Anatomy

Dogs have salivary glands that are located both within lining of the mouth and in the head and
neck region. Dogs have many salivary glands, but the most important ones include the
zygomatic (located by the eye), mandibular (located just behind the jaw bone), sublingual
(located under the tongue), and parotid salivary glands (located around the ear canal).


Causes of salivary mucoceles

The inciting cause of a salivary mucocele is usually not definitively identified; however, trauma
from a choke chain, bites to the neck, and sudden hyperextension of the neck are suspected
causes. These can cause stretching or tearing of the salivary gland or the duct that drains
saliva from the gland to the mouth. Saliva accumulates under the skin and incites a marked
inflammatory response. The body attempts to contain the leaking saliva by creating a layer of
connective tissue around the saliva (called a mucocele).


Signs and diagnosis

Mucoceles are primarily found in dogs, but are rarely seen in cats. Mucoceles are more
commonly seen in Dachshunds, German Shepherds, Poodles, and Silky Terriers that are at
any age. The clinical signs associated with a mucocele are dependent on the gland that is
affected:
1. Cervical mucocele is caused by
damage to the mandibular or
sublingual salivary glands or
their associated ducts. A
swelling located on the side or
under the neck is most
commonly seen.
2. Pharyngeal mucocele typically
does not have an external visible
swelling as the accumulation is
located in the back of throat and
will cause breathing difficulty.
This is caused by damage to the
mandibular or submandibular
salivary glands or their
associated ducts. Your
companion may need to be anesthetized to allow examination of the throat to make a
diagnosis.
3. Sublingal mucocele is also called a rannula and is a swelling under the tongue. This
type of mucocele is caused by damage to the sublingual ducts or salivary gland.
4. Zygomatic mucocele is due to damage to the zygomatic gland and causes a swelling
below the eye.

Other causes of a swelling in the neck may include inflammation of the salivary gland, salivary
gland tumors, infection with abscess in the neck due to a foreign enlarged lymph nodes, and
embryonic cysts such as a thyroglossal cyst, cystic Rathekes pouch, or a branchial cyst.

Prior to surgery, a fine needle aspirate of the swelling and examination of the fluid under a
microscope should be performed. In addition, blood work such as a complete blood count and
chemistry profile are completed to evaluate the internal organ health of your companion in
Salivary Mucocele
Surgery Service
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3412 E. Walton Blvd.
(West of Squirrel Rd.)
(248) 371-3713

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1425 Michigan St. NE
(East of Fuller Rd.)
(616) 284-5300

MVS Southfield
29080 Inkster Rd.
(North of 12 Mile Rd.)
(248) 354-6660
preparation for anesthesia and surgery.


The day of surgery

Our anesthesia and surgical team will prescribe a pain management
program, both during and after surgery, that will keep your companion
comfortable. This may include a combination of injectable analgesics,
oral analgesics and anti-inflammatory medication.


Treatments

Conservative treatment consisting of a wait and see approach or draining the fluid from the cyst rarely results in
resolution of the problem. Surgical removal of the involved salivary glands is the treatment of choice for a permanent
cure of the problem. Although many important vessels and nerves that control tongue movement and swallowing are
nestled around the gland, damage to these is very uncommon in the hands of an experienced surgeon. At the
decision of the surgeon, a drain many be placed after the glands have been removed. Removal of a set of salivary
glands will not impair your companions ability to produce adequate saliva, as other glands will take over the function.


Aftercare and results

After surgery, you can continue to give your pet a prescribed pain reliever to minimize discomfort. Its also extremely
important to limit your dogs activity and exercise level for three weeks after surgery. The incision should be checked
daily for signs of infection. A drain may be placed in the incision and typically will be removed 5 to 10 days after
surgery. The drain should be removed by one of our staff members after there is minimal fluid coming out of the
drain. Two weeks after surgery, the surgeon will monitor the healing of the incision.

Short-term complications following surgery are uncommon and may include temporary bleeding at the surgical site,
infection, nerve damage, and seroma formation (fluid accumulation under the incision). Recurrence of the mucocele
is caused by incomplete removal of the entire abnormal salivary tissue and will necessitate a second surgery.
Almost all patients are cured of the salivary mucocele with just one surgery.


















Salivary Mucocele Continued
Diagnosis
To diagnose a UT, your veterinarian should collect a sterile urine sample from your pet. The best method to collect urine
is by a technique called cystocentesis, during which a needle is inserted through the body wall into the bladder and urine
is removed by a syringe. This technique is very safe and painless to your pet. Free catch urine samples or samples ob-
tained from the floor or office examination table are invariably contaminated samples and not suitable for evaluation to
determine infection.

Your veterinarian will analyze this urine sample (urinalysis) and examine a small amount under a microscope. f either or
both bacteria or increased numbers of white blood cells (WBC's) are present, your veterinarian will suggest performing a
urine culture. The presence of white blood cells means that inflammation is present but does not necessarily mean a UT
is present. Likewise, in an animal whose immune system is compromised or having highly diluted urine, a UT may be
present, but the urinalysis may not reveal white blood cells or bacteria. A urine culture is the best method for confirming a
UT is present.

A urine culture involves sending a small part of the collected urine to a laboratory that will try to grow the bacteria. f no
bacteria grow, then a UT is unlikely to be present. f bacteria grow, then the organism will be identified and antimicrobial
susceptibility will be performed by the laboratory. Antimicrobial susceptibility testing usually takes 2-5 days for
completion.

n some animals, additional testing may need to be done, such as blood work or imaging studies (radiographs or ultra-
sound), because a bacterial UT may occur as a result of or in combination with other diseases (e.g., bladder stones,
chronic kidney disease, feline leukemia virus).
Treatment
Antibiotics are prescribed to treat bacterial UT's. How long antibiotics need to be given to your dog or cat depends on
several factors, including whether it is a dog or cat, the age of the animal, whether this is a first time UT or a
recurrence of a UT, what the bacterial organism is, and what antibiotics it is sensitive to, and if complicating factors are
associated with the UT.

