagus
How do you diagnose sialadenosis?
Usually based on exclusion of other causes
What treatment has been sucessful for sialadenosis, and why?
- Phenobarbital (1-2 mg/kg PO q12h)
- May improve clinical signs within 1 to 2 days
- *Response *to phenobarbital and detection of abnormalities on electroencephalography may support a diagnosis of** limbic epilepsy**
Lifelong phenobarbital therapy may be required.
Clinical signs are not alleviated by glucocorticoids, antibiotics, or surgical removal of the affected gland(s).
Salivary glands can develop inflammation that occasionally progresses to glandular necrosis and ductal metaplasia - what is this called?
Noninfectious Sialadenitis and Necrotizing Sialometaplasia
What clinical signs differentiate Noninfectious Sialadenitis/Necrotizing Sialometaplasia FROM Sialadenosis
Name 2
- Pain on palpation of glands
- Vomiting
Name a typical breed predisposed to: Noninfectious Sialadenitis and Necrotizing Sialometaplasia
Terrier breeds
True of false: Cytology is appropriate is diagnosis of noninfectious sialadenitis and necrotizing sialometaplasia
False: cytologic changes can be confused with inflamed, neoplastic glands, the diagnosis is based on histologic findings
Name the diagnosis: histologic findings of lobular necrosis, inflammation, squamous metaplasia, infarction, and hypertrophy of ductal epithelium
Sialadenitis and necrotizing sialometaplasia
Noninfectious Sialadenitis
What is the theorised link between esophageal or gastrointestinal disease concurrently with necrotizing salivary gland disease?
Hyperstimulation of the vagus nerve, resulting in a neural reflex syndrome similar to that seen with hypertrophic osteopathy, except that the salivary glands are the efferent target organ instead of the periosteum.
Resulting in a neural reflex syndrome similar to that seen with hypertrophic osteopathy, except that the salivary glands are the efferent target organ instead of the periosteum
True or false: Treament for sialadenitis and necrotizing sialometaplasia should be focused on addressing any oesophageal disease present as well as a trial of phenobarbital
True: Response to phenobarbital has been reported, which supports limbic epilepsy as a potential cause. Surgical removal of the affected salivary gland(s) and medical management with steroids and antibiotics alone do not appear to consistently resolve the clinical signs
Therefore treatment should be focused on addressing any esophageal disease present, as well as a trial of phenobarbital.
Define sialocele
Collections of saliva within subcutaneous tissue
True or false: Sialocele is a type of cyst
False: saliva-filled cavities are lined by inflammatory connective tissue and are not true cysts
What is the most common source of saliva leakage in sialocele formation?
Sublingual salivary gland or duct
Name 4 causes of sialoceles
- trauma (nonsurgical and surgical)
- sialoliths
- foreign bodies
- neoplasia
- majority have an unknown cause
Name the sialocele location based on exophthalmos
Zygomatic sialocele
Name 4 breeds predisposed to sialoceles
- Poodles
- German shepherds
- Australian silky terriers
- Dachshunds
No sex predisposition has been consistently identified
Name the sialocele location based on laboured breathing
Pharyngeal sialocele
Name the sialocele location based on dysphagia
Sublingual sialocele or ranula
Name the sialocele location based on intermandibular or cranioventral cervical swelling
Cervical sialocele
Name the diagnosis: Fluid-filled mass, contains a viscous, honey-colored, clear or blood-tinged fluid
Sialocele
Whats the diagnosis?
Sialocele
* small-moderate numbers of nondegenerate nucleated cells
* diffuse/irregular clumps of homogenous pink/violet staining mucin
* macrophages may contain abundant, foamy cytoplasm
* mucin-specific stain: periodic acid–Schiff
Name the mucin-specific stain
periodic acid–Schiff
Where is sialocele? What is the choice of treament?
Exophthalmos, protrusion of the third eyelid, painless orbital swelling
Zygomatic.
* Sialadenectomy.
* Use of a sclerosing agent has also been proposed.
Where is sialocele? What is the choice of treament?
