# A Stepwise Integrative Approach to Managing a Refractory Recurrent Cervical Sialocele in a Dog

## TL;DR

A dog with a recurring neck swelling caused by a salivary cyst was successfully treated using a combination of medication, minimally invasive therapy, and surgery.

## Contribution

This is the first report using OK-432 sclerotherapy as part of a staged treatment for a difficult-to-treat canine cervical sialocele.

## Key findings

- Phenobarbital reduced saliva production and slowed swelling recurrence.
- OK-432 sclerotherapy induced fibrosis but did not fully resolve the issue.
- Salvage ventral paramedian surgery achieved complete removal and no recurrence at 6 months.

## Abstract

Salivary cysts (sialoceles) are soft, saliva-filled swellings in dogs. While they are typically cured by surgical removal of the damaged gland, recurrence can occur if a small portion of abnormal tissue is left behind, especially when it becomes hidden within scar tissue from previous surgeries. This report describes the management of a small dog with a repeatedly recurrent neck swelling whose owners were hesitant to proceed directly to another major operation. A stepwise stabilizing plan, adapted from human protocols, was first employed: the anti-seizure medicine phenobarbital reduced saliva production and slowed the rate at which the swelling refilled. Next, a special injectable drug called OK-432 was administered under ultrasound guidance to induce internal scar tissue to make the area firmer and potentially easier to manage at the final surgery. Definitive ventral neck surgery then allowed complete removal of the deeply concealed remaining salivary tissue, and the dog showed no recurrence 6 months later. This case suggests that combining stabilizing medical treatments with a precise, wide surgical approach may provide a long-lasting cure for the most difficult recurrent sialoceles.

Recurrent canine cervical sialocele is most often caused by incomplete excision of the mandibular–sublingual gland complex, leading to anatomical distortion and concealment of residual tissue. This case describes the multimodal management of a repeatedly recurrent cervical sialocele in a young, small-breed dog following multiple previous revision surgeries. A stepwise bridging strategy was adopted before definitive salvage surgery. Oral phenobarbital was instituted, resulting in partial reduction in fluid accumulation and improved comfort. Ultrasound-guided intracavitary sclerotherapy with OK-432 was then performed, inducing a localized fibrotic response but without durable cure. Final resolution was achieved only after salvage ventral paramedian (VPM) sialoadenectomy, which provided wide exposure for complete excision of deeply concealed sublingual remnant tissue within a fibrotic pseudocapsule. Histology confirmed a cervical sialocele. Transient neuropraxia resolved within 3 weeks, and no recurrence was observed at 6 months postoperatively. To the authors’ knowledge, this is the first report describing intracavitary OK-432 sclerotherapy as part of a staged multimodal strategy for canine cervical sialocele. This case illustrates the feasibility of integrating medical salivary suppression and minimally invasive sclerotherapy as bridging measures before salvage VPM surgery for refractory cervical sialocele.