Mandibular and sublingual sialocoeles in the dog: a retrospective evaluation of 41 cases, using the ventral approach for treatment

AIMS: To review results of the ventral approach for mandibular and sublingual sialoadenectomy for the treatment of sialocoeles associated with the mandibular and sublingual salivary glands in the dog, and to determine rates of recurrence and complication following this procedure. METHODS: Thirty-nine dogs with 41 sialocoeles that underwent surgical intervention were retrospectively evaluated with respect to signalment, aetiology, location of sialocoeles, duration of clinical signs, treatment prior to referral, post-operative use of antibiotics and drains, complications, and recurrence. RESULTS: The mean age at the time of surgery was 5.1 (SD 3.8) years, and duration of clinical signs 6.6 (SD 10.6) months. Long-term follow-up was available for 31 dogs; the minimum was 8 months and mean 47.7 (SD 25.8) months post-surgery. There was no recurrence of sialocoeles following the ventral approach for mandibular and sublingual sialoadenectomy. Postoperatively, 6/35 (17%) cases developed a seroma at the surgical site. No breed or sex predisposition was determined. The cause of the sialocoele was unknown in 36/41 (88%) cases. CONCLUSIONS AND CLINICAL RELEVANCE: Excellent clinical results were achieved with a low rate of complications using the ventral approach for mandibular and sublingual sialoadenectomy. The ventral approach is recommended to minimise the risk of recurrence of sialocoeles.     

Transoral approach for mandibular and sublingual sialoadenectomy in a cat

Sialocele is an uncommon condition in cats. The treatment of choice for sublingual sialocele is excision of the ipsilateral mandibular and sublingual salivary gland/duct complex. Lateral and ventral cervical approaches have been described for mandibular-sublingual sialoadenectomy; however, the transoral approach, described here, has never been reported in cats. Ranula in the present case was likely caused by an inadvertent trauma of the sublingual duct during resection of a sublingual lesion performed by the referring veterinarian. The definitive surgery consisted of mass removal and sialoadenectomy through a unique oral approach. The surgery was effective without complications encountered after 6 months of follow-up.Key clinical message:This article reports a novel, transoral approach, for mandibular and sublingual sialoadenectomy in the cat. This approach decreases the surgical time and prevents recurrence of the mucocele.     

A method for intervertebral space distraction before stabilization combined with complete ventral slot for treatment of disc-associated wobbler syndrome in dogs

Objective— To evaluate the use of a modified K-wire spacer for maintaining intervertebral distraction after ventral decompression and during stabilization as a treatment for disc-associated wobbler syndrome in large breed dogs.
Study Design— A retrospective study.
Animals— Dogs (n=7) with disc-associated wobbler syndrome.
Methods— Medical records (2003–2006) of dogs treated by a modified surgical method were evaluated. Data retrieved were signalment, onset and duration of clinical signs, neurologic abnormalities, diagnostic methods, surgical procedure, immediate, and long-term (≥1 year) postoperative clinical and radiographic outcome.
Results— Mean duration of clinical signs was 4.8 months. Neurologic signs included ataxia (2), ambulatory tetraparesis (2), and non-ambulatory tetraparesis (3). Three dogs had disc protrusion in 2 sites, 2 dogs had the procedure in 1 location and stabilization of both affected sites. All dogs improved dramatically and remained for 1–3 years. One dog had recurrence of cervical discomfort 13 months later.
Conclusions— Despite the limited number of dogs, overall initial successful outcome with only 1 dog having mild recurrence 13 months later supports further use and evaluation of this technique.
Clinical Relevance— Distraction using a K-wire spacer after ventral decompression followed by stabilization should be considered in dogs with disc-associated wobbler syndrome to prevent collapse of the intervertebral space.     