Swelling caudal dorsal or lateral pharynx, just rostral to the level of the epiglottis. Labored breathing or stridor
**Pharyngeal. **
* Acute obstruction - immediate drainage (via incision) or temporary tracheostomy.
* After stabilisation redundant tissue resected and sialocele marsupialized. The origin of the sialocele (sublingual and mandibular salivary gland and duct complex), should also be removed.
Name the predominant breed and sex for pharyngeal sialoceles
Miniature poodles and male dogs
Paper reported concurrent ipsilateral cervical sialoceles with pharyngeal sialoceles in what percentage of affected dogs?
1. 23%
2. 33%
3. 43%
4. 54%
- 43%
Benjamino KP, Birchard SJ, Niles JD, et al: Pharyngeal
Mucoceles in Dogs: 14 cases. J Am Anim Hosp Assoc 48:
31–35, 2012.
Name the sialocele
Sublingual: AKA ranula
How do you treat a sublingual sialocele?
- Removal of the ipsilateral mandibular and sublingual salivary gland and duct complex (especially rostral glandular tissue).
- Along with sialadenectomy, the ranula should be drained and marsupialized into the oral cavity.
Where does a ranula leak from?
Leakage of the rostral sublingual salivary glands or duct
Name the sialocele
Swelling in the intermandibular or cranioventral cervical region
Cervical
True of False: Conservative treatment of sialoceles is not recomended due to high rate of recurrence
True: Conservative treatment is not recommended for definitive treatment because of the high rate of recurrence
What is the prognosis following sialedectomy?
Excellent when the affected salivary gland and duct are removed entirely.
Name 5 postoperative complications following sialedanectomy
- Seroma
- Infection
- Recurrence
- Sublingual swelling
- Bleeding
True or False: Placement of drains into the sialocele does decrease the risk for seroma formation
False: Placement of drains into the sialocele does not decrease the risk for seroma formation
What is the recurrence rate following sialedenectomy and why?
5% or less and usually results from incomplete removal of the affected gland(s) or removal of the wrong gland
Name how using the following methods you can identify a gland causing a sialocele:
1. Physical
2. Imaging
3. Surgery
- Physical: Chronic intermandibular cervical sialoceles - place in dorsal recumbency under GA, the fluid accumulation usually displaces laterally to the affected side
- Imaging: Sialography, CT, MRI
- Exploratory surgery: affected glands are usually adherent to the inner or outer wall of the mucocele capsule. If any question remains, bilateral sialadenectomy can be performed.
True of false: Dry mouth is an expected consequence following sialadenctomy
False: Because of the redundancy in saliva production from multiple glands, dry mouth is not expected after bilateral procedures
Where are sialoliths commonly associated?
Rarely reported. Most often associated with the parotid duct but have also been reported in the mandibular sublingual duct complex
Name 4 sialolith compositions:
7 available
- calcium
- oxalate
- phosphate
- magnesium
- carbonate
- ammonium
- nonmineral proteinaceous material
Stone-like structures identified within a sialocele composed of a proteinaceous material are not true sialoliths; rather, they are thought to be mineralized folds of sialocele lining that have sloughed into the sialocele.
Whats the diagnosis? Swelling on the lateral aspect of the face that may be painful and may regress and then reoccur.
Parotid sialolith
Diagnosis of a sialolith can be based on 3 things, name them.
- Palpation
- Radiographs
- CT
Treatment depends on location of the sialolith, presence of infection or stone, ease of duct and gland removal, suspicion of future duct stricture or fibrosis, and likelihood of stone recurrence. Name 4 different surgical technique options.
- Duct-gland complex can be surgically removed
- Located close to the oral papilla of the duct, an incision can be made through the mucosa directly over the stone which is removed - The incision is left to heal by second intention
- Complete ligation of the duct, resection and anastomosis, and primary repair of the affected duct
- Duct dilatation is the primary clinical sign - marsupialization of the duct into the oral cavity has been reported as a successful option
Salivary gland neoplasia is uncommmon in dogs and cats. What is the incidence in a percentage?
0.17%
Histological origin of salivary gland neoplasia?
