Redalyc.Rigid Endoscopy to Aid the Treatment of Cervical Mucocele in A

Acta Scientiae Veterinariae ISSN: 1678-0345 [email protected] Universidade Federal do Rio Grande do Sul Brasil

Scussel Feranti, João Pedro; Bonilla Trindade, Anelise; de Oliveira, Marília Teresa; Wiecheteck de Souza, Fernando; Dutra Corrêa, Luis Felipe; Dalmolin, Fabíola; Gomes Sprada, Arícia; Veloso Brun, Maurício Rigid Endoscopy to Aid the Treatment of Cervical Mucocele in a Dog Acta Scientiae Veterinariae, vol. 43, 2015, pp. 1-3 Universidade Federal do Rio Grande do Sul Porto Alegre, Brasil

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How to cite Complete issue Scientific Information System More information about this article Network of Scientific Journals from Latin America, the Caribbean, Spain and Portugal Journal's homepage in redalyc.org Non-profit academic project, developed under the open access initiative Acta Scientiae Veterinariae, 2015. 43(Suppl 1): 74.

CASE REPORT ISSN 1679-9216 Pub. 74

Rigid Endoscopy to Aid the Treatment of Cervical Mucocele in a Dog

João Pedro Scussel Feranti1, Anelise Bonilla Trindade2, Marília Teresa de Oliveira3, Fernando Wiecheteck de Souza3, Luis Felipe Dutra Corrêa3, Fabíola Dalmolin3, Arícia Gomes Sprada3 & Maurício Veloso Brun4

ABSTRACT Background: Sialocele or salivary mucocele is the accumulation of saliva in the glandular connective tissue due to a leakage from damaged salivary duct, which is surrounded by granulation tissue. The mucocele can be classified according to its location (cervical, pharyngeal or sublingual, the latter being known as ranula). The treatment consists of salivary gland and duct excision. However, in some cases, the definition of which side is affected is a challenge for surgeons. Keeping this in view, the aim of the present study was to describe the use of rigid endoscopy to determine the affected gland in a dog with cervical mucocele. Case: A five-year-old Dachshund, weighting 8.2 kg, was presenting progressive swelling in the ventral cervical area. The animal presented apathy, appetite loss and saliva drooling. A fluctuant, non-painful, fluid filled mass was noted on physi- cal examination. Sialocele was diagnosed and surgery was undertaken to excise the involved gland and mass. The patient was positioned in dorsal recumbence. A skin incision was performed in the cranial-ventral aspect of the mass as it was not possible to precise the affected side. Following drainage of the content, the inner aspect of the sialocele capsule was digitally palpated using the surgeon’s index finger. However, it was still not possible to determinate the affected side. A purse-string suture was performed around the incision and a 10mm cannula was inserted into the sialocele lumen. The cavity was insufflated with CO2, then using a 0º 10 mm endoscope, the whole extension of the capsule was inspected. On the right side, the wall was round shaped, suggesting the presence of the right gland compressing the wall of the affected gland to the left. On the left side, there were some recesses and irregular surfaces, and an orifice was identified, suggesting the presence of the ducts opening. Therefore, the left sublingual and mandibular glands were excised conventionally. The procedure lasted 150 min and it was performed uneventfully. The patient was followed-up for seven days and skin sutures were removed after complete primary intention healing. Thirty days postoperative the patient presented no signs of recurrence. Discussion: Although several maneuvers were performed in order to diagnose the affected side in the current report, some doubt remained. Thus, endoscopic diagnosis was tested, which has not been reported for that purpose in the author’s knowledge. Although not completely conclusive, such examination provided strong basis that the left side was affected. A month after the treatment, recurrence did not occur, which is usually one of the most common complications. Therefore, the exam purposed in this report fulfilled its expectancies, suggesting that rigid endoscopy may be used as a new tool for identification of which side and gland are involved in complicated extensive salivary mucoceles cases. Another important aspect of the procedure was the insufflation of the mucocele cavity that allowed the inner capsule inspection and did not result in subcutaneous emphysema. It was applied a pressure of 15 mmHg, higher than routinely used for laparoscopy in dogs, since it is a limited region, and presents reduced risk of subcutaneous absorption or alteration by compression. In conclusion, endoscopic view of the sialocele inner capsule is feasible in dogs as an adjunct for diagnosing the affected side in complicated cases.

Keywords: videosurgery, tumor, canine.

Received: 4 October 2014 Accepted: 17 January 2015 Published: 6 February 2015 1Mestrado, Programa de pós-graduação em Medicina Veterinária (PPGMV), Universidade Federal de Santa Maria (UFSM), Santa Maria, RS, Brazil. 2Dou- torado, PPGCV, UFRGS, Porto Alegre, RS, Brazil. 3Doutorado, PPGMV, UFSM, Santa Maria. 4PPPGMV, UFSM, Santa Maria. CORRESPONDENCE: M.V. Brun [[email protected] - Tel.: +55(54)9962-7707]. Av. Roraima n. 1000, Cidade Universitária, Bairro Camobi. CEP 97105-900 Santa Maria, RS, Brazil.

1 J.P.S. Feranti, A.B. Trindade, M.T. Oliveira, et al . 2015. Rigid Endoscopy to Aid the Treatment of Cervical Mucocele in a Dog. Acta Scientiae Veterinariae. 43(Suppl 1): 74.