Dorsal laminectomy for caudal cervical spondylomyelopathy: postoperative recovery and long-term follow-up in 20 dogs

OBJECTIVE: To evaluate the postoperative morbidity and long-term outcome of dogs after dorsal laminectomy for caudal cervical spondylomyelopathy (CCSM). STUDY DESIGN: Retrospective study. SAMPLE POPULATION: Twenty dogs with CCSM. METHODS: Medical records of dogs treated by dorsal laminectomy for CCSM at North Carolina State University and Colorado State University between 1989 and 1999 were reviewed. Information on signalment, onset, progression and duration of clinical signs, diagnostic testing, sites of dorsal laminectomy, postoperative complications, length of hospitalization, and the ambulatory status on discharge was recorded. A minimum follow-up of 7 months was required for inclusion in the study. Neurologic status was graded (0 to 5) preoperatively, 2 days after surgery, and at the time of the study (final score). Improvement or worsening of the neurologic status was assessed by comparison of different scores for each dog. Additional follow-up information was obtained by means of a detailed telephone questionnaire directed at both the owner and referring veterinarian. RESULTS: Mean duration of clinical signs before surgery was 4.9 months. At admission, 15 dogs were ambulatory and 5 were nonambulatory. Neurologic status worsened in 70% of dogs 2 days after surgery but improved in all but 1 dog over the long term. Mean time to optimal recovery was 3.6 months. Long-term follow-up ranged from 7 months to 9 years (mean +/- SD, 3.2 +/- 2.4 years). Four dogs had confirmed recurrence; 2 other dogs may have had recurrence. CONCLUSIONS: Dorsal cervical laminectomy is an effective treatment for CCSM in those dogs with dorsal compression or multiple sites of involvement. CLINICAL RELEVANCE: Although most dogs' neurologic status transiently worsened after surgery, long-term outcome and recurrence rates were comparable to those seen with other surgical techniques for CCSM.     

Ventral mandibulectomy for removal of oral tumours in the dog: Surgical technique and results in 19 cases

The purpose of this retrospective study is to describe in detail a novel ventral approach for mandibulectomy and the results in 19 dogs. The medical records of 19 dogs that received a partial or total unilateral mandibulectomy with the new ventral approach were reviewed. Information obtained included signalment, tumour type, extent of mandibulectomy, removal of regional lymph nodes, intrasurgical complications, immediate postoperative complications, histopathological diagnosis and study of margins. Intrasurgical complication occurred in one dog (haemorrhage) and required a blood transfusion. Postoperative morbidity was minor and included transient ventral cervical swelling and self‐limiting sublingual swelling (two dogs). All 19 animals were discharged between 24 and 48 hours of the procedure, and appetite was considered normal at discharge. Some perceived advantages of this procedure include easy identification of all the important anatomic structures in the area, including the inferior alveolar artery and temporo‐mandibular joint, and the fact that osteotomy of the zygomatic arch is not necessary (in case of caudal mandibulectomy). In addition, dissection of both mandibular and retropharyngeal lymph nodes is easily achieved by caudal extension of the same skin incision.     

Surgical management of recurrent cervical sialoceles in four dogs

Recurrent cervical sialoceles were diagnosed in four dogs associated with inadequate excision of the sublingual gland. Three dogs were managed by resection of the remnants of the sublingual gland via an oral approach. One dog was managed through a ventral approach as identification of the sublingual gland was not possible with the oral approach. The outcome was favourable in all cases and no relapses were detected after a median follow‐up time of 10 months.     

Zygomatic sialocele secondary to infarction treated with sialoadenectomy in a dog

Zygomatic salivary gland disease is not commonly reported in dogs and there is a paucity of literature reporting salivary gland disease secondary to infarction in dogs. A 9-year-old German wirehaired pointer presented with left eye exophthalmos, 3rd eyelid elevation, negative retropulsion, and pain upon opening of the mouth. Computed tomography revealed a mass extending from the left zygomatic salivary gland, consistent with a sialocele. A left-sided zygomatic sialoadenectomy was performed successfully. Histopathologic diagnosis concluded zygomatic salivary gland infarction. The dog had no signs of recurrence 20 mo after surgery.Key clinical message:To the authors’ knowledge, this is the first case report with long-term outcome of a zygomatic sialocele secondary to salivary gland infarction in a dog treated by zygomatic sialoadenectomy via zygomatic osteotomy.     

