Updated: Nov 9, 2020
Ah... Hi blog readers! This week was draining, just like last week. I am here to dump my thoughts on salivary gland disease.
My patient is an 11-year-old female spayed shepherd mix. Extremely treat motivated and a sweetheart. Last fall, she was in due to a painful jaw. Her history is that she is Addisonian and maintained on Zycortal injections every 25 days, as well as Prednisone, maintenance was every other day. In the fall, when she had unilateral enlargement and pain of one of her masseter muscles, I bumped up her Prednisone and put her on antibiotics, for the just in case it was of infectious origin. Her fever dropped, and she eventually went back to her usual self.
This week, she had come in with a new swelling, initially we thought it was related, but on examination, the swelling is coming from her submandibular region. As this blog post suggests, there are salivary glands in the submandibular region, but there are also lymph nodes. Unilateral lymph node enlargement is pretty rare, as when we see lymphoma, it tends to be multiple lymph nodes. The examination showed a fever, again, and I aspirated the swelling which was focal, round and firm, with edematous tissue under the chin and along the side of the mandible.
My least favourite diagnosis is no diagnosis at all. The pathologist read the slides and said it was inconclusive. As always, I stain a few in hospital so that I can look at them and build my knowledge. I determined that it was not of lymph node origin, and went on the suspicion that this firm region was salivary gland inflammation - as the cytology showed inflammatory cells. Sialadenitis is rare in the dog, and sialocele, or salivary mucocele is more common, however, with a sialocele, you expect it to be flocculent, not a firm swelling that arrived over night.
Since the patient was already on Prednisone, I increased the dose to an anti-inflammatory level. The edema under her chin improved and we thought she was on the mend. Her fever resolved, and she was eating normally. We concluded saying let's touch base in a week and see how she is doing, monitor for pain or lack of appetite, or anything unusual.
A few days later, the owner noticed she was scratching at her neck and some blood tinged fur was apparent. He sent some photos, because we're still in the middle of COVID-19 restrictions, and I saw the photos and slumped in my chair as I wrote to him saying she likely needs for that region to be shaved, and potentially drained. So that is what I did today. She is such a sweet girl. I opened the kennel for her, had a treat in hand and just pointed and asked if she could go in, and she went in on her own, cone and all. We couldn't ask for a more compliant patient.
Fast forwarding, we did that sedation on a Saturday morning, short-staffed without a technician, but what do you do when you want to help your patient? I started by taking a cytological sample with a butterfly catheter, then lanced the thin skin with a scalpel blade. About 1/2 a cup of mucousy, sanguinous material came pouring out. It just seemed to keep coming.
I had started her on antibiotics the night before, and she continued on this and the Prednisone for 2 weeks. My colleague had seen her on the Monday following, and had drained some serous material from the region. By the time I saw her on the Wednesday, she was bright and "smiley" being her bossy self, ordering the staff to give her treats. It made me pleased to see that she was back to her normal self! While the entire situation was stressful when I had to be two people at once, it makes it all worth it when you see the end result.