Diseases of the face

Question 1

which breed is overrepresented in canine chronic ulcerative gingivostomatitis ?

Answer 1

greyhounds

Question 2

at what age does craniomandibular osteopathy present?

Answer 2

3-8 months old

Question 3

what is the cause of craniomandibular osteopathy?

Answer 3

monogenic mutation in chromosome 5, which is autosomal dominant and has incomplete penetrance for westies, scotish and cairn terriers. (wiggs)

Question 4

which bredds are affected by craniomandibular osteopathy?

Answer 4

mainly westies and scottish terriers

Question 5

what bones are more commonly affected in craniomandibular osteopathy?

Answer 5

mandibles and tympanic bullae

Question 6

what are the histopathologic characteristics of eosinophilic granuloma?

Answer 6

granulation tissue is more sclerotic than edematous; it features increased amounts of collagen matrix, plump fibroblasts, and blood vessels lined by hypertrophied endothelial cells.
intravascular and extravasated eosinophils range from few to numerous.
Neutrophilic inflammation is also expected.

Question 7

what is the ideal treatment for eosinophilic granuloma?

Answer 7

• identifying and removing exposure to the underlying cause.
• Rule out food allergy and atopy.
• Control of ectoparasites

Question 8

what is the difference between eosinophilic granuloma and ulcer?

Answer 8

granuloma: proliferative, - linear, well-circumscribed, raised lesion, cheek, lip commissure, hard palate, soft palate, base of the tongue, lip margin with chin swelling, giving the cat a “pouting” look
ulcer: flat, well-circumscribed lesion, most frequently located on the upper lip, not painful

Question 9

Briefly name potential causes for chronic feline gingivostomatitis

Answer 9

• less diverse oral flora, involving Pasteurella Multocida
• Hyperimmune response
• Concurrent dental disease
• FCV infection
• Tannerella forsythia is associated with more severe lesions
• inadequate b cell function
• colony cats
• elevated IgG and IgM, lower IgA in the saliva

Question 10

describe the ideal diagnostic workup for a stomatitis cat

Answer 10

• eliminate other systemic conditions for poor thriving
• Perform a full examination of the head and mouth

• Score the oral soft tissues using the standard method (e.g., SDAI)

• Testi for FCV/FHV
• tests for retroviruses (FIV, FeLV)
• Biopsy to eliminate neoplasms

Question 11

what does stomatitis look like on histo?

Answer 11

• Abundant inflammatory cell infiltrates. They are lymphoplasmacytic, but mostly plasmacytic. Expansion of the mucosal lamina propria by sheets of mature plasma cells in which Mott cells are usually easy to find. The inflammatory infiltrates are superficial, but may extend into the underlying submucosa.
• At the surface, the mucosal epithelium is typically intact despite heavy infiltrates of plasma cells that are immediately deep to the basement membrane. Although not ulcerated in most cases, the epithelium is often attenuated due to erosion. Epithelial hyperplasia can be quite exaggerated and demonstrate features of dysplasia.

Question 12

what is the ideal stomatitis patient to receive feline recombinant interferon omega?

Answer 12

FCV positive

long-term non-responder to full mouth extraction.

Question 13

what does hyperparathyroidism look like on radiograph?

Answer 13

loss of the lamina dura
loss of density of mandibular trabecular and cortical bone
Teeth may appear unsupported by bone.

Question 14

which bone is first affected in hyperparathyroidism?

Answer 14

mandible

Question 15

what are the 2 types of hyperparathyroidism?

Answer 15

primary (functional adenoma)

secondary (renal or nutritional)

Question 16

briefly describe the pathophys for renal secondary hyperparathyroidism

Answer 16

• reabsorption of phosphate is impaired, which results in hyperphosphatemia.
• leads to a lower blood calcium concentration
• stimulates parathyroid gland
• Concurrent with this, synthesis of 1,25-dihydroxyvitamin D in the kidney is decreased
• leads to a decrease in intestinal calcium absorption and impaired mineralization of osteoid.

Question 17

what are the 4 immune-mediated skin disease that have oral involvement?

