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sam dr green > disorders of the oral cavity > Flashcards

disorders of the oral cavity Flashcards

1
Q

causes for cealocele

A
  • Accumulation of saliva in SQ tissue
  • •Salivary duct obstruction / rupture
  • •Most are traumatic
  • •May be idiopathic
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2
Q

clinical featres of cealocele

A
  • Large, painless swelling
  • •Ventral cervical region
  • May cause gagging, dyspnea
  • •Under tongue (ranula)
  • May cause dysphagia
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3
Q

dx for cealocele

A

Aspiration
•Thick fluid (mucus, saliva)

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4
Q

tx and px for cealocele

A
  • Mass opened and drained
  • •Salivary gland removed
  • Prognosis
  • •Excellent
    • If correct gland removed
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5
Q

etiology of sialodenosis

A

unknown

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6
Q

clinical features of sialodenosis

A
  • Painless enlargement of salivary glands
  • •Submandibular gland most common
  • •Episodic ptyalism, dysphagia, regurgitation/vomiting
  • •Palpation of glands sometimes triggers signs
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7
Q

dx for sialodenosis

A
  • Diagnosis of exclusion
  • •MDB
  • •Normal pharyngeal & esophageal function
  • •Normal salivary histopathology
    • Non inflammatory
    • Non infectious
    • Non neoplastic
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8
Q

tx and px for sialodenosis

A

Phenobarbital

px?

uncommon dz

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9
Q

neoplasia of the oral cavity

A
  • Soft tissue masses in oral cavity (most are malignant)
    • Melanoma, SCC, fibrosarcoma, MCT, lymphoma
  • •Some are benign
    • Epulis (“on the gums”) –arise from periodontal ligament
    • Fibromatous (peripheral odontogenic fibromas) –BOXERS!!!
    • Ossifying (peripheral odontogenic fibromas)
    • Acanthomatous (canine acanthomatous ameloblastoma)
    • Oral papillomatosis
    • Eosinophilic granulomas (Siberian Husky, CKCS)
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10
Q

clinical features of oral neoplasia

A
  • Halitosis, dysphagia
  • •Bleeding
  • •Visible growth
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11
Q

dx for oral neoplasia

A
  • Thorough oral exam (+/-anesthesia)
  • •MDB
  • •Cytology / histopathology
  • •Regional lymph nodes
  • •Thoracic radiographs
  • •Skull radiographs / CT
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12
Q

tx for oral tumors

A
  • Surgical removal
  • •Radiation therapy
  • •Chemotherapy
  • •Melanoma vaccine
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13
Q

px for oral tumors

A

Variable, dependent on:
Tumor type
Tumor location
Complete / incomplete excision
Metastatic disease present

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14
Q

most common neoplasia in cats

A

Oral tumors less common in cats
•Squamous cell carcinoma most common
•May mimic eosinophilic granuloma

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15
Q

clinical features of neoplasia in cats

A

Dysphagia
•Halitosis
•Anorexia
•Bleeding

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16
Q

dx of neoplasia in cats

A
  • MDB
  • •Large, deep biopsy needed
  • •Superficial portions often ulcerated, necrotic
  • •Differentiate neoplasia from eosinophilic granuloma
  • •Radiographs / CT
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17
Q

tx n px of neoplasia in cats

A

Surgical excision
•Radiation therapy
•Chemotherapy

px

SCC on tongue or tonsil –Guarded to Poor

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18
Q

causes of feline eosinophilic granuloma

A

unkwown

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19
Q

clinical features of feline eosinophilic granuloma

A
  • Cutaneous Eosinophilic Granuloma
  • •Oral Eosinophilic Granuloma
  • •Eosinophilic Ulcer (Indolent Ulcer, Rodent Ulcer)
  • •Eosinophilic Plaque
  • •Mosquito-Bite Hypersensitivity
  • If severe oral involvement
    • Dysphagia
    • Halitosis
    • Anorexia
  • •May have concurrent cutaneous lesions
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20
Q

