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| − | Also known as: '''''Sialocoele — Ranula
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| − | ==Introduction==
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| − | Salivary mucocoele is a term used to describe the abnormal accumulation of saliva outside of a salivary gland. The cause of mucocoeles is often unknown but it may occur where there is a lesion of the sublingual or mandibular salivary duct, or in one of the small ducts of the polystomatic sublingual salivary gland. Saliva leaks out and is not absorbed - causing the formation of a pseudocyst.
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| − | Mucocoeles are not true cysts because they are not lined by a layer of epithelium but by inflammatory connective tissue. The sublingual and mandibular salivary glands are most commonly involved but any of the glands produce a mucocoele. The saliva accumulates in one of three places:
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| − | *'''Cervical mucoceles''' are the most common, developing caudal and ventral to the mandible. The swelling is usually to one side but may occur in the midline.
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| − | *A '''ranula''' is an elongated swelling on the floor of the mouth. They usually originate from the polystomatic sublingual glands and are therefore most often found beneath the tongue. Due to its location, it may interfere with mastication and swallowing.
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| − | *Mucocoeles on the '''pharyngeal wall''' are less common but they may interfere within respiration or swallowing.
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| − | ==Signalment==
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| − | Salivary mucocoeles are not common but they occur mainly in dogs.
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| | + | ==Typical Signalment== |
| | + | *most common in the dog |
| | + | ==Description== |
| | + | An accumulation of mucoid saliva following salivary duct rupture or obstruction but the cause is usually unknown. It most commonly affects the sublingual and mandibular glands but can also affect the zygomatic and parotid salivary glands. The saliva accumulates in one of three places: |
| | + | # '''Cervical mucocele''': The most common site, develop caudal and ventral to the mandible and is usually to one side but may also be in the midline. |
| | + | # '''Ranula''': An elongated swelling on the sublingual tissues on the mouth floor that can interfere with eating. |
| | + | # '''Pharyngeal wall''': A less common site, may interfere within breathing and eatting. |
| | ==Diagnosis== | | ==Diagnosis== |
| | ===Clinical Signs=== | | ===Clinical Signs=== |
| − | Salivary mucocoeles may be asymptomatic but the following signs may be observed:
| + | May be none at all but can see: |
| − | *'''Dysphagia''' with obvious gagging or pharyngeal retching. | + | *dysphagia |
| − | *'''Dyspnoea''' or respiratory stridor. | + | *gagging |
| − | *Initially '''painful swelling''' evolving to a '''non-painful, enlarging, fluctuant mass''', usually in the cervical region. | + | *dyspnoea |
| − | *Mucocoeles originating from the '''zygomatic gland''' may cause exophthalmus or strabismus if they impinge on the orbit. | + | *painful swelling evolving to a nonpainful, enlarging, fluctuant mass, mostly in the cervical region. |
| − | *If the structure becomes infected, '''pain''' and typical signs of infections ('''pyrexia, depression and anorexia''') may be observed.
| + | *pain and fever if it becomes infected |
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| | ===Laboratory Tests=== | | ===Laboratory Tests=== |
| − | A definitive diagnosis relies on '''fine needle aspiration''' of the structure and cytological examination of the fluid obtained. Typically, this reveals yellow/amber mucoid or blood-tinged material with evidence of mild inflammation. Periodic Acid Schiff (PAS) staining may be used to detect mucus in the fluid.
| + | '''Fluid aspiration and cytological evaluation''': Mucoid or blood-tinged, with low-grade inflammation saliva |
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| | ===Diagnostic Imaging=== | | ===Diagnostic Imaging=== |
| − | An '''ultrasound scan''' may be performed over the area of swelling to discount other possible diagnoses (including neoplasia, abscesses or lymphadenopathy). This imaging modality can also be used to guide fine needle aspiration. Alternatively, any of the salivary ducts can be cannulated within the oral cavity and water soluble iodine-containing contrast medium can be instilled into the salivary gland ('''positive contrast sialography'''). Radiographs of the affected area will then show whether the mucocoele is associated with a particular gland. This technique is technically difficult to perform and care should be taken not to spill contrast material into the mouth, potentially confusing the radiographic image.
| + | '''Sialography''' |
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| | ==Treatment== | | ==Treatment== |
| − | '''Surgical drainage and removal of the damaged gland''' and duct is the treatment of choice. Many of the salivary glands lie in close association with major structures of the head (including the cranial nerves and major blood vessels) and it may be advisable to refer such cases to a specialist centre for surgical removal. If the mucocoele cannot be removed surgically, it may be drained periodically by percutaneous aspiration. However, mucocoeles managed in this way rapidly recur and surgical removal of the tissue responsible for production of the saliva is preferable.
| + | Surgical drainage and removal of the damaged gland and duct is recomended. If this is not an option, then cervical mucoceles can be periodically aspirated. Ranulas can be treated by draining, marsupialization, or salivary gland removal. Pharyngeal mucoceles require complete gland and duct removal to alleviate the dyspnoea. |
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| − | '''Ranulas''' (which are within the buccal cavity) may be treated by '''marsupialisation''', in which the wall of the ranula is incised to allow the contents to drain into the mouth. The rim of the ranula must then be sutured to the oral mucosa to hold the aperture open. Additionally, the monostomatic and polystomatic sublingual and mandibular salivary glands on the affected side can be surgically resected.
