Case of the Month – June 2012

Our case of the month this time is Pippa Newman a Springer Spaniel with a very unusual swelling on her face. Pippa is a very lively 5 year old female neutered Springer Spaniel, who like most springers enjoys a life of bouncing around the woods and  generally getting muddy! Her owners had noticed a fluid swelling on her right cheek that originally came up, then within a day or so disappeared again.Approximately a month later the right side of her face suddenly swelled up dramatically and this time with no sign of it settling Pippa made a visit to the surgery. On examination she had an enormous fluid swelling on the side of her face and resented palpation of this mass. However she was still eating with gusto and polished off her chicken treats in the consult room as usual. On close examination of her mouth and face there was no obvious sign of injury or sting. Given the size of the swelling she was admitted for an anaesthetic and to have the fluidy mass sampled and potentially lanced. There are photographs below of her face prior to lancing and then some rather unpleasant photos of what the mass contained! You have been warned! The contents of the mass can only be described like the thick gelatinous gloop used in the film Ghostbusters! So thick was the slime that on sending it for investigation at the lab they refused to process it as it was so thick it ‘might break their expensive analysers’! A bacterial culture of the gloop was negative for any signs of infection. There was no sign of any foreign material within the cyst so it was decided to flush it and place a drain to see if it would heal. At this point a provisional diagnosis of a Salivary Mucocele was made. A Salivary Mucocele is a rare condition where the salivary gland becomes damaged and as a result the saliva produced cannot enter the mouth. This creates a ‘traffic jam’ of saliva and as the pressure builds a cyst or mucocele is formed. They can form very quickly – if you consider how much some dogs slobber – the production rate of saliva can be vast. Pippa recovered very well from her anaesthetic and was back to her bouncy self almost immediately. The surgical drain placed did it’s work well and there was no evidence of fluid reforming under the skin. However drains cannot remain in forever and within 2 weeks of the drain being removed the Salivary Mucocele was back with vengeance. With palliative treatment not working it was decided to perform some technical imaging to ascertain which salivary gland was causing the problem (dogs have eight different glands in total!). We needed to know if it was just one gland, where the blockage was incase it could be corrected, and to confirm there was no evidence of any cancer or a lurking foreign body that had been missed. We are lucky enough to have Noel Fitzpatrick Referrals on our doorstep in Eashing and they allowed us to use their very expensive MRI machine on an out patient basis, even though they don’t see soft tissue cases (they only specialise in Orthopaedics and Neurological Patients). This was fantastic as it meant Pippa came to us at Oak Barn one morning, very jolly as she knows us so well. We then took her to the referral practice for her MRI scan and collected her 3 hours later with the results that very evening. A pretty amazing service I think you will agree! The MRI involved using a specialist dye to allowed the diagnosis that the right Parotid Salivary gland was the only gland involved (despite it being so big). The pictures are amazing and give a completely 3D analysis of her entire head. There was evidence of trauma in the draining duct to the mouth – most likely caused by a stick, that had completely scarred over resulting in the blockage (you can see the area highlighted with the yellow arrows). There was no evidence of any foreign material or cancerous growth thankfully. The images were sent to a Veterinary Soft Tissue Surgeon as surgery on these glands is extremely fiddly and involves some very large vessels (such as the facial artery) and some incredibly important nerves (such as the trigeminal). As we have such fantastic facilities here at Oak Barn, he was more than happy to come to the clinic and operate to remove this gland. So again Pippa had the luxury of being in her ‘usual’ environment nice and close to home. The surgery took over 3 hours and was very difficult as the photographs show. But since the gland has been removed Pippa has not looked back! There has been no more facial swelling or saliva build up and the sutures have all been removed and her hair is growing back already. She still dashes into the surgery looking for her chicken treats too! With 7 other functional salivary glands it certainly hasn’t affected her appetite!