Epithelial
Name 2 salivary gland neoplasias
- Adenocarcinoma
- Acinic carcinoma
These are the majority.
Several other benign and malignant variants have also been reported.
Which glands are the most commonly affected by neoplasia?
2 glands
Mandibular and** parotid** salivary glands
Tumor invasion into local tissues and spread to regional lymph nodes occasionally occur.
In a study, what percentage of felines and canines had salivary gland neoplasia with regional lymph node involvement:
1. 39% of cats and 17% of dogs
2. 17% of cats and 39% of dogs
3. 29% of cats and 17% of dogs
4. 39% of cats and 27% of dogs
In addition, what is the rate for distant metastasis?
- 39% of cats and 17% of dogs
Distant metastasis at presentation less common (16% for cats and 8% for dogs).
Therapy for salivary gland neoplasia is initially directed toward aggressive cytoreduction of gross disease. Postoperative adjuvant therapy may be recommended based on what?
Histologic findings and margin evaluation
What is the prognosis for salivary gland cancer?
largely unknown
What is the median survival time for salivary gland neoplasia?
74 to 550 days
The prognosis is not correlated with histologic grade but is associated with stage of disease
Name two different approaches for sublingual and mandibular sialadenectomy
Although most cervical sialoceles originate from the sublingual gland-duct complex, the mandibular gland and duct are removed as well because of their intimate anatomic association with the sublingual glands and duct
- Lateral approach - combined with duct traction or tunneling under the digastricus muscle
- Ventral approach
In one cadaveric study using the lateral approach combined with tunneling under the digastricus muscle, complete removal of the rostral salivary tissue was noted in 13 of 15 cadaveric salivary chains. Leaving remnants of the rostral salivary glands could result in sialocele recurrence.
Name the preferred approach for sublingual and mandibular sialadenectomy and why?
As per Tobias authors
Ventral approach is preferred by the authors because it permits removal of the entire sublingual gland-duct complex
Describe the ventral approach for sublingual and mandibular sialadenectomy
- Incision: starting 4 to 5 cm caudal to the mandibular ramus on the affected side and extending rostrally toward the mandibular symphysis
- Platysma muscle incised: allows ID of the external jugular bifurcation; the mandibular gland sits at or just cranial to this bifurcation
- Tissues are bluntly dissected to expose the capsule covering the mandibular and sublingual salivary glands
- Glands must be differentiated from mandibular lymph nodes (which are more rostral and ventral at this location)
- Capsule is incised and bluntly dissected off the glandular tissue to allow ligation of vessels on the medial side of the gland
- Gland complex is retracted caudally - blunt dissection of the sublingual gland under (dorsal to) the digastricus muscle
- Place hemostat from rostral to caudal under the digastricus muscle, the ducts are clamped just rostral to the large glandular complex - mandibular and main sublingual gland are excised
- The remaining ducts and sublingual glands are pulled under the digastricus muscle
- Blunt and sharp dissection are continued rostrally to the level of the lingual nerve; the mylohyoideus muscle is incised for best exposure of the rostral glandular tissue and lingual nerve
- Glandular tissue removed up to the lingual nerve - exect if ranular present
- The mylohyoideus, platysma muscle, and subcutaneous tissues are reapposed with an absorbable monofilament suture
If bilateral gland removal is to be performed, a midline incision can be made.
If a ranula is present, discribe how surgery may differ
Dissection should continue rostral to the lingual nerve under the mylohyoideus to remove all of the glandular tissue up to the **sublingual caruncle **. The duct is ligated as rostrally as possible and transected.
Should a sialocele be dissected out?
The sialocele can be dissected out and removed; however, incisional drainage with or without drain placement is much less traumatic and time consuming and has similar results.