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| − | Pharyngeal mucocoeles require complete gland and duct removal to alleviate dyspnoea and a temporary tracheostomy tube may be required in severe cases. | |
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| | ==Prognosis== | | ==Prognosis== |
| − | The prognosis is good for complete recovery. Complications arise if the salivary glandular tissue is not completely removed (leading to recurrence of the mucocoele) or if major structures are damaged during the surgical procedure.
| + | Good providing no complications. |
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| − | {{Learning
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| − | | Vetstream = [https://www.vetstream.com/canis/Content/Disease/dis00631.asp, Salivary mucocoele]<br>[https://www.vetstream.com/canis/Content/Illustration/ill05084.asp, Salivary mucocoele image]<br>[https://www.vetstream.com/canis/Content/Illustration/ill05079.asp, Ranula]
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| − | |flashcards = [[Veterinary Dentistry Q&A 10]]
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| − | |literature search = [http://www.cabdirect.org/search.html?q=%28%28title%3A%28%22Ranula%22%29%29%29+OR+%28%28title%3A%28%22Sialocoele%22%29%29%29+OR+%28%28title%3A%28%22Salivary+Mucocele%22%29%29%29 Salivary Mucocele publications]
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| − | }}
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| | ==References== | | ==References== |
| − | Guilford, W.G., Center, S.A., Strombeck, D.R., Williams, D.A. and Meyer, D.J. (1996) '''Strombeck's Small Animal Gastroenterology (3rd Edition)''' ''W.B. Saunders Company''
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| | Hall, E.J., Simpson, J.W. and Williams, D.A. (2005) '''BSAVA Manual of Canine and Feline Gastroenterology (2nd Edition)''' ''BSAVA'' | | Hall, E.J., Simpson, J.W. and Williams, D.A. (2005) '''BSAVA Manual of Canine and Feline Gastroenterology (2nd Edition)''' ''BSAVA'' |
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| | Merck & Co (2008) '''The Merck Veterinary Manual''' | | Merck & Co (2008) '''The Merck Veterinary Manual''' |
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| − | Verstraete, F. J. M. (1998) '''Self-Assessment Colour Review - Veterinary Dentistry''' ''Manson''
| + | Guilford, W.G., Center, S.A., Strombeck, D.R., Williams, D.A. and Meyer, D.J. (1996) '''Strombeck's Small Animal Gastroenterology (3rd Edition)''' ''W.B. Saunders Company'' |
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| − | {{review}}
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| − | {{OpenPages}}
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| − | [[Category:Salivary_Glands_-_Pathology]]
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| − | [[Category:Oral Diseases - Dog]][[Category:Oral Diseases - Cat]]
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| − | [[Category:Expert_Review - Small Animal]]
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Typical Signalment
Description
An accumulation of mucoid saliva following salivary duct rupture or obstruction but the cause is usually unknown. It most commonly affects the sublingual and mandibular glands but can also affect the zygomatic and parotid salivary glands. The saliva accumulates in one of three places:
- Cervical mucocele: The most common site, develop caudal and ventral to the mandible and is usually to one side but may also be in the midline.
- Ranula: An elongated swelling on the sublingual tissues on the mouth floor that can interfere with eating.
- Pharyngeal wall: A less common site, may interfere within breathing and eatting.
Diagnosis
Clinical Signs
May be none at all but can see:
- dysphagia
- gagging
- dyspnoea
- painful swelling evolving to a nonpainful, enlarging, fluctuant mass, mostly in the cervical region.
- pain and fever if it becomes infected
Laboratory Tests
Fluid aspiration and cytological evaluation: Mucoid or blood-tinged, with low-grade inflammation saliva
Diagnostic Imaging
Sialography
Treatment
Surgical drainage and removal of the damaged gland and duct is recomended. If this is not an option, then cervical mucoceles can be periodically aspirated. Ranulas can be treated by draining, marsupialization, or salivary gland removal. Pharyngeal mucoceles require complete gland and duct removal to alleviate the dyspnoea.
Prognosis
Good providing no complications.
References
Hall, E.J., Simpson, J.W. and Williams, D.A. (2005) BSAVA Manual of Canine and Feline Gastroenterology (2nd Edition) BSAVA
Merck & Co (2008) The Merck Veterinary Manual
Guilford, W.G., Center, S.A., Strombeck, D.R., Williams, D.A. and Meyer, D.J. (1996) Strombeck's Small Animal Gastroenterology (3rd Edition) W.B. Saunders Company
