Ch. 87-88: Oral Cavity ST & Salivary Glands Flashcards
Doyle VCOT 2019
Evaluation of the Superior Labial Musculomucosal Flap in Dogs: an angiographic study and case report
What arteries do this flap provide? What layer?
At junction of rostral and caudal ½ of upper lip, extensive choke anastomoses joined the angiosome of what a?
Arteries perfused where?
Superior and inferior labial arteries located within musculomucosal layer of the labia
At junction of rostral and caudal ½ of upper lip, extensive choke anastomoses joined the angiosome of infra-orbital artery
Inferior labial a. perfused caudal ½ of lower labium & had extensive choke anastomses w/ the middle & rostral mental arteries
Superior labial survived to level of canine tooth; inferior could be narrower but just as long
Jones VSURG 2020
The impact of tongue dimension on air volume in brachycephalic dogs
Absolute volume difference bw groups?
Volume relative to BW difference bw groups?
Volume relative to ratio btwn skull length/width?
Volume relative to skull length?
Brachycephalics had decreased air proportion by how much? Tongue denser how much?
Volume absolute not different between groups
Volume relative to body weight greater in brachycephalics (5650) than mesaticephalics (4454)
Volume relative to ratio btwn skull length/width greater in brachycephalics 70 833, vs mesaticephalics 48 064
Volume relative to skull length greater in brachycephalics 689 vs mesaticephalics 460
Proportion of air in brachycephalics decreased by 60% & tongues 10 x denser than in mesaticephalics
Song VRU 2023
CT volumetric analysis permits comparison of tongue size & tongue fat in different canine brachycephalic & mesaticephalic breeds
Why do we care?
BC dogs had greater what?
More fat localized where?
Significant predictors (2) of increased tongue fat volume in BC dogs?
macroglossia is a newly accepted component of BOAS in dogs, & macroglossia w/ increased tongue fat is a well-known cause for obstructive sleep apnea (OSA) in people
Total tongue & tongue muscle vol. (P < 0.0001) & tongue fat vol. (P = 0.01) normalized to BW were greater in BC dogs.
More fat was localized in the caudal tongue in both groups (P < 0.04).
In regression analysis → BC conformation & increased weight were significant predictors of increased tongue fat volume.
Riggs JAVMA 2018
Outcomes following surgical excision or surgical excision combined with adjunctive, hypofractionated radiotherapy in dogs with oral squamous cell carcinoma or fibrosarcoma
MST of all dogs? Difference between tumor types?
Post-op radiotherapy affects on MST in dogs with incompletely excised SCC?
Post-op radiotherapy affects on MST in dogs with incompletely excised FSA?
MST all 87 dogs 2049 d – not reached for SCC, only 557 d for FSA; tumor significant predictor of survival time
Dogs with postop radiotherapy after incomplete excision of oral SCCs significantly longer MST 2051d than no radiotherapy 181d
Postop radiotherapy had no protective value for dogs with incompletely excised FSA (299d w/ vs 694 w/o)
Grimes JAVMA 2019 PQ
Histologic evaluation of mandibular and medial retropharyngeal lymph nodes during staging of oral malignant melanoma and squamous cell carcinoma in dogs
LN mets difference between OMM & OSCC?
Distant Mets between OMM & OSCC?
Medial retropharyngeal LN affected in what # of dogs with LN mets?
Mets found in what % of excised contralateral LN?
LN mets not significantly different between OMM 37% and OSCC 29%;
Distant mets in 41% OMM & suspect 1 in OSCC
Medial Retro LN was affected in 13/16 (81%) dogs with lymph node metastasis, and 3 of those dogs had metastasis to the MRLN without concurrent metastasis to an Mandibular LN.
Metastasis was identified in lymph nodes contralateral to the primary tumor in 4 of 17 dogs (24%) that underwent contralateral lymph node removal
Carroll JAVMA 2020
Tumor size as a predictor of lymphatic invasion in oral melanomas of dogs
Relationship bw size of OM & lymphatic invasion?
Specific size association to rule in and rule out Lymphatic invasion?
A significant relationship was ID between size of oral melanomas and single variable of histo grade - lymphatic invasion - with larger tumors more likely to show lymphatic invasion
Further analysis revealed 2 applicable size thresholds for different clinical scenarios:
Lymphatic invasion can confidently be ruled out for tumors < 6.5 mm in diameter (100% sens) and ruled in for tumors ≥ 24.5 mm in diameter (100% spec)
Turek VRU 2020
Multimodality treatment including ONCEPT for canine oral melanoma: a retrospective analysis of 131 dogs
Median time to progression?