Concurrent sialocoele and necrotising sialadenitis in a dog

A seven-year-old male, entire rottweiler was presented to Murdoch University Veterinary Hospital with a 24 hour history of blindness, chemosis, exophthalmus, pain on opening the mouth and hypersialism. Bilateral mandibular and zygomatic salivary gland enlargement with concurrent bilateral zygomatic salivary gland sialocoeles were identified. The cause of the mandibular salivary gland enlargement was confirmed as necrotising sialadenitis, while the cause of the zygomatic gland enlargement was presumed to be because of a similar disease process. No underlying aetiology was identified. Treatment consisted of supportive management, corticosteroids and paracentesis of the sialocoeles and resulted in resolution of the salivary gland enlargement and the associated clinical signs. This is an unusual presentation of salivary gland disease in the dog with multiple gland involvement and a spectrum of disease processes occurring at the same time.     

Bilateral thyroarytenoid cartilage lateralization and vocal fold excision with mucosoplasty for treatment of idiopathic laryngeal paralysis: 67 dogs (1998-2005)

Objective— To evaluate combined bilateral thyroarytenoid cartilage lateralization, vocal fold excision, and mucosoplasty technique (BTAL) through ventral median laryngotomy for treatment of laryngeal paralysis in dogs.
Design— Retrospective study.
Animals— Dogs (n=67) with laryngeal paralysis.
Methods— Medical records were reviewed for dogs with idiopathic laryngeal paralysis that had BTAL between January 1998 and March 2005. Retrieved data included signalment, history, physical and laryngoscopic examination findings, clinicopathologic tests, and results of recheck examination findings.
Results— BTAL was performed by a single surgeon. Short-term (<6 months) follow-up information was available for 67 dogs and long-term (>12 months) for 40 dogs. Major postoperative complications were surgical failures (13; 7 short term, 6 long term) and aspiration pneumonia (1). Mean recurrence of clinical signs was at 19 weeks (range, 2–30 weeks). Minor complications occurred in 22 (33%) dogs including occasional coughing or gagging, stridorous breathing during exercise, panting, noisy or heavy breathing, and aspiration pneumonia (3 dogs) that did not require hospitalization. All owners reported an improved quality of life and had no regrets with surgical outcome.
Conclusions— BTAL is seemingly an effective procedure for treatment of laryngeal paralysis.
Clinical Relevance— BTAL is associated with a low incidence of aspiration pneumonia; however, there is substantial risk of recurrence of clinical signs associated with narrowing of the glottis. Consequently, unilateral arytenoid lateralization currently represents the accepted approach to the treatment of laryngeal paralysis.     

Cisterna chyli ablation with thoracic duct ligation for chylothorax: results in eight dogs

OBJECTIVE: To report use of combined cisterna chyli ablation (CCA) and thoracic duct ligation (TDL) for treatment of spontaneously occurring chylothorax in dogs. STUDY DESIGN: Retrospective study. ANIMALS: Eight dogs with chylothorax. METHODS: TDL was performed through a right caudal intercostal thoracotomy and CCA through a left flank paracostal approach or ventral median celiotomy. Long-term outcome (range, 2-48 months; median, 11.5 months) was evaluated by telephone communication with owners. RESULTS: Seven dogs were free of clinical signs related to chylothorax at last follow-up (range, 4-48 months; median, 15.5 months). One dog was euthanatized 2 months after surgery because of lack of improvement. No major complications occurred from CCA. CONCLUSION: CCA and TDL resolved chylothorax in most dogs (88%). CLINICAL RELEVANCE: CCA combined with TDL may improve the outcome of chylothorax in dogs.     

Insulin-secreting tumours of the canine pancreas: Clinical and pathological features of 11 cases

This paper describes the clinical and pathological features of 11 dogs with insulin-secreting tumours of the pancreas. All the dogs showed episodic weakness or collapse. The diagnosis was made on fasting plasma glucose and serum insulin concentrations, the insulimglucose ratio, and the results of an intravenous glucose tolerance test. Ten of the dogs had exploratory laparotomy, and partial pancreatectomy was performed in nine of the cases. One case was euthanased at surgery because of widespread metastases. The tumours were graded histologically and the results compared with the time to recurrence of clinical signs and postoperative survival time. Postoperative survival time for dogs which died or were euthanased as a direct result of tumour recurrence, and time to recurrence of clinical signs were calculated from actuarial survival curves. The median time to recurrence of clinical signs after surgery was 12 months (range from four to 16 months; mean time to recurrence of clinical signs 12 months). Two cases died of unrelated disease, without recurrence of hypoglycaemic signs. The median postoperative survival time was 14 months (range 10 to 33 months; mean survival time 15 months). There is a suggestion that tumours with a high mitotic count carried a worse prognosis.     