dx for feline eosinophilic granuloma

A
  • Presence of ulcerated mass
    • Base of tongue
    • Hard palate
    • Glossopalatine arches
    • Anywhere in mouth
  • •Deep biopsy
  • •MDB, FeLV/FIV
    • +/-peripheral eosinophilia
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21
Q

tx for feline eosinophilic granuloma

A
  • Rule out / treat underlying cause
  • •Corticosteroids
    • Prednisolone (2-4 mg/kg/day PO)
    • Taper once in remission (2 mg/kg/q 48 hrs PO)
  • •Cyclosporin(5-10 mg/kg/day PO x 4 weeks)
    • Intractable, corticosteroid-resistant forms of disease
    • Dose reduced to alternate daily for 4 weeks, then twice weekly
  • •Chlorambucil (0.1-2 mg/kg q 24-48 hrs PO)
    • Refractory cases
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22
Q

px for feline eosinophilic granuloma

A
  • Variable
  • •Young cats often have better prognosis
    • Cats < 1 yr, lesions may regress over 3 to 5 months
  • •Cats with recurring lesions with no underlying cause
    • Long-term therapy typically required
    • May become refractory to medications
    • May develop side effects from medications
    • Poorer prognosis
23
Q

etiology for stomatitis

A
  • Inflammation of the mucous lining of any of the structures in the mouth
  • •Causes
    • Renal failure
    • Trauma
    • Immune mediated disease
    • Viral (Calicivirus, FVR)
    • Immunosuppression (FeLV, FIV)
    • Tooth root abscess
    • Severe periodontitis
    • Osteomyelitis
24
Q

clinical features of stomatitis

A
  • Thick saliva
  • •Severe halitosis
  • •Anorexia (pain)
  • •Pyrexia
  • •Weight loss
25
Q

dx of stomatitis

A
  • Thorough oral exam (anesthesia)
  • •Gross observation
  • •MDB, FeLV / FIV
  • •Biopsy / histopathology
  • •Radiographs
26
Q

tx for stomatitis

A
  • Symptomatic (to control signs)
    • Teeth cleaning
    • Antibiotics (metronidazole, clindamycin)
    • Cleansing oral rinses (chlorhexidine)
    • Analgesics
    • Teeth extraction
  • •Specific (treat underlying disease)
27
Q

px for stomatitis

A

Variable, dependent on underlying disease

28
Q

etiology for feline lymphocytic plasmacytic stomatitis

A

unknown

29
Q

clinical features of feline lymphocytic plasmacytic stomatitis

A
  • Anorexia, halitosis (most common signs)
  • •Reddened gingiva (around teeth, pharynx)
  • •Gingiva bleeds easily
  • •Dental neck lesions (FORLs)
  • •Teeth chattering
30
Q

dx for feline lymphocytic plasmacytic stomatitis

A

Biopsy / histopathology
•MDB, FeLV / FIV
•+/-Hyperglobulinemia

31
Q

tx for feline lymphocytic plasmacytic stomatitis

A
  • Teeth cleaning
  • •Antibiotics
  • •Teeth extraction
  • •(Prednisolone 2-4 mg/kg/day PO)
  • •No reliable / consistent therapy
32
Q

px for feline lymphocytic plasmacytic stomatis

A

Variable
•May be guarded
•Some severely affected animals do not respond to therapy

33
Q

primary cleft palate

A

Cleft lip or harelip

34
Q

secondary cleft palate

A
  • Roof of the mouth
  • Hard palate, soft palate, both
35
Q

clinical features of claeft palate

A
  • Hard palate clefts
    • Unable to nurse
    • Milk comes out of the nose
    • Aspiration pneumonia
  • •Unable to maintain weight
  • •Sneezing, coughing, gagging
  • •Nasal discharge when eating
  • •Fatal pneumonia
    • 30% of animals
36
Q

dx for cleft palate

A
  • Primary –obvious on exam
  • •Secondary –thorough oral exam (anesthesia)
  • •Thoracic radiographs
  • •MDB
37
Q

tx for cleft palte

A
  • Surgery
  • •Often delayed until 3-4 months of age
  • •Stomach tube feeding
  • •Esophagostomy tube
38
Q