Answer 17

mucous membrane pemphygoid
pemphigus vulgaris
erythema multiforme
lupus erythematosus

Question 18

quickly name the characteristics of mucous membrane pemphygoid

Answer 18

destruction of basement membranes by antibodies
65% of cases have oral involvement
affects keratinized portions of the mouth
presents as vesicles

Question 19

quickly name the characteristics of

pemphigus vulgaris

Answer 19

antibodies against desmoglein 3 in the basal cell layers
90% of cases have oral involvement
affects keratinized portions of the mouth
oral lesions occur before skin lesions in 50% of cases
presents as vesicles

Question 20

quickly name the characteristics of

erythema multiforme

Answer 20

t-cells target keratinocytes
uncommon oral involvement
oral involvement presents as diffuse ulcerative stomatitis or glossitis

Question 21

quickly name the characteristics of

lupus erythematosus

Answer 21

apoptosis of basal keratinocytes
affects keratinized oral epithelium
less common oral involvement

Question 22

what muscles are affected by MMM and what do they have in common?

Answer 22

masseter, temporalis, pterygoids

innervated by the mandibular branch of the trigeminal nerve

Question 23

what is the gold standard for diagnosis of MMM?

Answer 23

type 2M fiber antibody detection

Question 24

what does biopsy of MMM show?

Answer 24

lymphocytes and macrophages

Question 25

what is the treatment for trigeminal neuropathy and how long does it take?

Answer 25

none, supportive care

recovery in 2-4 weeks

Question 26

in what breeds is TMJ dysplasia considered ‘‘normal’’?

Answer 26

dachshunds and cavalier king charles spaniels

Question 27

what are the characteristics of tmj dysplasia?

Answer 27

• shallow mandibular fossa
• flattened mandibular head
• abnormal obliquity of the mandibular head and fossa - joint capsule and ligamentous laxity.
• hyperplastic or misshapened retroarticular process
• widened irregular joint space
• osteophytosis

Question 28

what is open-mouth locking?

Answer 28

the dorsal edge of the coronoid process moves laterally to the zygomatic arch when the mouth is opened widely

Question 29

at what age does open-mouth locking typically present?

Answer 29

young adults

6 months to 5 yo

Question 30

when open-mouth locking is present, on what side is the lower jaw shifted towards?

Answer 30

on the side of the lock

Question 31

name differential diagnoses for closed-mouth locking

Answer 31

Proliferative diseases (skull osteomyelitis, ossification of adjacent soft tissues (bilateral lateral pterygoid muscles)
tumors
trauma
pathological changes in the middle ear (cholesteatomas), and tympanic bullae (ex squamous cell carcinoma))

Question 32

is true or false ankylosis more common?

Answer 32

false ankylosis

Question 33

what is the definition of osteonecrosis?

Answer 33

exposed necrotic bone in the maxillofacial region that fails to heal after 6 to 8 weeks

Question 34

what are the 4 types of osteonecrosis?

Answer 34

radiation induced
traumatic
non-traumatic
idiopathic

Question 35

what breed is predisposed to idiopathic osteonecrosis?

Answer 35

cocker spaniels

Question 36

what cause of osteonecrosis bears the best prognosis, and the worst?

Answer 36

Best: traumatic
worse: radiation induced

Question 37

what is the problem with radiation induced osteonecrosis?

Answer 37

predisposed to breakdown and delayed healing/dehiscence
risk of recurrence is higher
may mimic neoplasm

Question 38

where is osteomyelitis more common?

Answer 38

in the mandible

Question 39

what are the 3 routes by which bone can get osteomyelitis?

Answer 39

hematogenous (theoretical) implantation

local extension *** the most frequent

Question 40

what bacteria can cause osteomyelitis?

Answer 40

Staphylococcus spp.
Streptococcus sp.
Fusobacterium necrophorum
Truperella pyogenes 
Nocardia spp.

Question 41

what fungi can cause osteomyelitis?

Answer 41

Coccidioides immitis (cats, and dogs)
Cryptococcus neoformans (cats),
Aspergillus spp.
Candida spp.

Question 42

describe the pathogenesis of periodontal osteomyelitis?

Answer 42

bacterial periodontitis
microorganisms stimulates osteoblasts and inflammatory cells to produce inflammatory cytokines
These mediators stimulate osteoclasts, resulting in bone and tooth root resorption.