Describe the lateral approach for sublingual and mandibular sialadenectomy
- Lateral recumbency with the affected side upwards and the neck extended
- Jugular bifurcation is identified, and a horizontally oriented incision is made over the expected location of the mandibular salivary gland, between the linguofacial and maxillary veins
- Overlying subcutaneous tissues are removed with blunt and sharp dissection to expose the capsule of the sialocele (or mandibular gland) - capsule is perforated, and the contents are removed with suction
- Next the mandibular and largest sublingual glands are identified and dissected free from surrounding tissues
- Ligation of the blood supply (entering the rostromedial surfaces of the glands) may be necessary during dissection
- Blunt dissection continues rostrally along, and parallel with, the ducts, exposing more clusters of sublingual salivary tissue
- A hemostat is placed distally across the ducts, and traction is applied to the gland-duct complex
- Blunt dissection of fascia proceeds between the duct-gland complex and surrounding muscles (digastricus caudomedially and masseter muscle rostrolaterally); the** lingual branch **of the trigeminal nerve may need to be dissected free of the duct at this time
- Hemostat can be replaced more distally as more duct and glandular tissue are exposed
- Ducts can either be ligated distally and transected just proximal to the ligature, or they can be separated from oral cavity tissue with slow, steady traction
- Alternatively, the duct salivary gland can be transected proximal to the hemostat, and a Carmalt hemostatic forceps passed medial to the rostral digastricus muscle from a caudoventral to rostrodorsal direction
- Transected ends of the remaining salivary ducts are grasped with the tips of the forceps and pulled medial to the rostral digastricus muscle to allow further dissection of the duct
Describe a Zygomatic sialadenectomy
- Incision is made horizontally through the skin and subcutaneous tissue over the dorsal aspect of the arch
- Aponeurosis of the masseter muscle is reflected off of the ventral aspect of the zygomatic arch, and the orbital fascia is reflected dorsally
- Portion of the rostrolateral zygomatic arch is removed, as necessary, with a bone saw or rongeurs to gain access to the region of the zygomatic gland
- Orbital fat is dissected and retracted to gain access to glandular tissue
- Gland resides medial to the zygomatic arch and adjacent to the globe on the rostroventrolateral aspect
- Gland is gently retracted and dissected free from surrounding tissue
- A branch of the infraorbital (malar) artery supplying the salivary gland is accessed for ligation by dorsal retraction of the gland
- During closure, orbital fascia is reapposed to the aponeurosis of the masseter muscle, and subcutis and skin are closed routinely
Careful dissection is required due to sensitive structures in that area and anatomic changes caused by the presence of the sialocele.
Describe a Parotid sialadenectomy
- Patient in lateral recumbency. The skin is incised over the vertical ear canal, starting at a point below the external acoustic meatus and extending ventrally to the level of the caudal angle of the mandible
- Platysma and parotidoauricularis muscles are incised to gain exposure to the glandular tissue
- Ligation and division of the caudal auricular vein
- Parotid gland is bluntly dissected from its attachments, beginning at its dorsocaudal border - continued rostrally, separating the gland from the ear canal and other surrounding tissues
- Dissection should proceed cautiously near the horizontal canal in an attempt to spare the facial nerve
- Several small vessels that require cauterization or ligation will be encountered during the dissection of the medial side of the gland
- The gland is dissected out to the level of the duct, which is freed from surrounding tissues, ligated, and divided
- If clinical presentation included lateral cheek swelling, the accessory parotid gland just dorsal to the parotid duct should also be dissected free and removed
Complete removal of the parotid salivary gland is difficult - dissection extends to the region of the horizontal ear canal, facial nerve paresis or paralysis is a common complication.
Sublingual sialoceles (ranulas) are treated by marsupialization of the fluid-filled pocket and removal of the mandibular and sublingual salivary gland complex, including as much of the rostral submandibular glandular tissue as possible. Descibe options for ranula marsupialization.
- Large full-thickness oval area of the tissue overlying the sublingual sialoceles is excised. The remaining external (oral) mucosa is sutured to the lining of the sialoceles with small-gauge, absorbable, monofilament suture
- The mucosal edge is folded inward and sutured in place, similar to hemming a pair of pants.
Because there is not a true epithelial lining of the sialocele, the mucosa will try to heal in the face of marsupialization. Therefore prevention of recurrence can be ensured only by removal of the glandular source of saliva.
