Sialoadenectomy in Dogs with Sialocele

In the literature

Cinti F, Rossanese M, Burraco P, et al. Complications between ventral and lateral approach for mandibular and sublingual sialoadenectomy in dogs with sialocele. Vet Surg. 2021;50(3):579-587.

The Research …

Sialoceles are commonly diagnosed and can be classified as cervical, sublingual (ranula), pharyngeal, zygomatic, or nasopharyngeal, depending on which gland is involved. The mandibular/sublingual salivary gland/duct complex is most commonly affected. The sublingual gland is an aggregation of 2 to 4 lobulated masses extending along the mandibular duct, which extends anteromedially between the masseter and digastric muscles. A separate portion of the sublingual gland lies under the mucosa, extending from the jaw to the tongue. The sublingual duct and mandibular duct course together between the genioglossal and mylohyoid muscles. The standard of care for treating mandibular/sublingual sialoceles involves complete excision of the mandibular and sublingual salivary glands. 

This retrospective study of 140 dogs evaluated lateral and ventral paramedian surgical approaches. 

In the lateral approach, the patient is positioned in lateral recumbency with the neck extended over a roll positioned below the ear opposite the lesion. A linear incision is made between the maxilla and linguofacial veins in the angle of the jaw, and the mandibular gland capsule is incised. Caudolateral traction on the glandular chain and salivary duct is applied, and the gland is removed with the sublingual gland/duct complex. A ligature is then placed around the salivary duct. 

In the ventral paramedian approach (see Related Article), the patient is positioned supine with the neck extended. A longitudinal incision is made on the midline between the mandible rami, extending caudally beyond the level of the angular process where the mandibular gland is palpable. This approach can help clarify which side is affected, allowing surgical excision of the salivary gland. 

The lateral approach offers simpler dissection, whereas the ventral paramedian approach offers greater and simultaneous exposure of both the right and left mandibular and sublingual glands. Although either approach is acceptable if care is taken to ensure complete removal of the sublingual gland(s), extensive cranial dissection may be required in some cases.

Data analyzed to compare complications associated with each approach included age, sex, body weight, duration of clinical signs, sialocele location and side, inflammatory pseudocapsule excision, surgical time, drain placement, and bandage placement. Results demonstrated that sialoadenectomy via the ventral paramedian approach led to a lower risk for recurrence but more wound-related complications compared with the lateral approach. All recurrent cases in this study were treated using a lateral approach. In addition, a higher incidence of sialocele was identified in male and crossbreed dogs as compared with previous studies in which miniature poodles and German shepherd dogs were overrepresented.^1-3

… The Takeaways

Key pearls to put into practice:

• The 24% postoperative complication rate in this study is similar to previously published reports,^2,4 with minor complications (eg, seroma, surgical site swelling, wound dehiscence) predominating. The ventral paramedian approach was associated with more wound-related complications.

• No significant difference in wound-related complications occurred with or without a postoperative drain.

• The ventral paramedian approach for mandibular and salivary gland/duct complex excision is preferable, as there is decreased risk for sialocele recurrence in dogs; however, self-limiting wound-related complications are common.