Median progression-free survival?
Median tumor specific OST?
Main negative PF?
Other negative PF (4)?
What had protective effect?
131 dogs, retrospective, most dogs had sx +/- RT. Dogs excluded if they had distant mets or got chemotherapy.
All dogs got ONCEPT vaccine
Median time to progression 304 d,
median progression-free survival 260 d,
median tumor-specific overall survival 510 days.
multivariable analysis: presence of gross disease correlated negatively with all measures of clinical outcome.
Other negative prognostic indicators: primary tumor ≥2 cm,
higher clinical stage (stages 2 and 3),
presence of lymph node metastasis at diagnosis,
and caudal location in the oral cavity.
Radiotherapy had a protective effect against tumor progression.
Lee VRU 2021
CT features of malignant and benign oral tumors in 28 dogs
Diagnoses?
CT characteristics to support a possible malignancy?
Overlapping characteristics with benign?
Conclusion?
Most tumors were malignant (n = 20)
- malignant melanoma (n = 14), squamous cell carcinoma (SCC, n = 4), adenocarcinoma (n = 1), and fibrosarcoma (n = 1)
Benign tumors (n = 8)
diagnosis of possible malignancy for dogs with oral tumors having the following CT characteristics:
large size, heterogeneous contrast enhancement pattern, bone lysis, tooth loss, and ipsilateral lymphadenopathy
Sig overlap bw benign & malignant with: bone lysis, periosteal reactions, bone expansion - therefore still need histopath
Sharma VSURG 2021
Survival time of juvenile dogs with oral squamous cell carcinoma treated with surgery alone: A Veterinary Society of Surgical Oncology retrospective study
Presenting ages?
% with mets at time of sx?
Sx performed?
Majority tumors located where?
MST?
Conclusion?
18 dogs < 12mo, 7 dogs <24mo
no dog had mets prior to surgery
Sx: partial mandibulectomy or maxillectomy w/ complete margins in 24 dogs and incomplete in 1 dog
80% of tumors were rostral
MST not reached, all dogs alive at final follow-up (median 1556 days)
Conclusion: px excellent after wide sx excision. Wide excision could lead to cure?
Zaccone JVIM 2022
Environmental risk factors for the development of oral squamous cell carcinoma in cats
4 covariates significantly associated with an increased risk of OSCC?
RF shared with chronic gingivostomatitis & Periodontal dz?
On multivariable logistic regression, covariates significantly associated with an increased risk of OSCC:
rural environment (OR: 1.77)
outdoor access (OR: 1.68)
environmental tobacco smoke (OR: 1.77)
petfood containing chemical additives (OR: 1.98).
Risk factors shared with chronic gingivostomatitis - outdoor access; and periodontal dz - petfood containing chemical additives
Cotter VRU 2022
Inter- and intraobserver agreement for CT measurement of mandibular and medial retropharyngeal lymph nodes is excellent in dogs with histologically confirmed oral melanoma
interobserver intraclass correlation coefficient (ICC) was 0.96 and intraobserver ICC was 0.977, indicating excellent agreement (ICC > 0.9 considered excellent).
Similar findings were noted following sub-analysis for most variables (experience, size, laterality, axis of measurement).
Therefore you dont have to worry when multiple different radiologists are looking at LN at various stages when determining response to tx (when using the same measurement method)
Menghini VRU 2023
Contrast-enhanced CT predictors of lymph nodal metastasis in dogs with oral melanoma (OM)
Mandibular ln mets in %?
Retro ln mets?
Diff in Mandibular lymphocenter volume?
Diff in voxel number or attenuation?
Mandibular lymphocenter volume & mets - conclusion & PPV?
CT imaging was used to assess mandibular & retropharyngeal lymphocenter (LC) changes in dogs w/ nodal metastatic (n = 12) & non-metastatic (n = 10) OM, & then compared w/ healthy control dogs
Mandibular lymphocenter (MLC) metastasis was present in 12 of 22 (55%) dogs
No dogs had confirmed retropharyngeal lymphocenter (RLC) mets
Mandibular lymphocenter volume was significantly different between positive & negative LCs (median 2221 and 1048 mm3), and between positive and control LCs (median 880 mm3).
There was no evidence of a significant difference in voxel number or attenuation between groups.
Mandibular lymphocenter volume moderately discriminated for metastatic status (AUC 0.754), with a positive predictive value of 57% – suggests 3d CT volume measurement may predict nodal mets, needs further study
Treggiari JVIM 2023
Tonsillar carcinoma in dogs : Treatment outcome and potential prognostic factors in 123 cases
OST?
longer survival in who?
