April 2010
Dr Gerhard Steenkamp

A dog is presented for a soft fluctuant non-painful swelling of the cervical region.

a What would be your diagnostic protocol in this case?

b In the case of a cervical mucocoele, how would you treat it?

Answers

a After having done a full clinical examination the clinician should turn his/her attention to the swollen area in the neck. Careful palpation will aid in forming an idea if the structure is only soft (as in this case) or if it is hard and painful as in the case of many tumours.

Fine needle aspiration of the swelling will help to differentiate between several differential diagnoses. This swelling could be a hematoma, abscess or a salivary gland mucocoele. In the former 2 the fluid can be examined under a microscope to evaluate the types of cells present as well as the presence of bacteria. In the latter a straw coloured viscous fluid will be extracted that, when placed between the fingers, will form strands as you pull the fingers apart.

Radiography of the skull will help the clinician evaluate the structures around the salivary glands for sialoliths or ossification of the mucocoele. Contrast radiography of the salivary glands may be helpful on determining the side affected if this is not obvious with the dog in dorsal recumbency (on his back).

Ultrasound would also be an excellent modality to find the origin of the mucocoele. The area is however scanned very infrequently and the clinician should be very comfortable with the anatomy in that area.

b The treatment of choice for cervical mucoceles is the removal of the ipsilateral mandibular and sublingual salivary glands, through a ventral midline approach.
This approach allows the surgeon to remove both glands with the associated polystomatic salivary gland chain of the sublingual salivary gland. Both glands and their associated structures are removed up to the level of the lingual nerve.

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