Ch 88 Salivary Gland Flashcards
Ortilles JAVMA 2020
Intracanalicular injection of N-acetylcysteine
as adjunctive treatment for sialoceles in dogs:
25 cases (2000–2017)
Boxers and mixed-breed dogs were most commonly represented. Subjectively
decreased globe retropulsion and conjunctival or periorbital swelling
(23/25 [92%] dogs each) were the most common clinical signs, with no vision
deficits in any patient. The zygomatic gland was mainly affected (23/25
[92%] dogs), followed by parotid and mandibular glands (1 [4%] dog each).
The condition was unilateral in 22 (88%) dogs. Ultrasonography (19/25
[76%] dogs), MRI (14 [56%]), fine-needle aspiration (20 [80%]), and biopsy
(4 [16%]) were performed; however, the condition was deemed idiopathic
in 22 (88%) dogs. Most IINACs were performed with local anesthesia (median
volume, 5 mL/gland; range, 1.5 to 9 mL). No complications were identified.
Other treatments included antimicrobials and anti-inflammatories.
Mean follow-up time was 18.8 months. All recurrences (5/23 [22%] dogs)
were controlled with medical management.
CONCLUSIONS AND CLINICAL RELEVANCE
Results suggested noninvasive IINAC may be a useful adjunctive treatment
for sialoceles in dogs. The procedure was easily and safely performed with
local anesthesia (or general anesthesia with concurrent diagnostic imaging)
in these dogs.
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)
RESULTS
There were no significant differences in incidences of intraoperative complications, recurrence, or postoperative complications between dogs in which a lateral versus ventral approach was used. Clinically important intraoperative complications included iatrogenic tears in the oral mucosa, ligature slippage from the duct end, hemorrhage, and possible lingual nerve transection. Surgical experience was associated with the likelihood that intraoperative complications would develop. Suspected recurrence was reported in 2 of 26 (8%) dogs that underwent a lateral approach and 2 of 12 (17%) dogs that underwent a ventral approach. Hospitalization time was significantly shorter with the lateral approach than with the ventral approach. Postoperative complications had a short-term onset and occurred in 4 of 25 (16%) dogs that underwent a lateral approach and 3 of 12 (25%) dogs that underwent a ventral approach. Age and presence of a pharyngeal sialocele were associated with development of postoperative complications.
CLINICAL RELEVANCE
Long-term outcomes for ventral and lateral approaches to sialoadenectomy were favorable and appeared to be comparable. Further prospective study into potential associations of sialoadenectomy approach, age, and pharyngeal sialoceles on outcome is needed.
Gordo JSAP 2020
The use of methylene blue to assist with parotid sialadenectomy in dogs
Retrospective study included seven client-owned dogs that underwent parotidectomy after injection of methylene blue from 2016 to 2019 in a referral centre. Cross-sectional imaging was used to confirm parotid gland surgical disease and for staging purposes. All dogs underwent parotid resection and removal of the parotid duct after injection of methylene blue. Methylene blue was either administered via cannulation of the parotid duct or directly injected into the abnormal gland.
R
esults: In all cases, the gland stained dark blue within seconds without any evident leakage. Complete parotid gland resection and removal of the parotid duct was achieved successfully in all dogs with a mean surgical time of 97 minutes. Subjectively, the staining was useful to identify innervation outside the coloured gland and facilitated dissection. No complications, including facial nerve injury, were recorded.
C
linical Significance: Methylene blue staining for complete parotidectomy was feasible, rapid and easy in these dogs. It can be used as an indirect facial nerve identification technique, and can therefore facilitate dissection and possibly reduce the incidence of post-operative facial nerve paralysis.
Gordo JSAP 2020
The use of methylene blue to assist with parotid sialadenectomy in dogs
Cinti Vet Surg 2021
Complications between ventral and lateral approach
for mandibular and sublingual sialoadenectomy
in dogs with sialocele
Results: Seventy dogs were included in each group. The most represented
breed was crossbreed (26%), and males (99/140 [71%], intact/neutered) were
overrepresented. 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%], P = .116). Recurrences were
more likely after LAT approach (5/70 vs 0/70, respectively; P = .029), whereas
wound-related complications were more likely after VPM approach (20/70 vs
9/70, respectively; P = .018). Prolonged duration of surgery was associated with
an increased risk of recurrence, and none of the other variables affected the
complication rate.
