Small Ani. Sx- Salivary glands

wilsbach's version from 2015-11-04 19:35

conditions and txs

Question Answer
what are the major salivary glands and where are they?
what is unique about cat salivary glands?there is an extra!!! the molar salivary gland
what are the minor salivary glands? how do they differ from the majors?Lingual, Labial, Buccal, Palatine... Open directly into oral cavity
which glands are serous and which are seromucus?serous- parotid. All others are seromucus.
(he skipped this slide in class- salivary duct openings?)(Sublingual caruncle (Mandibular and sublingual glands), Parotid papilla (Aboral to upper 4th premolar), Major and minor zygomatic ducts (Aboral to parotid papilla, behind last molar) )
7 dzs of salivary glands are?Mucocele (most common), Parotid Fistula (usu FB or thorn), Sialoliths(little concretions), Sialoadenitis (inflammation), Canine Necrotizing Sialometaplasia + Canine Sialoadenosis(not much known about these two dzs, they are super painful tho), Neoplasia
how does pt with mucocele present?Noticeable swelling-- Pocket of saliva, Swollen/enlarged gland (*not a cyst bc no secreting epithelium)
mucocele usu bc?rupture of salivary duct --> accumulate saliva
how to dx mucocele?FINGER MEMORY and Needle aspiration of swelling (cervical is called “honey cyst”)<--thick material so need large gauge needle
ddx for mucocele? (2)(1) neoplasia- but neo is usually harder (2) abscess- hot bc infection there. if clear skin would see redness. and needle aspirate will show pus. (so if see pus, lance it)
how can radiography be used to help dx a mucocele?(rarely helpful or used, but..) (1) Plain radiography- Rarely helpful, May confirm diagnosis of sialolith (2) Contrast radiography (Sialography)- Rarely used. May help determine extent of salivary involvement in cases of trauma, neoplasia, sinus tracts, and foreign bodies (need to place little canula in duct opening)
in a mucocele, where does the fluid usually sit? how is it diff from a cyst?Subcutaneous (submucosal) accumulation of saliva within a non-epithelial, non- secretory lining (unlike a cyst)
what is the most common disease of the salivary system in dogs and cats?mucocele
if a mucocele isn't in the cervical region, but rather is under the tongue, what is it called?a ranula
what is the most commonly affected gland in a mucocele?Sublingual salivary duct, monostomatic portion. monostomatic (one opening) portion is intimately adhered to portion of mandibular salivary gland
what are the three types of mucoceles (in terms of locations) and where does the saliva accumulate? which is most common?(1) cervical- Intermandibular or cervical accumulation. MOST COMMON! (2) Ranula- Sublingual accumulation (3) Pharyngeal mucocele- Pharyngeal wall accumulation (Least common).
which mucocele can be life threatening and why?Pharyngeal mucocele bc might obstruct airway.
which dog breeds are overrepresented with salivary mucoceles?German shepherd dog, Miniature poodle, Pekingese, Dachshund
if you have a mucocele, how do you know which side to operate on? (ex is cervical)place pt in dorsal recumbancy- cele will go to side of neck prob started on.
wuts dis? pharyngeal mucocele
how to tx mucocele (talking about pharyngeal specifically)use deep sedation, get a 12 blade (have a little hook) and lance it. Make sure ET tube well inflated to keep saliva out of trachea, maybe try aspiration if fluid not too thick.
dont confuse a pharangeal mucocele with..neoplasi (this would be harder upon palpation) or inflamed tonsils
what's the newly discovered place a mucocele was discovered to happen?from glands of soft palate!
how does a zygomatic mucocele tend to present?since lots of bone around it only has so many places to go, so, Periorbital accumulation of saliva. fluid pushing whole content of eye forward
must differentiate a zygomatic mucocele from?abscess and neoplasia
aside from bulging of eye, where else will you see bulging with a zygomatic mucocele?see bulging behind (aboral) to last molar in mouth (make sure not adenocarcinoma of nose, in similar place in mouth- but it would be medial to teeth)
how do you tx zygomatic mucocele?lance it- this is usually curative
clinical signs of salivary mucocele?Soft, nonpainful swelling (May be painful if in acute inflammatory stage or if secondarily infected). Respiratory distress (Pharyngeal mucocele)
