Page 44 - BSAVA Manual of Canine and Feline Head, Neck and Thoracic Surgery, 2nd Edition

Chapter 3 · Surgery of the oral cavity and oropharynx

Initial wound management includes control of haemor-
rhage without compromising the blood supply to the
VetBooks.ir and early efforts should be made to reduce further con-
damaged area. Most traumatic wounds are contaminated,
tamination. Particulate debris is removed by gentle lavage
with saline or dilute chlorhexidine solution. Larger frag-
ments embedded in a wound are removed manually during
sur gical wound exploration.
Dog owners are often unaware of a problem until the
animal shows clinical signs and is taken to the veterinary
surgeon (veterinarian). A history of chewing wooden
objects may be reported. Older penetrating injuries are
serious and require surgical exploration, cleansing and, if
appropriate, suturing. Finding a foreign body that has
penetrated deep into the tissues can be challenging
despite the support of advanced imaging techniques.
Foreign body impaction, including stick injuries, may
lead to abscess formation in suborbital, submandibular
and retropharyngeal tissues. Abscesses must be lanced
and explored, and the foreign body removed. Excision of
necrotic tissue is essential to promote early granulation.
Surgical drains are useful for severely contaminated
wounds (Lewis and Reiter, 2011). 3.12 Cervical sialocele arro ed in a oodle.

Salivary glands submucosal tissue and the consequent tissue reaction to
saliva. They have a non-epithelial, non-secretory lining,
Neoplasia consisting primarily of fibroblasts and capillaries (Smith
and Reiter, 2015).
Neoplasia of the salivary glands is uncommon. Spaniel Sialoceles occur most often in dogs aged 2–4 years and
breeds, Poodles and Siamese cats may be predisposed. more frequently in German Shepherd Dogs and Miniature
The prevalence of salivary gland neoplasia in cats is Poodles. Trauma has been proposed as the cause of
almost twice that in dogs, with the mandibular salivary sialoceles because of the activity of young dogs and the
gland most commonly affected. In dogs, the parotid and documented damage to the salivary gland–duct complex
mandibular salivary glands are most often affected associated with sialoceles. The inability to induce sialoceles
(Hammer et al., 2001). by trauma in healthy dogs suggests the possibility of a
developmental predisposition in affected animals.
Tumour type The sublingual gland is the most common salivary
gland associated with sialocele. Sialography indicates
Multiple tumour types affecting the salivary glands have
been described, including mucoepidermoid tumours, SCC, that the sialocele origin most often occurs in the rostral
malignant mixed tumours, adenoid cystic carcinoma, acinic portion (that portion of the sublingual gland superimposed
cell carcinoma, adenocarcinoma, undifferentiated carci- on the mandible) of the sublingual gland–duct complex.
l
noma and sarcoma. Adenocarcinoma is the most common Regard ess of the location of the origin, a sialocele often
neoplasm affecting the salivary glands in dogs and cats and forms near the intermandibular area (cervical sialocele).
Other locations include the pharynx (pharyngeal sialocele)
is locally infiltrative, with frequent metastasis to regional
lymph nodes and lungs. Cats have a more advanced stage and associated with a sublingual or mandibular gland–
duct defect in the sublingual area (sublingual sialocele
of disease at the time of diagnosis when compared with
dogs (Hammer et al., 2001). or ranula).
Management Clinical signs
Salivary gland neoplasia should be staged according to The clinical signs depend on the location of the sialocele.
the TNM system to generate an appropriate prognosis and
treatment plan. Thoracic radiography and biopsy of the • A cervical sialocele is initially acutely painful, due to the
neoplasm and nearest regional lymph nodes provide inflammatory response. Cessation of the inflammatory
necessary information. response results in a marked decrease in size of the
Total surgical excision of malignant neoplasms is diffi- mass. A decreased inflammatory response allows for
cult because of their invasive characteristics and the intri- the more common presenting history of a slowly
cate neurological and vascular anatomy of the salivary enlarging or intermittently large, fluid-filled, non-painful
gland region. Therefore, local treatment should include mass.
radiotherapy, with or without surgical intervention to debulk • Blood-tinged saliva secondary to trauma caused by
the neoplasm. eating, abnormal prehension of food or reluctance to
eat may be clinical signs associated with sublingual
sialocele.
Sialocele • The most common clinical signs associated with
Sialocele (Figure 3.12) is the most commonly recognized sialocele of the pharyngeal wall are respiratory distress
clinical disease of the salivary glands in dogs. A sialocele and difficulty in swallowing secondary to partial
is an accumulation of saliva in the subcutaneous or obstruction of the pharynx.

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