Conclusion: Ventral paramedian approach for mandibular and sublingual
sialoadenectomy was associated with a lower risk of recurrence but a higher
risk of wound-related complications compared with LAT approach.
Clinical significance: Ventral paramedian approach for mandibular and sublingual
sialoadenectomy may be preferred to reduce recurrence in dogs with
sialoceles, but wound-related complications are common.
Dorner Vet Surg 2021
Comparison of three surgical approaches for zygomatic
sialoadenectomy in canine cadavers
Animals: Cadavers of mesocephalic dogs (n = 20).
Methods: Each skull was assigned to a lateral approach with zygomatic arch
ostectomy on the left (n = 20) and one approach without ostectomy on the
right, ventral (n = 10) or dorsal (n = 10) to the zygomatic arch. Approaches
were evaluated for surgical exposure (rated on a scale of 1-5 with one optimal
exposure), tissue trauma, and completeness of gland removal. Glands from
each side were weighed to compare as internal control.
Results: The ostectomy-based approach offered excellent surgical view and
good exposure of the zygomatic gland but caused more tissue trauma. The dorsal
nonostectomy approach did not allow complete zygomatic gland extraction
in nine of the 10 dogs, whereas the ventral nonostectomy approach enabled
complete extraction in all 10 dogs.
Conclusion: The ventral zygomatic approach allowed complete removal of
the zygomatic gland, with good surgical overview, while reducing tissue
trauma and preserving the zygomatic arch.
Clinical significance: The ventral nonostectomy approach should be considered
as an alternative to excise the zygomatic gland in dogs.
Bobis Villagara
Feline sialocoele: clinical
presentation, treatment and
outcome in 19 cases
Nineteen cats were identified. The most common clinical signs were ptyalism, dysphagia and anorexia.
Localisation of the sialocoele was cervical (n = 6), sublingual (n = 6), cervical/sublingual (n = 3), facial (n = 2),
cervical/pharyngeal (n = 1) and zygomatic (n = 1). The affected salivary glands were mandibular–sublingual (n = 15),
mandibular–sublingual/parotid (n = 1), zygomatic/parotid (n = 1) and parotid (n = 2). The aetiology of the sialocoele
was traumatic in two cases, neoplastic in one cat and unknown in 16 cats. Sialoadenectomy was performed in 11
cats. Other treatments included ranula marsupialisation (n = 3), needle drainage (n = 2), single stab incision (n = 2)
and parotid duct ligation (n = 1). The median follow-up time was 399 days (range 15–1460). Postoperative seroma
was the only complication observed in one cat. No recurrence was reported.
Conclusions and relevance Feline salivary sialocoele are relatively rare and have a good prognosis. They can be
managed successfully with sialoadenectomy; however, a more conservative approach can be used with appropriate
case selection.
Martinez JSAP 2024
Clinical outcomes of dogs with parotid duct ectasia
Martinez JSAP 2024
Clinical outcomes of dogs with parotid duct ectasia
Viitanen Vet Surg 2023
Intraoral approach for zygomatic sialoadenectomy
in dogs: An anatomical study and three clinical cases
Bilateral zygomatic sialoadenectomies were performed in six mesocephalic,
two brachycephalic and two dolichocephalic cadavers, randomly
assigned to IOA on one side and LOA on the contralateral side. Duration of
surgery, ease of surgical stage scores (rated on 5-point Likert scale) and completeness
of gland removal were recorded. Additionally, IOA was performed in
three dogs with zygomatic salivary gland (ZSG) disease.
Results: Removal of the ZSG was complete in 8/10 and 10/10 dogs using the
IOA and LOA, respectively. Surgery was faster with IOA (42.0 min;
33.5–49.6 min) than LOA (65.7 min; 54.9–76.4 min, p = .005). Ease of removal
did not differ between approaches (p = .091). Diseased ZSGs were successfully
removed in three dogs without intra- or short-term postoperative complications.
Conclusions: The intraoral approach described here was technically equally
challenging but faster than the LOA. Its clinical use led to an uneventful surgery
with excellent short-term outcome in three dogs.