how do you tx mucocele? (definitive tx is?) (he skipped this slide)(1) Surgical removal of the involved gland sialoadenectomy which is the DEFINITIVE tx (2) Drainage of accumulated saliva (In conjunction with definitive treatment. Conservative treatment in high-risk patients) (3) Aspiration of ranula or marsupialization? (4) Lancing of pharyngeal mucocele (to relieve resp distress)
definitive tx for mucocele is.. sialoadenectomy
how to do a sialoadenectomy (Sublingual salivary duct ex)Pt in LATERAL recumb with towel underneath head to slightly elevate. Look for landmarks: lingualfacial v and maxillary v. They converge to form a jugular vein. Want to go between these two veins, and make longitudinal incision. (pic is wrong, not verticle, because might harm veins) once disect skin an SQ, will see glistening capsule. Incise the capsule, then bluntly peel off from the capsule both sublingual and mandibular glands. With blunt dissection, continue in an orad(oral) direction, bluntly go underneath digastricus mm (no need to dissect which can lead to probs anyway) then keep going parallel to tongue till you see a white band (approx 2/3 downward orally) this is the lingual nerve. that is your landmark to stop dissection. place a circumferential ligature/hemoclip. Then remove both ducts and both glands. But now still have cervical mucocele- dont try to peel it off or itll break. So go to most ventral aspect of neck, make incision, and let it drain. Squeeze content out. If needed place drain.
where is the blood vessel you will need to ligate during a sialoadenectomy?when removing mandibular gland, on cr-dorsal aspect, there is the vessel you need to ligate.
how can you help the drain from coming out that you placed during your sialoadenectomy?Place a single loose stitch to adhere end of drain to capsule. When time to remove, just give it a tug and it'll pull through the rubber and itll come out.
how is tx of ranula different?do Marsupialization
how do you do Marsupialization?(for ranulas!) make eliptical portion of the cele, then have an opening, then suture edge of duct that is broken to mucosa of mouth. (allow for permanent drainage).
what is marsupialization?Marsupialization is performed by suturing the inner lining of the mucocele to the oral mucosa
prog of salivary mucocele?Excellent prognosis
how often is recurrance of mucocele and what are the main reasons?Recurrence after mandibular/sublingual gland resection is <5%. Usually due to Inadequate excision (Failure to remove enough of the POLYSYSTOMC sublingual gland), or Operation of the wrong side
what are sialoliths? where do they come from? (which gland gets them the most)they are Salivary duct stones, Parotid is most commonly affected gland (dogs)
sequale of sialoliths?Obstruction of duct leads to painful swelling (not a mucocele) (will need to open and drain it)
how can you tx sialoliths?Removal through oral incision over duct at site of sialolith. He said also might have to tie off parotid gland's duct to cause atrophy to prevent recurrance
sialoadenitis (inflammation) etiology?Primary disease (rare) or secondary to trauma or systemic infection (viral?)
sialoadenitis (inflammation) ddx?mucocele, Neoplasia
sialoadenitis (inflammation) is usually which salivary gland? what problems can this lead to due to which gland is most affected?Most commonly affected gland is Zygomatic salivary gland. *May lead to retrobulbar abscess
salivary gland neoplasia (usu adenocarcinoma) breed dispositions for dog/cat?DOG: no breed predilection. CAT: Siamese
how to tx parotid fistula (usually result of trauma to parotic duct)Ligation of the parotid duct results in atrophy of the gland by the 5th day.
canine necrotizing sialometaplasia--> what probs are involved with this? breed disposition? tx?Mandibular salivary gland necrosis; ptyalism, lip smacking, gulping, dysphagia, and pain, Terrier breeds, Anticonvulsivant medication
canine sialoadenitis--> (very similar canine necrotizing sialometaplasia to ) tx?Response to treatment with phenobarbital is rapid
with canine sialoadenitis and canine necrotizing sialometaplasia which gland is most commonly affected?Mandibular gland most commonly affected (Less commonly zygomatic)