Positive PFs (3)?
OST ~126 d
Longer survival seen in dogs w/o metastatic disease, ~380 days (this was significant)
Positive prognostic factors: absence of CS, Sx (tonsillectomy), use of adjuvant chemo and NSAIDs
Cinti VSURG 2021
Complications between ventral and lateral approach for mandibular and sublingual sialoadenectomy in dogs with sialocele
VPM group more likely to have what?
LAT group were more likely what?
Comp rates & differences in groups?
Recurrence rates & differences in groups?
Wound comp difference bw groups?
Increased risk of recurrence associated with what?
Dogs in the VPM approach group were more likely to undergo digastricus tunnelization and placement of a drain or a bandage.
Dogs in the LAT approach group were heavier and more likely to undergo excision of an inflammatory pseudocapsule.
No difference was detected in complication rates between groups (LAT [20%], VPM [31%])
Recurrences were more likely after LAT approach (5/70 vs 0/70),
wound-related complications were more likely after VPM approach (20/70 vs 9/70)
Prolonged duration of surgery was associated with an increased risk of recurrence
Gordo JSAP 2020
The use of methylene blue to assist with parotid sialadenectomy in dogs
Success of visualization? Leakage?
Gave it how?
Complete resection in how many?
Complications?
Gland stained dark blue within seconds in all cases
No leakage
Cannulation of duct at the level of the fourth premolar attempted in all cases, but unsuccessful in all cases - Injected via catheter into duct (5) or directly into gland (2)
Complete gland and duct resection in all cases
No complications in any case; no recurrence for non-neoplastic cases
Dorner VSURG 2021
Comparison of three surgical approaches for zygomatic sialoadenectomy in canine cadavers
Approaches?
Pros/Cons of each?
Conclusion?
Ostectomy, Nonoestectomy - Dorsal, Nonostectomy - Ventral
ostectomy based approach offered excellent sx view and good exposure of zygomatic gland but caused more tissue trauma (maximal tissue trauma)
dorsal nonostectomy did not allow complete zygomatic gland extraction in 9/10 dogs (roughly 1/3 left behind) vs ventral nonostectomy that allowed complete excision in 10/10
dorsal approach was least traumatic
Conclusion: ventral nonostectomy allowed complete removal of zygomatic gland w/ good sx overview, reduced tissue trauma and preservation of zygomatic arch
Ortilles JAVMA 2020
Intracanalicular injection of N-acetylcysteine as adjunctive treatment for sialoceles in dogs: 25 cases (2000-2017)
What is n-acetylcysteine?
Which glands affected? Unilateral %? Idiopathic %?
Complications?
Recurrence %?
Conclusion?
N-acetylcysteine, a cysteine prodrug and glutathione precursor, has been used mainly as a mucolytic and antioxidant agent
Zygomatic gland affect in 90% of dogs, parotid and mandibular (5% each)
Unilateral in 90%
Idiopathic in 90%
Most cases tx under local anesthesia w/ median 5mL per gland
No complications
Recurrence in 20% → all medically managed successfully anti-inflammatory drugs, antimicrobials, analgesics, alone or in combo
Other tx included antimicrobials and anti-inflammatories
Conclusion: safe as an adjunct tx for sialoceles in dogs and can be performed w/ local anesthesia
Swieton JAVMA 2022
Multi-institutional study of long-term outcomes of a ventral versus lateral approach for mandibular and sublingual sialoadenectomy in dogs with a unilateral sialocele: 46 cases (1999-2019)
Difference in intra-op, post-op comp, or recurrence between groups?
Clinically impt intra-op comps?
Hosp time shorter for who?
Recurrence %?
Short term post-op comp %?
RF for post op comps (2)?
No difference in intraoperative complications, recurrence, or postop complications between dogs in which a lateral vs ventral approach was used
Clinically important intraop complications
Iatrogenic tears in oral mucosa
Ligature slippage from duct end
Hemorrhage
lingual nerve transection
Surgical experience associated with likelihood of intraop complications
Hospitalization sig shorter with lateral approach
Recurrence (no sig difference)
8% lateral; 17% ventral
Short-term post-op complications (no sig diff)
16% lateral; 25% ventral
Age and presence of pharyngeal sialocele associated with development of postop complications
For each year of age, the odds of developing a postoperative complication increased by 24%
Oetelaar VRU 2022
Computed tomographic appearance of sialoceles in 12 dogs
CT findings?