masticatory muscle myositis

A
  • Idiopathic
  • •Immune mediated
  • •Inflammatory disorder –muscles of mastication
  • •Circulating antibodies (IgG) to Type 2M myofibers
  • •Dogs (not reported in cats)
39
Q

signalment for masticatory mm. myositis

A

Young, middle aged dogs
•Any breed

acute or chronic

40
Q

cs of acute mm myositis

A
  • Recurrent painful swelling
  • •Temporalis, masseter muscles
  • •Exophthalmus
  • •Pyrexia
  • •Anorexia, depression
  • •Pain on palpation of muscles of head
  • •Pain when trying to open mouth
41
Q

clinical presentation of chronic mm. myositis

A
  • Most common presentation
  • •Progressive, severe atrophy of temporal, masseter muscles
  • •Difficulty opening mouth
  • •Otherwise BAR
42
Q

dx for mm myositis

A
  • History, clinical findings
  • •MDB
  • Elevated CK, AST, globulin (+/-)
  • •Serum antibodies to Type 2M fibers
  • > 80% of cases
  • •Histopathology is definitive (immunohistochemistry)
43
Q

tx for mm myositis

A
  • Prednisone (1-2 mg/kg PO q 12 hours)
  • •Rapid response
  • •Start to wean at 3-4 wks, gradual taper (4-6 months)
  • •Inadequate dosing, early weaning -HIGH RATE of relapse!!
  • •Other immunosuppressives (azathioprine)
  • •Opening jaw under anesthesia –not recommended
44
Q

px for masticatory mm myositis

A
  • Usually good with treatment
  • •Long term medication may be needed
  • •Fibrosis in jaw muscles –poor prognostic indicator
45
Q

cause of cricopharyngeal achalacia/dysfunction

A
  • Incoordination between cricopharyngeus muscle (UES) and swallowing reflex
  • •Sphincter does not open at proper time
  • •Causes obstruction at UES (cricopharyngeal sphincter)
  • •UNCOMMON disease!!
46
Q

clinical features of cricopharyngeal achalasia

A
  • Primarily seen in young dogs
  • •RARELY an acquired disorder
  • •Regurgitation immediately after/during swallowing
  • •Anorexia, weight loss
  • •Clinically similar to pharyngeal dysfunction
47
Q

dx for cricopharyngeal achalasia

A
  • History, clinical signs
  • •MDB
  • •Fluoroscopy / Barium swallowing study
  • •Must distinguish from pharyngeal dysphagia
  • Experienced radiologist needed !!
48
Q

tx and px for crichopharyngeal achalasia

A
  • Cricopharyngeal myotomy
  • •Esophageal function MUST be evaluated prior to sx
  • Prognosis
  • •Good (if no stricture formation)
49
Q

etiology for pharyngeal dysfnction

A
  • Acquired disorder
  • •Neuropathies, myopathies, junctionopathies
    • Myasthenia gravis
  • •Inability to form food bolus at base of tongue
  • •Inability to propel food bolus into esophagus
  • •CN IX (Glossopharyngeal) & CN X (Vagus)
  • •Food retention in cranial esophagus due to concurrent esophageal dysfunction
50
Q

clinical features of pharyngeal dysfunction

A
  • Usually seen in older animals
  • •May mimic cricopharyngeal achalasia
  • •Regurgitation during swallowing
  • •More difficulty with fluids than solids
  • •Aspiration is common (liquids)
51
Q

dx for pharyngeal dysfunction

A
  • History, clinical signs
  • •MDB
  • •Fluoroscopy / Barium swallowing study
  • •Must distinguish from cricopharyngeal dysphagia
  • Experienced radiologist needed !!
52
Q

tx for pharyngeal dysfunction

A
  • Bypass pharynx (gastrostomy tube)
  • •Treat underlying disease (myasthenia gravis)
  • •Cricopharyngeal myotomy CONTRAINDICATED!!
53
Q

px for pharyngeal dysfunction

A

Guarded (difficult to find / treat underlying disease)
•Prone to weight loss / recurrent aspiration pneumonia

sam dr green (10 decks)

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