Selected Acquired Diseases Of The Lips, Cheeks, And Palate

By | 2011-07-16

Feline eosinophilic granuloma complex (FEGC) comprises an eosinophilic ulcer, plaque, and a linear granuloma. Oral lesions are usually a linear granuloma or an eosinophilic ulcer; the latter has a predisposition for the maxillary lips (80%). Intraoral lesions appear as one or more discrete, firm, raised nodules. Clinical signs include dysphagia and / or ptyalism. Although the etiology of this disease is unknown, bacterial and viral infections and immune-mediated and hypersensitivity diseases have been associated with feline eosinophilic granuloma complex. Biopsy of the lesion, with the aforementioned diseases in mind, should be performed to confirm the diagnosis and to differentiate it from neoplastic disease. Ancillary tests should include a complete blood count, which usually shows an absolute eosinophilia. Concurrent or potentially causative hypersensitivity diseases should be considered during the diagnostic phase of treatment. The mainstay of feline eosinophilic granuloma complex treatment is corticosteroid therapy. Intralesional triamcinolone (3 mg weekly), oral prednisolone (1. 0 to 2. 0 mg / kg given twice daily), and subcutaneous methylprednisolone acetate (20 mg every 2 weeks), administered until feline eosinophilic granuloma complex resolves, are efficacious treatments. Progestational compounds (progesterone or medroxyprogesterone) are often used to treat feline eosinophilic granuloma complex These compounds are not approved for use in cats and have potential side effects that make them undesirable, including adrenocortical suppression, polydipsia, polyuria, polyphagia, obesity, personality change, reproduction abnormalities, mammary hypertrophy, neoplasia, and diabetes mellitus. Cats with untreated chronic lesions, responsive previous lesions, and lesions refractory to corticosteroid therapy have a 50% recurrence rate within 5 months. Failure of treatment is usually related to inadequate dosage or premature cessation of therapy. Animals that do not respond to either corticosteroids or progestational compounds have a poor prognosis and are candidates for more aggressive therapy, such as irradiation, cryosurgery, laser therapy, or immunotherapy.

The term stomatitis refers to an inflammation of the oral mucosa. Oral inflammatory lesions in dogs and cats have multiple causes, necessitating a consistent and logical diagnostic approach. A complete history and thorough physical examination are essential. Dogs and cats with no evidence of debilitating systemic disease should receive a short-acting intravenous anesthetic to allow an unimpeded visual and tactile oral examination. Oral ulcerations occur in at least four different immunemediated diseases, including systemic lupus erythematosus, bullous (pemphigus) disease, idiopathic vasculitis, and toxic epidermal necrosis. The many infectious diseases that are manifested by lesions in the oral cavity include feline leukemia virus, feline immunodeficiency virus, feline syncytium-forming virus, feline calicivirus, feline herpes virus, and feline infectious peritonitis. fis Canine distemper and feline panleukopenia virus may cause stomatitis, although other organs are more severely affected. Candidiasis (infection with Candida albicans) may cause severe stomatitis in dogs and cats. Many cats with stomatitis have immunosuppressive disease or systemic debilitation or have received chronic immunosuppressive therapy. Although the oral manifestation may appear as a white, pseudomembranous covering of the tongue, the lesions are usually irregular, ulcerated areas in zones of inflamed mucosa.

Feline oral inflammatory disease ranges from simple gingivitis to varying degrees of stomatitis in which inflammation extends beyond the mucogingival junction into the oral mucosa. Cats with chronic gingivitis / stomatitis may have ulceration and extension of granulation tissue involving the palatoglossal folds and fauces. Clinical signs include halitosis, ptyalism, dysphagia, inappetence, and weight loss. Extensive disease is marked by root resorption and possibly bony sequestrae in edentulous areas. Unfortunately, because the causation is usually unknown, treatment is symptomatic, including professional cleaning of the teeth, therapy with antimicrobials or with systemic or local corticosteroid agents similar to those used for feline eosinophilic granuloma complex, and laser therapy to stimulate re-epithelialization over inflamed, ulcerated areas. It is not unusual for refractory cases to require extraction of all molars and premolars or all teeth to alleviate the symptoms of this disorder.

Stomatitis may be described as idiopathic despite a thorough diagnostic evaluation. Immunemediated ulcerativc gingivitis / stomatitis afflicts Maltese terriers, although the etiology is verified in only 20% of animals. If diagnostic test results are negative in idiopathic stomatitis, it is appropriate to assume a possible immune-mediated component. A prudent treatment plan includes regular cleaning of the teeth, oral preventive medicine at home, and intermittent or chronic provocative corticosteroid therapy. Antimicrobial therapy emphasizing anaerobic pathogens (e. g. , metronidazole, amoxicillin, clavulanic acid / amoxicillin) may he administered on an intermittent, chronic basis.