A simple (or uncomplicated UT) occurs primarily in spayed female dogs and is not associated with systemic illness or
complicating diseases. n this case, antibiotics are typically given for 7 to 14 days.

A complicated UT occurs when there are one or more complicating diseases or if the UT is recurrent. Remember, that
young cats rarely have a UT and in older cats UT is usually complicated by chronic kidney disease. Another example of
a complicating disease is diabetes mellitus or hyperadrenocorticism (Cushing's disease). n animals with a complicated
UT, antibiotics may be recommended for 3 to 6 weeks. A urine culture will likely be recommended partway through the
treatment to make sure the UT is under control, and then again after the antibiotic treatment is finished to make sure the
UT is cleared.

Although other treatments are sometimes recommended (i.e., cranberry juice), no conclusive evidence proves they are of
benefit to dogs and cats. Prompt and appropriate antibiotic treatment based on urine culture and sensitivity is the best
way to eradicate a bacterial UT.
Urinary Tract InIection (UTI) Continued...
Prevention
n most instances nothing specific can be done to prevent a UT from occurring. Your dog or cat should be re-evaluated if
clinical signs recur. With complicated UT, your veterinarian should periodically evaluate your pet to make sure that the
UT has not recurred or is under control. n some animals with complicating factors present, a urinary antiseptic or an
antibiotic must be given long term to prevent a UT from reoccurring.

Assessment and recommendations

Patient: _________________________________________ Date: _____________________

Treatment
Surgery is recommended
Surgery is not recommended
Please make an appointment for a consultation with one of our oncologists

The following has been prescribed
No medications or special diet are necessary at this time
Antibiotic: _______________________________________________________
Other medication: _________________________________________________

Exercise
Unlimited
Please use a harness instead of a collar on your companion
Confine your pet to the house other than very short leash walks necessary for bowel movements and
urination
Restrict exercise to leash walks 10 minutes twice daily

Preparation for surgery
Start fasting your companion at midnight before the day of surgery; water should not be withheld
Pepcid AC 10 mg tablets: give ______ tablet(s) with water (use syringe if needed) at 6 AM on the day of
surgery

Composed by Daniel A. Degner, DVM, DACVS
Edited by Ned F. Kuehn, DVM, MS, DACVIM


Salivary Mucocele Continued
Diagnosis
To diagnose a UT, your veterinarian should collect a sterile urine sample from your pet. The best method to collect urine
is by a technique called cystocentesis, during which a needle is inserted through the body wall into the bladder and urine
is removed by a syringe. This technique is very safe and painless to your pet. Free catch urine samples or samples ob-
tained from the floor or office examination table are invariably contaminated samples and not suitable for evaluation to
determine infection.

Your veterinarian will analyze this urine sample (urinalysis) and examine a small amount under a microscope. f either or
both bacteria or increased numbers of white blood cells (WBC's) are present, your veterinarian will suggest performing a
urine culture. The presence of white blood cells means that inflammation is present but does not necessarily mean a UT
is present. Likewise, in an animal whose immune system is compromised or having highly diluted urine, a UT may be
present, but the urinalysis may not reveal white blood cells or bacteria. A urine culture is the best method for confirming a
UT is present.

A urine culture involves sending a small part of the collected urine to a laboratory that will try to grow the bacteria. f no
bacteria grow, then a UT is unlikely to be present. f bacteria grow, then the organism will be identified and antimicrobial
susceptibility will be performed by the laboratory. Antimicrobial susceptibility testing usually takes 2-5 days for
completion.

n some animals, additional testing may need to be done, such as blood work or imaging studies (radiographs or ultra-
sound), because a bacterial UT may occur as a result of or in combination with other diseases (e.g., bladder stones,
chronic kidney disease, feline leukemia virus).
Treatment
Antibiotics are prescribed to treat bacterial UT's. How long antibiotics need to be given to your dog or cat depends on
several factors, including whether it is a dog or cat, the age of the animal, whether this is a first time UT or a
recurrence of a UT, what the bacterial organism is, and what antibiotics it is sensitive to, and if complicating factors are
associated with the UT.

A simple (or uncomplicated UT) occurs primarily in spayed female dogs and is not associated with systemic illness or
complicating diseases. n this case, antibiotics are typically given for 7 to 14 days.

A complicated UT occurs when there are one or more complicating diseases or if the UT is recurrent. Remember, that
young cats rarely have a UT and in older cats UT is usually complicated by chronic kidney disease. Another example of
a complicating disease is diabetes mellitus or hyperadrenocorticism (Cushing's disease). n animals with a complicated
UT, antibiotics may be recommended for 3 to 6 weeks. A urine culture will likely be recommended partway through the
treatment to make sure the UT is under control, and then again after the antibiotic treatment is finished to make sure the
UT is cleared.

Although other treatments are sometimes recommended (i.e., cranberry juice), no conclusive evidence proves they are of
benefit to dogs and cats. Prompt and appropriate antibiotic treatment based on urine culture and sensitivity is the best
way to eradicate a bacterial UT.
Urinary Tract InIection (UTI) Continued...
Prevention
n most instances nothing specific can be done to prevent a UT from occurring. Your dog or cat should be re-evaluated if
clinical signs recur. With complicated UT, your veterinarian should periodically evaluate your pet to make sure that the
UT has not recurred or is under control. n some animals with complicating factors present, a urinary antiseptic or an
antibiotic must be given long term to prevent a UT from reoccurring.