MR anatomy of salivary glands in the dog

This retrospective analysis documented the magnetic resonance imaging (MRI) appearance of normal salivary glands based on 101 studies in dogs with no detectable disease in the splanchnocranium. Surface, signal intensity, homogeneity, structure, symmetry and the relationship of glands to surrounding tissues were noted, and gland topography was assessed with E12 plastinated embedded sections. Signal intensity of salivary glands was isointense (7-40%) to hyperintense (60-90%) to muscle tissue on T1- and hyperintense on T2-weighted images. Salivary glands had an increased T1 signal after contrast medium was applied. Salivary gland structure appeared homogeneous in mandibular and major sublingual glands and heterogeneous in zygomatic and parotid glands. Consistent landmarks were the external auditory canal for parotid glands, the digastric muscle for mandibular and major sublingual glands, and the pterygopalatine fossa for zygomatic glands. The minor sublingual and ventral buccal glands could not be localized with low-field MRI.     

Treatment of dogs infected with Hepatozoon americanum: 53 cases (1989-1998)

OBJECTIVE: To determine clinical and pathologic findings before and after short-term (group 1) and long-term (group 2) treatment in dogs with Hepatozoon americanum infection. DESIGN: Retrospective study. ANIMALS: 53 dogs with H. americanum infection. PROCEDURE: Medical records of dogs that were treated for hepatozoonosis diagnosed on the basis of meront or merozoite stages in skeletal muscle were reviewed. RESULTS: Circulating gametocytes of H. americanum were identified in 12 of 53 dogs. Dogs were treated with various drugs, including toltrazuril, trimethoprim-sulfadiazine, clindamycin, pyrimethamine, and decoquinate. Mean WBC counts prior to treatment were 85,700 and 75,200 cells/microl in groups 1 and 2, respectively, and 1 month after initiation of treatment were 12,600 and 14,600 cells/microl, respectively. Initial response to treatment was excellent in all dogs. Twenty-three of 26 dogs in group 1 relapsed at least once and died within 2 years; mean (+/- SD) survival time was 12.6+/-2.2 months. Twenty-two of 27 group-2 dogs survived; 11 dogs had no clinical signs and were still receiving decoquinate (mean duration of treatment, 21 months), 11 dogs had no clinical signs after treatment for 14 months (range, 3 to 33 months; mean survival time, 39 months [range, 26 to 53 months]), 2 dogs were lost to follow-up, and 3 dogs were euthanatized because of severe disease. CONCLUSIONS AND CLINICAL RELEVANCE: Although no treatment effectively eliminated the tissue stages of H. americanum, treatment with trimethoprim-sulfadiazine, clindamycin, and pyrimethamine followed by long-term administration of decoquinate resulted in extended survival times and excellent quality of life.     

Canine salivary mucocoeles Results of sialographic examination and surgical treatmentof fifty cases

Fifty consecutive cases of salivary mucocoeles in dogs were investigated. Twenty-four dogs were presented with both cervical and sublingual mucocoeles; in twenty-three cases a cervical swelling only was noted and in three cases a sublingual mucocoele (ranula) existed on its own. Sialography demonstrated sublingual gland, or duct, defects in forty cases. In seven of the remaining ten cases, normal mandibular sialograms were obtained on the affected side. Bilateral sublingual gland involvement was confirmed by sialography in eight cases and suggested by circumstantial evidence in a further two cases. Surgical excision of the mandibular and sublingual glands on the affected side, combined with drainage of the mucocoele contents, has proved to be a reliable approach to treatment.     

