November 2009
Dr Gerhard Steenkamp

A cat is presented 1 month after it was shot.  At that time it was clear that the bullet entered its right mandible and the exit wound was though the dorsum of the caudal tongue.  It now has a fluctuant swelling ventral to the tongue.

a What diagnostic test would be helpful to make a diagnosis?
b What is your most likely diagnosis?
c What is the lesion comprised of?
d How would you treat this case?

Memo

a Fine needle aspirate.  The colour of the fluid, its consistency and cytology will assist you in making a diagnosis.  The consistency should be tested by placing a drop of the fluid between 2 fingers and then these fingers pulled apart.  If the fluid sticks to the fingers and forms a long strand it is most probably saliva.

b Salivary mucocoele (under the tongue this is often referred to as a ranula), probably brought about by trauma to the sublingual/mandibular salivary gland ducts and scarring from the bullet wound.

c The whole side of this lesion must be cut away and the suture should be used circumferentially to attach the inner lining to the oral epithelium.  This is called marsupialisation.  Should the lesion return sialadenectomy of the ipsilateral mandibular and sublingual salivary glands should be performed.