Diseases of the face Flashcards
which breed is overrepresented in canine chronic ulcerative gingivostomatitis ?
greyhounds
at what age does craniomandibular osteopathy present?
3-8 months old
what is the cause of craniomandibular osteopathy?
monogenic mutation in chromosome 5, which is autosomal dominant and has incomplete penetrance for westies, scotish and cairn terriers. (wiggs)
which bredds are affected by craniomandibular osteopathy?
mainly westies and scottish terriers
what bones are more commonly affected in craniomandibular osteopathy?
mandibles and tympanic bullae
what are the histopathologic characteristics of eosinophilic granuloma?
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.
what is the ideal treatment for eosinophilic granuloma?
- identifying and removing exposure to the underlying cause.
- Rule out food allergy and atopy.
- Control of ectoparasites
what is the difference between eosinophilic granuloma and ulcer?
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
Briefly name potential causes for chronic feline gingivostomatitis
- 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
describe the ideal diagnostic workup for a stomatitis cat
- 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
what does stomatitis look like on histo?
- 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.
what is the ideal stomatitis patient to receive feline recombinant interferon omega?
FCV positive
long-term non-responder to full mouth extraction.
what does hyperparathyroidism look like on radiograph?
loss of the lamina dura
loss of density of mandibular trabecular and cortical bone
Teeth may appear unsupported by bone.
which bone is first affected in hyperparathyroidism?
mandible
what are the 2 types of hyperparathyroidism?
primary (functional adenoma)
secondary (renal or nutritional)
briefly describe the pathophys for renal secondary hyperparathyroidism
- 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.
what are the 4 immune-mediated skin disease that have oral involvement?
mucous membrane pemphygoid
pemphigus vulgaris
erythema multiforme
lupus erythematosus
quickly name the characteristics of mucous membrane pemphygoid
destruction of basement membranes by antibodies
65% of cases have oral involvement
affects keratinized portions of the mouth
presents as vesicles
quickly name the characteristics of
pemphigus vulgaris
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
quickly name the characteristics of
erythema multiforme
t-cells target keratinocytes
uncommon oral involvement
oral involvement presents as diffuse ulcerative stomatitis or glossitis
quickly name the characteristics of
lupus erythematosus
apoptosis of basal keratinocytes
affects keratinized oral epithelium
less common oral involvement
what muscles are affected by MMM and what do they have in common?
masseter, temporalis, pterygoids
innervated by the mandibular branch of the trigeminal nerve
what is the gold standard for diagnosis of MMM?
type 2M fiber antibody detection
what does biopsy of MMM show?
lymphocytes and macrophages
what is the treatment for trigeminal neuropathy and how long does it take?
none, supportive care
recovery in 2-4 weeks
in what breeds is TMJ dysplasia considered ‘‘normal’’?
dachshunds and cavalier king charles spaniels
what are the characteristics of tmj dysplasia?
- 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
what is open-mouth locking?
the dorsal edge of the coronoid process moves laterally to the zygomatic arch when the mouth is opened widely
at what age does open-mouth locking typically present?
young adults
6 months to 5 yo
when open-mouth locking is present, on what side is the lower jaw shifted towards?
on the side of the lock
name differential diagnoses for closed-mouth locking
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))
is true or false ankylosis more common?
false ankylosis
what is the definition of osteonecrosis?
exposed necrotic bone in the maxillofacial region that fails to heal after 6 to 8 weeks
what are the 4 types of osteonecrosis?
radiation induced
traumatic
non-traumatic
idiopathic
what breed is predisposed to idiopathic osteonecrosis?
cocker spaniels
what cause of osteonecrosis bears the best prognosis, and the worst?
Best: traumatic
worse: radiation induced
what is the problem with radiation induced osteonecrosis?
predisposed to breakdown and delayed healing/dehiscence
risk of recurrence is higher
may mimic neoplasm
where is osteomyelitis more common?
in the mandible
what are the 3 routes by which bone can get osteomyelitis?
hematogenous (theoretical) implantation
local extension *** the most frequent
what bacteria can cause osteomyelitis?
Staphylococcus spp. Streptococcus sp. Fusobacterium necrophorum Truperella pyogenes Nocardia spp.
what fungi can cause osteomyelitis?
Coccidioides immitis (cats, and dogs)
Cryptococcus neoformans (cats),
Aspergillus spp.
Candida spp.
describe the pathogenesis of periodontal osteomyelitis?
bacterial periodontitis
microorganisms stimulates osteoblasts and inflammatory cells to produce inflammatory cytokines
These mediators stimulate osteoclasts, resulting in bone and tooth root resorption.