All sialoceles were characterized by fluid attenuating, non-contrast enhancing contents (median 18.5 HU) and soft tissue attenuating, contrast-enhancing walls.
The external margins of all sialocele walls were smooth; however, the internal margins in six sialoceles were irregular with poorly defined nodular to frond-like protrusions.
Stones visible in 7 sialoceles (three sialoliths and 2 osseous metaplasia)
Tan VRU 2022
Clinical and CT sialography findings in 22 dogs w/ surgically confirmed sialoceles
Contrast leakage in %? What kind of leak MC?
Reviewers had substantial agreement for what?
CT Sn to determine diseased gland?
CT sialography results were compared to surgical findings to determine sensitivity.
Contrast leakage was detected in 12 of 22 dogs (55%)
Intra-sialocele leakage was most frequently observed (7/12, 58%).
There was substantial agreement (κ = 0.70) btwn reviewers identifying diseased glands, substantial agreement (κ = 0.62) on the diagnostic quality, and no to slight agreement (к = 0.13) in the detection of contrast leakage.
The overall sensitivity of CT sialography to detect surgically confirmed diseased glands was 66.7%
Bobis-Villagrá JFMS 2022
Feline sialocoele: clinical presentation, treatment and outcome in 19 cases
MC CS?
Localization?
MC affected glands?
Etiologies?
Complications?
Recurrence?
Most common clinical signs: ptyalism, dysphagia and anorexia.
Localisation: cervical (n=6), sublingual (n=6), cervical/sublingual (n=3), facial (n=2), cervical/pharyngeal (n=1) and zygomatic (n=1).
Affected salivary glands: mandibular–sublingual (n=15, 79%), mandibular–sublingual/parotid (n=1), zygomatic/parotid (n=1) and parotid (n=2).
Etiology: traumatic in 2, neoplastic in 1, unknown in 16 cats.
Complications:
Postoperative seroma was the only complication observed in 1 cat. (1/19 = 5%)
Recurrence: No recurrence was reported (0%)
Viitanen VSURG 2023
Intraoral approach for zygomatic sialoadenectomy in dogs: An anatomical study and three clinical cases
Removal complete in how many cadavers with each?
Faster with which?
Any approach easier?
Clinical case series result?
described an intraoral approach (IOA) for zygomatic sialoadenectomy in dogs and compared this surgical approach to a modified lateral orbitotomy approach (LOA).
Removal of the ZSG was complete in 8/10 with IOA and 10/10 dogs using LOA
Surgery was sig faster with IOA
Ease of removal not different
Diseased ZSGs were successfully removed in 3 clinical dogs without intra- or short-term postoperative complications.
Bush VSURG 2023
** largest retrospective on this disease, 72 dogs
Outcomes and clinical features associated with surgically excised canine salivary gland carcinoma: A multi-institutional, retrospective, Veterinary Society of Surgical Oncology study
Overall MST?
Local recurrence? DFI to recurrence?
Mets in %? DFI of ?
LN mets found at sx in what % of dogs that had LN excision? What was their MST and DFI?
Overall MST with salivary carcinoma 1886 days
Local recurrence in 29/69 (42%) dogs; overall disease-free interval (DFI) of 191 days.
Metastatic disease in 22/69 (31.9%) dogs, with an overall DFI of 299 days.
Lymph node metastasis was present at the time of surgery in 11/38 (29%) dogs in which lymphadenectomy was performed at the time of surgery
These dogs had a shorter DFI at 98 days (P = .03) and MST at 248 days (P < .001).
Conclusion: Prognosis for dogs with salivary gland carcinoma treated surgically was more favorable than previous reports.
Nodal metastasis was a negative prognostic factor for canine salivary gland carcinoma.
Sarrowitz JSAP 2017 PQ
Outcome and prognostic factors following curative-intent surgery for oral tumours in dogs: 234 cases (2004 to 2014)
Survival shortest for what types?
RR highest for what?
Distant mets highest for what?
Complete sx margins in %?
Median cause-specific survival was shortest for malignant melanoma (206 days) and osteosarcoma (209 days).
Local recurrence rate was highest for fibrosarcoma (54%) and distant metastatic rate was highest for malignant melanoma (30%).
Curative-intent surgery resulted in complete surgical margins in 85% of cases.
Clinical significance: Results suggest tumour type, completeness of excision, tumour size, and age may affect disease-free interval and cause-specific survival. Fibrosarcoma had a higher risk of recurrence compared to other tumour types.
