Feline orofacial pain syndrome Flashcards
What is feline orofacial pain syndrome
Feline orofacial pain syndrome is a syndrome characterized by acute and severe oral and facial pain
- affected cats present with face and tongue mutilation and often have exaggerated licking and chewing movements especially after grooming or eating, and pawing at the mouth
Which breed of cats is predisposed to feline orofacial pain syndrome
Burmese
What is the pathomechanism explaining feline orofacial pain syndrome
The disease is most likely a neuropathic pain disorder similar to trigeminal neuralgia
It is hypothesized that this condition is caused by dysfunction of processing of sensory trigeminal information within the brain in combination with damage/sensitisation of the endings of the trigeminal nerves
What is the signalment for feline orofacial pain syndrome
The Burmese cat is over-represented
- however other breeds can be affected
Any age of cat can be affected
- however many affected cats will first show signs when erupting permanent teeth
What are the causes and risk factors for FOPS
Predilection to the Burmese cat (all colors) and their crosses suggests a hereditary susceptibility for some cases
Predisposing factors are oral lesions:
- erupting permanent teeth
- dental disease (especially periodontal disease and dental resorptive lesions)
- mouth ulceration
The condition can also be triggered by routine dental treatment, including dental extraction
Individuals with poor social coping strategies in multi-cat households appear to be more vulnerable to this condition
What are the main presenting signs for FOPS
The main presenting signs are:
- exaggerated licking and chewing movements
- with pawing at the mouth
- +/- self induced trauma to the face and oral cavity (especially the tongue)
The cat remains alert but may be anorexic/unwilling to eat
Clinical signs may be episodic or continuous
How is the neurological examination in cats suffering FOPS
Neurological examination is normal
- there are no motor or sensory trigeminnal deficits
- discomfort appears to be confined to the oral cavity and lips
- typically the discomfort is unilateral or worse on one side
How can you make a diagnosis of FOPS
There is no definitive diagnostic test
- the diagnosis is made on the basis of appropriate signalment, elimination of other explanations and identification of contributory causes
What are the main differentials for FOPS
The main differential diagnoses are:
- oropharyngeal foreign body
- other neurological diseases causing dysfunction of processing of sensory trigeminal information within the nerve or brain (e.g., neoplasia)
What are the two main investigations for cats suffering FOPS
Dental X-rays are recommended as dental disease is a predisposing factor
As environmental factors can influence this condition, it is important to explore the history for possible social stress (i.e., social incompatibility in a multi-cat household)
- does the cat have its own secure core territory
- visual access into the home
- points of entry and exit
What would be your therapeutic plan for FOPS
Until discomfort can be controlled, mutilation should be prevented by using an Elizabetahn collar and/or paw bandaging (e.g. soft claws)
Any dental disease should be appropriately treated
- feline dental resorption lesions are of particular importance
- dental atomisation of retained roots should be avoided
A combination of NSAIDs and opioids should be tried first
If ineffective, an anti-epileptic drug with anti-allodynic effect may be prescribed
- phenobarbitone 2-3 mg/kg, q12h
- carbamazepine 25 mg, q12h
- gabpentin or pregabalin
What would be your advice to a Burmese breeder
An autosomal recessive inheritance is suspected for FOPS thus Tom and Queen of an affected cat either have or carry the condition
Because environmental factors influence the disease, not every animal with an affected genotype will have clinical signs
- in addition, the signs of the disease might occur after the animal has been bred
As the disease gene has not yet been identified, it is advised not to use any cat which has had signs of the disease even if the signs are not persistent