Inflammatory polyps of the middle ear in 5 dogs

OBJECTIVE: To describe inflammatory polyps of the middle ear in 5 dogs. STUDY DESIGN: Case series. ANIMALS: Five dogs with ear disease. METHODS: Medical records (1995-2001) were reviewed to identify dogs with inflammatory polyps of the middle ear. Signalment, clinical signs, ancillary diagnostic procedures, treatment, postoperative complications, and outcome were recorded. Owners and referring veterinarians were contacted to document outcome. RESULTS: Dogs with inflammatory polyps of the middle ear were male and aged 4 to 13 years. Two dogs had bilateral polyps, whereas 3 had unilateral polyps. The most common clinical presentation was otitis externa and media, with radiographic evidence of otitis media. Polyps were treated by ventral bulla osteotomy (VBO) in 1 dog and total ear canal ablation with lateral bulla osteotomy (TECA-LBO) in 4 dogs. Polyps consisted of a fibrovascular stroma infiltrated with neutrophils, macrophages, lymphocytes, and plasma cells. The overlying epithelium was frequently ulcerated. Immediate postoperative complications included a seroma after VBO (1 dog) and transient unilateral facial nerve paralysis after bilateral TECA-LBO (1 dog). No recurrence occurred within 9 to 69 months. CONCLUSIONS: Unilateral or bilateral, inflammatory polyps can occur in the middle ear of dogs in association with otitis externa and media. No recurrence occurred after surgical removal of the polyps. CLINICAL RELEVANCE: Inflammatory polyps of the middle ear in dogs can be a cause of otitis externa/media. Surgical removal of aural polyps has a good prognosis.     

Application of Ventral Pins and Polymethylmethacrylate for the Management of Atlantoaxial Instability: Results in Nine Dogs

Objective — The purpose of this report was to determine the efficacy of the application of ventral pins and polymethylmethacrylate for the management of congenital and traumatic atlantoaxial instability (AAI) in dogs.
Study Design — Medical records and radiographs of nine dogs with AAI were reviewed for neurological deficits, clinical diagnosis, surgical technique, and long-term outcome.
Sample Population — Six toy breed dogs with congenital AAI and three medium or large breed dogs with traumatic AAI were identified for inclusion in the study.
Methods — The atlantoaxial joints of nine dogs with AAI were surgically stabilized using ventral application of pins and polymethylmethacrylate. Follow-up evaluation for resolution of clinical signs and possible complications of surgery was performed in all dogs. The median follow-up time for surviving dogs (8) was 11.5 months with a mean of 13 months.
Results — An excellent outcome was identified in five patients. Three dogs had a good outcome and one dog died of respiratory complications. Cervical pain was eliminated or significantly reduced in all dogs that survived and none of the dogs had major residual neurological deficits.
Conclusions — Arthrodesis could not be confirmed on follow-up radiographs due to the presence of the polymethylmethacrylate; however, adequate stabilization of C1-C2 appears to have been achieved based on the resolution of clinical signs.
Clinical Relevance — Application of ventral pins and polymethylmethacrylate is an effective means of surgical treatment for congenital and traumatic AAI.     

Acute Oropharyngeal and Esophageal Stick Injury in Forty‐One Dogs

Objective— To report clinical findings, treatment, and outcome in dogs with acute (<7 days) oropharyngeal or esophageal stick injury. Study Design— Retrospective study. Animals— Dogs (n=41) with acute oropharyngeal or esophageal injury. Methods— Dogs had clinical and radiographic examination, and frequently, cervical surgical exploration. The decision to operate was based on radiographic findings of cervical emphysema. Outcome was determined by owner or veterinarian interview. Results— Of 41 dogs, 27 had oropharyngeal injury and 14 had esophageal injury. Five dogs with esophageal injury died. All dogs with radiographic evidence of cervical emphysema (n=34) had ventral median cervical exploration or necropsy; 11 had wood fragment(s) retrieved. In 7 dogs without radiographic signs of cervical emphysema, wounds involving the pharynx or soft palate were treated by local debridement and lavage using an oral approach. Mean follow‐up time was 36.4 months. All wounds healed without complication; however, 1 dog that was not surgically explored had a piece of wood surgically retrieved 3 months later. Conclusions— Radiographic evidence of cervical emphysema is a frequent finding in dogs with acute penetrating oropharyngeal or esophageal injury and indicates trauma to the deeper cervical tissues. Acute penetrating injury of the oropharyngeal region, when treated appropriately, has a better prognosis than acute esophageal penetration. Clinical Relevance— Ventral median cervical surgical exploration is recommended in dogs with acute penetrating injury of the oropharynx or esophagus if there is radiographic evidence of tissue emphysema.     

