Page 53 - BSAVA Manual of Canine and Feline Head, Neck and Thoracic Surgery, 2nd Edition

BSA V A Manual of Canine and F eline Head, Neck and Thoracic Surger y
BSAVA Manual of Canine and Feline Head, Neck and Thoracic Surgery

OPERATIVE TECHNIQUE 3.6
VetBooks.ir Mandibular and sublingual salivary gland resection

(lateral approach)

PATIENT POSITIONING

Lateral recumbency. The patient’s neck is rotated contralaterally and extended over an elevated padded area (rolled
towel); the mandible is secured to the operating table with adhesive tape.

ASSISTANT
Optional.

SURGICAL TECHNIQUE

Approach
A curvilinear skin incision is made from the bifurcation of the
external jugular vein to the caudoventral aspect of the mandibular
body. The subcutaneous tissue and platysma are incised. The
parotidoauricular muscle is divided to expose glandular, venous
and neurological structures.
Surgical manipulations osition of curvilinear incision hite dotted line from the
bifurcation of the e ternal ugular vein sho n in blue to
1 Identify the mandibular salivary gland between the maxillary the caud ventral aspect of the mandibular body.
and linguofacial veins.
2 Incise the gland capsule and grasp the parenchyma with tissue forceps to provide caudal traction.
3 Incise the fascia between the masseter and digastricus muscles, allowing digital and sharp dissection of
connective tissue attachments to expose the entire mandibular salivary gland and the contiguous sublingual
gland complex. The end point for dissection is visualization of the lingual nerve that courses laterally over the
sublingual gland complex.
4 Ligate the gland–duct complex and divide just caudal to the lingual nerve. The digastricus muscle may obscure
the surgeon’s view rostrally, necessitating either increased caudal retraction on the mandibular and sublingual
gland complex or manoeuvring the complex under the digastricus muscle and floor of the sialocele to allow
further rostral dissection. Myotomy of the digastricus muscle can be performed to aid complete visualization of
the gland–duct complex and the location of the defect causing the sialocele.
5 Incise the sialocele and drain it to facilitate tissue manipulation around the digastricus muscle.

PRACTICAL TIP
Salivary gland
The gland–duct defect causing the sialocele rarely
occurs rostral to the lingual nerve. If the lingual
nerve is not visualized, dissection may continue to
the oral mucosa. The surgeon should make every
effort to isolate the origin of the defect, verifying
that the correct side has been operated upon.
Failure to identify the defect indicates that the
sialocele may have originated from the contralateral
gland–duct complex. Bilateral resection of the
Digastricus Mandibular mandibular and sublingual gland–duct complex is
muscle lymph node not associated with xerostomia
The mandibular salivary gland and the contiguous sublingual gland
comple course bet een the masseter and digastricus muscles.
issection is performed carefully rostral to the digastricus muscle in
order to visuali e the lingual nerve.

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