2014.02太郎的唾液腺囊腫手術－TanTan & P.T.L.J

太郎的唾液腺囊腫，是2013年底的某天晚上幫他刷牙時間發現的

發現時的囊腫還沒大到影響外觀，一開始不覺得怎樣，只覺得怎麼嘴巴裡多了一塊肉？

後來某一根神經突然繃起來，覺得好像不太對勁，一挖開他的嘴

囊腫就像青蛙的氣囊一樣跑了出來

這是今年（2014)2月開刀前，在麻醉的情況下所拍，可以看到囊腫完整的樣子

太郎的囊腫藏在舌下，如果不嘴巴打開，從外觀看上去，並沒有什麼特別

這是開刀前(1月)所拍的生活照，外觀看起來完全沒有異狀，還沒有到像犬類疾病書上的病例，腫到整個下巴像含了一顆橘子

所以也算我發現的早

從13年12月發現，到14年2月開刀，約莫過了3個月左右

為什麼經過了快3個月才決定開刀？

因為一開始醫師希望能從內科的方式下手處理！

如果內科能夠使太郎的囊腫消失，那太郎就可以免於一刀，這是醫生所希望的

發現的當時，太郎的囊腫並沒已造成什麼生活上的問題，一切的飲食,精神都很正常

還記得醫師的診斷指向唾液腺囊腫的時候，他還苦笑著說，上天真是考驗你這位姊姊，把棘手的問題都讓你遇上了 ......

醫生說他一年裡會遇上唾液腺囊腫的case不多，有更多是已經腫到向拳頭一樣大了，主人才發現帶去就診

相較於我傾向積極的處置，也就是馬上手術

醫生並不同意！

因為這個手術說大不大，說小不小，為了把囊腫取出，耳下必須開一刀，把唾液腺,舌下腺都取出來，才不會造成日後復發，白開一刀的結果

還有口腔內部的囊腫也要取出，也就是太郎總共會有2個傷口，一個在嘴內，一個在耳下！

光是聽了就很痛，後來的手術之後，也證明這確實是讓狗兒與主人都非常受苦的手術，也了解當初醫生的初衷

犬唾液腺囊腫，到底是什麼疾病？

如果用這個中文名稱去google，得不到什麼有參考性的資料，相關病例實在太少了

所以要從他的英文名稱下手：Salivary Cycts

在peteducation網站中有很詳細的介紹（連結在此）

比較一下正常犬的下顎與唾液腺囊腫犬的下顎（圖片來自peteducation）

sal_cyst

摘要如下(若有不足，請多見諒)：

what is Salivary Cycts？

The salivary glands, as their name implies, are responsible for the production of saliva. Several sets of them lie in the tissue area beneath the skin in the upper and lower jaw. Saliva production goes on constantly. It continuously makes its way into the mouth through small ducts that originate within the salivary glands and course under the skin, opening directly into the oral cavity. The purpose of saliva is to lubricate the mouth, moisten the food, and begin the digestive process.

犬的口腔在組織中有許多負責液體分泌的腺體，這些腺體負責製造唾液，功能在於滋潤口腔與消化食物

Salivary cysts occur when saliva leaks from the salivary ducts into the tissues near or within the mouth. This may be caused simply by trauma to the ducts. In some instances, the duct may have been broken or it may have been bruised with the resultant swelling closing off the duct. In other cases, an abscess or tumor in the area may put enough outside pressure on the duct to pinch it off as you might a garden hose. Finally, there are instances when the glands, because of an internal inflammatory process, release a fluid that is just too thick to make its way through the tiny ducts. This again leads to an obstruction. All of these cases have the same final result. Whether the duct was originally ruptured or not, the pressure of continued saliva production by the glands will finally cause the walls of these tiny tubes to break and allow saliva to leak into the surrounding tissue.

唾液因導管破裂或阻塞，使唾液大量分泌流入組織或口腔內造成阻塞，原因有可能是創傷,膿瘡,或腫瘤！因為口腔內部持續性的發炎與刺激，造成唾液無法使組織吸收，形成囊腫

ps.這部分我有看過一些國外的病例是，抽取囊液，可以加以化驗，或是使囊腫變小有可能消失。不過這部分醫生不建議，因為麻醉的風險很大，如果麻醉只是為了取樣，最後手術還要再麻醉一次，只是徒然增加風險！

what is Salivary Cycst look like？

in an affected animal, we see the salivary cysts in either of two places. Typically, a large pocket of saliva will form under the jaw at the base of the neck......The other area where cysts are found is within the mouth, under the tongue.

囊腫可能發現的地方有二：顎下與舌下

ps.網站介紹是說前者比較不會對生活有影響，可以正常吃喝;後者則是會影響到飲食,飲水。太郎是屬於後者，但並沒有在飲食,飲水方面產生問題，也不會表現出痛感。除非他是太會忍，或是癡癡的驅動力實在太大了，以至於他可以忍耐極度不適的感覺(唉，除非他能開口講話告訴我)！

What is the treatment to Salivary Cycst

When dealing with a salivary cyst, medical therapy alone is rarely successful. There are isolated instances in which a local infection or inflammation can be eliminated with medication. If the salivary duct flow has only been restricted, all may return to normal.

很少有病例是靠藥治成功解決的！

Surgery is required in cases where saliva is leaking into the surrounding tissues. In those animals with a large, fluid-filled cyst below the jaw, the salivary glands on the affected side are completely removed. Usually this means all of the mandibular and sublingual glands on one side. Although this may seem extreme, the remaining glands respond to the increased need and adjust their production to compensate for the removal.

發病處的腺體要完全處下，雖然看起來是很極端的做法，不過口腔內的其他腺體會補充取下線體的作用。

In cases involving a ranula, the surgery is much more simple. The ranula is opened and its walls are basically turned inside out and sutured down to the lining of the mouth. This creates an everted pouch that slowly heals, forming a new opening for the salivary duct. The salivary glands themselves are not affected in the surgical correction of a ranula.

另一種手術方式是：把囊袋中的組織取出，把囊皮外翻與口腔的內襯縫合，製造一個新的袋狀出口，讓唾液導管的唾液流出，這種方式並不會影響腺體本身

ps.這就是後來太郎的囊腫手術醫生所採行的方式，所用的縫線是特製的細線，是可以自行吸收的！

The important point for owners to recognize is that salivary cysts should be seen by a veterinarian as soon as possible. If the owner waits too long in a case of the cyst below the jaw, it is difficult for the clinician to determine on which side it originated. No one wants to surgically remove all the mandibular and sublingual glands from one side and then discover it was the wrong side.

早期發現是必要的，否則等到兩邊的唾液腺都腫起來了，就很難分辨囊腫的原發之處，那可能就要把2邊的腺體都取下，這樣子製造的傷口就會更大了！

雖然早就看過這些資料，對內科方式的處理雖然不抱太大希望，但還是期盼太郎就是那少數可用藥物治療的例外

一開始用類固醇與抗生素下去控制，的確出現了效果，吃了一個禮拜的藥，囊腫縮得非常小，那時候內心的喜悅真是無法形容，或許太郎真的可以免除這次手術。

於是拿掉類固醇再開了一個禮拜的藥後，令人傷心的是，囊腫又腫回來了