Pharyngeal mucoceles in dogs: 14 cases

This report describes the clinical features of a series of dogs with pharyngeal salivary mucoceles. A retrospective study of 14 dogs with pharyngeal mucocele was performed. Medical records from 1983 to 2003 were reviewed for information regarding signalment, clinical signs, diagnosis, surgical procedures, and short-term and long-term outcome. Miniature and toy poodles were common breeds in the study population, and 79% of the dogs were male. The most common presenting sign was dyspnea (50%). Diagnosis was by fine-needle aspirate, which revealed a mucoid substance in 93% of dogs. Histopathology of the excised salivary glands revealed lymphoplasmacytic inflammation in all dogs that had histopathology performed. Forty-three percent of the dogs had a cervical mucocele on the same side as the pharyngeal mucocele. Surgical therapy was performed in 13 dogs, which consisted of excision of the mandibular and sublingual salivary glands, excision of the mucocele, or marsupulization of the mucocele. Only two dogs had recurrence of the pharyngeal mucocele. In this study, pharyngeal mucoceles occurred in predominantly small dogs that frequently presented with respiratory signs. Surgical treatment was successful in most dogs.     

Canine sialocoeles - 60 clinical cases

Sixty cases of canine sialocoele were reviewed from the records of the Sydney University Veterinary Teaching Hospital. Poodles, dachshunds and Australian silky terriers were significantly over represented in the survey when compared to the hospital sample population (P&0.01). No other statistically significant breed, sex, or age trends were noted. Neoplasia was associated with sialocoele formation in three cases. The sialocoele location was cervical (42), sublingual (four), pharyngeal (four), not recorded (one) or in more than one site (nine). Thirty-five of 39 surgically treated cases were managed by extirpation of the mandibular and sublingual salivary glands together with drainage. Few complications were recorded. Forty-two per cent of the cases had received previous veterinary treatment in the form of drainage alone. Drainage of saliva from sialocoeles without removal of the offending salivary glands is inappropriate.     

Oropharyngeal penetrating injuries in 50 dogs: a retrospective study

OBJECTIVES: To summarize the presenting complaints and clinical signs associated with traumatic penetrating injuries to the canine oropharynx. To determine how the site of injury, causative agent, and duration of disease affect the presentation and clinical outcome of treatment. STUDY DESIGN: Retrospective study. SAMPLE POPULATION: 50 client-owned dogs. METHODS: The medical records of 50 dogs with oropharyngeal penetrating injuries referred to Glasgow University Veterinary Hospital (GUVH) between 1979-1999 were reviewed. Data regarding signalment, owners' presenting complaint, history, physical examination, radiographic and endoscopic findings, surgical findings, and outcome were recorded and compared with the GUVH population. Estimates of individual breed-specific odds ratios were calculated. Outcome was evaluated by reexamination 6 weeks after surgery with recurrence of disease recorded as failure. RESULTS: Oropharyngeal injuries occurred most often in medium to large breed dogs. The majority of dogs presented with chronic disease (82%). The common findings on clinical examination were discharging sinus (72%) and swelling (70%). Acute cases typically presented with dysphagia and oral pain. The original site of injury was evident in only 34% of dogs, with the sublingual area the most frequently traumatized. The apparent cause of injury to the oropharynx was most commonly a piece of wood (72%). Other causes were metallic foreign bodies (3 dogs) and bones (2 dogs). In the remaining 9 dogs, the cause was not determined. The clinical signs resolved in all dogs that presented acutely compared with only 62% in dogs with chronic signs. CONCLUSION: Medium to large breed dogs appear to be prone to oropharyngeal injuries caused mainly by wooden foreign bodies. This may be attributable to stick chewing or retrieving behavior in these animals. CLINICAL RELEVANCE: History of trauma, stick retrieval, submandibular/cervical swelling, and discharging sinus are commonly encountered in the presentation of this condition. The sublingual area was the most frequent portal of entry recorded, although in chronic cases the initial site of injury was often unclear. Radiography and endoscopy, while offering definitive diagnosis with positive findings, often provide false negative findings. Aggressive surgical debridement of all sinus tracts is essential in obtaining a successful result, but recovery of a foreign body is not necessarily a determinant of success.