INTRODUCTION The patient was placed in dorsal recumbence to Sialocele, also known as salivary mucocele, determine the affected side, but it was not possible. Then, consists of saliva collection surrounded by granulation an incision was made in the cranial-ventral aspect of the tissue [1,2,4]. The saliva leaks from damaged salivary mass and the surgeon did digital palpation of the inner gland or duct causing inflammation in the tissue. The sialocele capsule surface. However, this maneuver also majority of cases occur by trauma, but some are idio- did not allow determining precisely which glands were pathic, and the diagnosis is based on history, clinical affected. Thus, it was considered the use of endoscopy signs and pathological findings [6]. Mucocele can be for this purpose. A purse-string suture was performed denominated according to its location (cervical, pha- around the incision and a 10 mm cannula was inserted. ryngeal or sublingual/ranula) [5]. The sialocele cavity was insufflated with CO2 at 15 Treatment consists of gland and duct removal. mm/Hg pressure. Using a 10 mm/0º rigid endoscope The complications associated include seroma, infection, the mucocele capsule was completely visualized. It was bleeding and recurrence. The recurrence occurs in less found that in the right side, toward the correspondent than 5% of the patients and is related with incomplete mandibular gland, the wall was rounded. On the left resection of the gland, erroneous resection of the unaf- side, there were several recesses and the surface was fected gland or the lymph node instead of the gland [2,6]. irregular and it was possible to visualize an orifice, The diagnosis may be reached using several probably the ducts opening, and a tunnel. These find- noninvasive imaging methods such as radiography or ings suggested that the left mandibular and sublingual ultrasound. However, the gold diagnostic method is glands were damaged and their removal was performed provided by computed tomography and/or magnetic by conventional surgery. resonance imaging, along with cytology, which, in In the dead space formed upon the sialocele most cases, reveals a viscous fluid, straw-colored and excision a closed and active drain attached to a 10 mL mucin content [3]. Considering that the diagnosis of syringe was placed. The adenectomy were performed the affected side can be difficult in some cases, the following the technique previously described by present study describes the use of rigid endoscopy for Fossum et al. [1]. Postoperative therapy consisted of this purpose, in a canine presenting cervical mucocele. cefalexin (Keflex®1 - 30mg kg-1, TID, orally) for seven days, flunixin meglumine2 (Banamine® - 1.1mg kg-1, CASE SID, s.c.) for three days and daily cleaning of wounds A five-year-old dachshund dog, 8.2 kg, present- with NaCl 0.9% until complete healing. ing a mass in the ventral cervical region, was referred to Procedure lasted 150 min, uneventfully. The the veterinary hospital. According to the dog’s owner, patient was monitored for a period of seven days. At the enlargement of the cervical region had first appeared the seventh day, the skin presented good healing by approximately a month ago and became more evident first intention and sutures were removed. The drain two days prior the consultation. The patient was lethar- placed in the adenectomy region was removed after gic, with appetite loss and saliva drooling. On clinical 48 hours by the dog itself, even with protective collar examination, a non-painful, fluid filled, fluctuant mass and bandages. However, there was no complication was observed. Based on the clinical presentation, it was associated to the event. Thirty days after surgery, the diagnosed sialocele and surgical treatment was indicated. dog presented no signs of recurrence.

Figure 1. Five-year-old dachshund dog 8.2 Kg. (A) Enlargement of the ventral cervical region (Arrow). (B) 0º/10mm Endoscope inserted into the subcutaneous after insufflations with medicinal CO2 at a pressure of 15 mm/Hg pressure. 2 J.P.S. Feranti, A.B. Trindade, M.T. Oliveira, et al . 2015. Rigid Endoscopy to Aid the Treatment of Cervical Mucocele in a Dog. Acta Scientiae Veterinariae. 43(Suppl 1): 74.

DISCUSSION It is worth note that the use of CO2 to inflate Regarding to the determination of the affected the cavity improved the visualization of the capsule’s side, an important stage in the treatment of sialocele, lumen and it did not cause subcutaneous emphysema. Fossum et al. [1] claim that its definition is possible The authors suggest that the fibrous tissue prevented from positioning the patient in dorsal decubitus, once the gas dissipation into the subcutaneous tissue. It was the swelling tends to move to the region where the applied 15 mmHg of pressure, higher than routinely alteration originated. When this maneuver is insuffi- used in laparoscopic surgery in dogs, since the insufflation was limited to a specific region, with reduced risk cient, the authors suggest performing a small incision of subcutaneous absorption or compressive alterations. in the sialocele and digital palpation of the mucocele’s It is concluded that endoscopic visualization of lumen. On the affected side, normally, it is possible to sialocele internal capsule may be performed in dogs find a tract towards the leakage. In this case, although using the technique described to assist in defining the both maneuvers were performed the affected glands side where the affection originated. remained unclear. The authors decided to use the endoscopic to establish the affected region correctly. MANUFACTURERS In the authors’ knowledge, this attempt has not been 1Eli Lilly, São Paulo, SP, Brazil. reported. The use of endoscopic was not completely 2Schering Plough, São Paulo, SP, Brazil. conclusive, although it demonstrated strong indication Declaration of interest. The authors report no conflicts of that the left side was the sialocele location due to the interest. The authors alone are responsible for the content and marked differences of the right side. writing of the paper.

REFERENCES

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