The sublingual and mandibular salivary glands lie at the bifurcation of the jugular vein as it divides into the external maxillary and sublingual veins. The incision is made directly over the salivary gland, being careful not to extend the incision too far caudally to engage the commissure of the jugular vein bifurcation. The platysma muscle (which can be quite robust in large-breed dogs, such as this patient) is incised. Directly under this muscle is the capsule for the sublingual and mandibular salivary glands. The glands are carefully peeled out of the interior of the capsule. The major blood supply to the glands is located on its dorsomedial aspect. These vessels are identified and either ligated or cauterized, allowing improved visualization of the duct. Taking care to remove both the monostomatic and the polystomatic portions of the sublingual salivary gland decreases the chances of recurrence of the mucocele. As the duct is dissected deeper, the polystomatic branches appear. Allis tissue forceps are used to apply caudal traction on the gland, allowing blunt dissection of the duct away from the connective tissue as the duct continues below the digastricus muscle and along the medial aspect of the mandibular ramus. The lingual artery courses across the deep aspect of the duct, and this is identified and retracted for further dissection to occur.
Once the pharyngeal mucocele is exposed, it is entered so the saliva can be aspirated, thus facilitating visualization during the deeper dissection of the duct. This ensures removal of the remaining polystomatic glands. Once exposure of the duct is complete, it is ligated using a stapling device or grasped and pulled out via traction. A penrose drain is placed in the remaining mucocele cavity making certain it exits at the ventral most aspect of the neck. Wound closure is performed in three layers: first, the platysma muscle; then, the subcutaneous tissue; and finally, the skin. Some surgeons combine the platysma and subcutaneous closures. All layers are closed using a simple continuous pattern with synthetic absorbable suture material.