Clinical relevance: The IOA provides an alternative approach for zygomatic
sialoadenectomy in dogs with ZSG disease.
Viitanen Vet Surg 2023
Intraoral approach for zygomatic sialoadenectomy
in dogs: An anatomical study and three clinical cases
The intraoral approach
2.3.1 | Intraoral approach
Dogs were positioned in dorsal recumbency, with a cushion
underneath the neck to position the hard palate in
the horizontal plane. The mouth was kept open utilizing
a rope tied to a surgical table frame. The zygomatic major
papilla, located approximately 1 cm caudal to the parotid
papilla on a ridge of mucosa at the level of the last maxillary
molar tooth,11 was identified. A 2.5 cm incision was
made into the oral mucosa and muscular tissue overlying
the rostral part of the pterygopalatine fossa, oriented in a
45 caudomedial to rostrolateral direction, ending immediately caudal to the zygomatic major papilla
(Figure 1B). At each side of the incision stay sutures were
placed to retract the oral mucosa. The ventral edge of the
salivary gland was freed carefully from the surrounding
loose connective tissue by blunt dissection. An Allis tissue
forceps was used to gently grasp the ZSG, and mild
traction was applied in a rostroventral direction. The caudal
extent of the ZSG was gently levered by inserting a
periosteal elevator between the gland and the pterygopalatine
fossa (Figure 2). Care was taken not to damage the
deep facial vein, the auriculotemporal nerve and the
branch of the infraorbital artery by performing gentle
blunt dissection. Once the gland was completely freed
from its surrounding tissue, the major salivary duct was
transected close to the major zygomatic papilla and subsequently
removed en bloc with the ZSG. The muscular
tissue and the oral mucosa were closed in separate continuous
layers using 4–0 poliglecaprone 25.
Viitanen Vet Surg 2023
Intraoral approach for zygomatic sialoadenectomy
in dogs: An anatomical study and three clinical cases
The modified lateral orbitotomy approach
A modified lateral
orbitotomy approach (LOA), with osteotomy of the zygomatic
arch while preserving the insertion of the masseter
muscle, is the currently recommended approach for
orbital mass removal.8
2.3.2 | Modified lateral orbitotomy approach The LOA was performed with the dogs in lateral recumbency with a cushion under the nose to keep the zygomatic arch in a horizontal plane. The surgical technique was performed as previously described by Gilger et al.8 Briefly, a curved skin incision was made 1 cm ventral to the lateral canthus, extending caudally over the dorsal rim of the zygomatic arch, ending just rostral at the base of the ear. Care was taken to avoid damaging the palpebral branch of the auriculopalpebral nerve and the dorsal buccal branch of the facial nerve, which lies subcutaneously and runs rostrodorsal to the zygomatic arch. The orbital ligament was transected at its midpoint and an incision was made in the temporal aponeurosis 5 mm dorsal to the zygomatic arch. Two holes were drilled through the zygomatic arch using a 0.8 mm K-wire on each side of the planned zygomatic osteotomy sites, approximately 3–5 mm apart. Two parallel zygomatic arch osteotomies were created with an oscillating saw, and the zygomatic arch was reflected ventrally, preserving the insertion of the masseter muscle. The ZSG was identified and freed by careful combined blunt dissection. The major salivary duct was ligated as close as possible to the major zygomatic papilla and transected. After sialadenectomy, the zygomatic arch was replaced and attached with 0.8 mm orthopedic cerclage wire. The orbital ligament was sutured using 3–0 polydioxanone prior to simple continuous closure of the subcutaneous tissue and the skin using 4–0 poliglecaprone 25.
Bush Vet Surg 2023
Outcomes and clinical features associated with
surgically excised canine salivary gland carcinoma:
A multi-institutional, retrospective, Veterinary Society of
Surgical Oncology study
Results:
The overall median survival time (MST) associated with salivary carcinoma was 1886 days.
Local recurrence occurred in 29/69 (42%) dogs with an overall disease-free interval (DFI) of 191 days.
Metastatic disease occurred 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 (28.9%) 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: The prognosis for dogs with salivary gland carcinoma treated surgically was more favorable than previously reported.
Nodal metastasis was a negative prognostic factor for canine salivary gland carcinoma.
Clinical significance: Surgical intervention should be considered for dogs with salivary carcinoma.
