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| − | {{review}}
| + | #REDIRECT[[:Category: Oral Cavity and Gingiva - Pathology]] |
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| − | {{toplink
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| − | |backcolour =BCED91
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| − | |linkpage =Alimentary System - Pathology
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| − | |linktext =Alimentary System
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| − | |maplink = Alimentary System (Content Map) - Pathology
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| − | |pagetype =Pathology
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| − | }}
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| − | <br>
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| − | ==Introduction==
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| − | *Stomatitis - generalised inflammation throughout mouth.
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| − | *Glossitis - inflammation of [[Oral Cavity - Tongue - Anatomy & Physiology|tongue]].
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| − | *Pharyngitis - pharynx inflammation.
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| − | | |
| − | ==Functional Anatomy==
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| − | See anatomy and physiology [[Alimentary - Anatomy & Physiology#Oral Cavity|of the oral cavity]]
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| − | | |
| − | ==Defence Mechanisms==
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| − | ==Developmental Pathology==
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| − | [[Image:Cleft-palate.gif|right|thumb|125px|<small><center>A congenital cleft palate defect (Courtesy of Alun Williams (RVC))</center></small>]]
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| − | ===Cleft Palate===
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| − | *The commonest structural defect is probably the various forms of cleft palate due to:
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| − | **failure of fusion and the ingrowths of the [[Skull and Facial Muscles - Anatomy & Physiology#Palatine Bone (os palatinum)|palatine]] shelves or
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| − | **[[Skull and Facial Muscles - Anatomy & Physiology#Frontal Bone (os frontale)|frontonasal]] and [[Skull and Facial Muscles - Anatomy & Physiology#Maxilla|maxillary]] processes.
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| − | ==Erosive & Ulcerative Pathology==
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| − | *"True ulcer" occurs when connective tissue under epithelium is exposed i.e. stratum germinativum is breached and then lesion takes much longer to heal.
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| − | ===[[Bovine Virus Diarrhoea Virus]]===
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| − | *'''Mucosal Disease''': erosive condition produces small multiple, cleanly punched out lesion in mouth
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| − | *Neutrophils invade the ulcer and if bacterial colonisation occurs, further excavation follows. Either:
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| − | ::#This lesion develops a granular base and becomes diphtheritic.
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| − | ::#If bacterial colonisation does not take place, healing occurs within fourteen days.
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| − | *Seen in most parts of mouth (or maybe on muzzle) e.g. dental pad, [[Cheeks - Anatomy & Physiology|cheeks]], sides of [[Oral Cavity - Tongue - Anatomy & Physiology|tongue]]
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| − | *Lesions extend throughout gut with particularly big ulcers in small intestine over [[Peyer's Patches - Anatomy & Physiology|Peyers patches]]. Necrosis occurs in lymph nodes and [[Spleen - Anatomy & Physiology|spleen]]
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| − | | |
| − | ====<span id="BVDHistology">Histology</span>====
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| − | *No vesicular stage, prickle cells die off from surface resulting in layer of necrotic debris over epithelial layer
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| − | *Infection penetrates inward through stratum germinativum.
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| − | *Epithelium does not recover as animal does not recover
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| − | ===[[Malignant Catarrhal Fever Virus]]===
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| − | ==Vesicular Pathology==
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| − | ===Pathology===
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| − | *Damage to [[prickle cell]]s ([[stratum spinosum]]).
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| − | *Appears as accumulation of fluid within epithelium, quickly erodes leaving hyperaemic [[stratum germinativum]].
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| − | *Heals by proliferation of new cells, so long as infection does not continue.
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| − | ===Pathogenesis===
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| − | May be caused by:
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| − | #Ingestion of hot food (corrosive liquids)
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| − | #Systemic viral diseases. e.g:
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| − | ##[[picornaviridae#Foot and Mouth Disease Virus|Foot and Mouth disease]] - ruminants and pigs
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| − | ##[[Vesicular stomatitis]] - horse, pigs, cattle
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| − | ##[[Vesicular exanthema]] - pigs
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| − |
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| − | N.B. All are indistinguishable from FMD clinically.
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| − | ===[[Foot and Mouth Disease (FMDV)]]===
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| − | ====Pathology====
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| − | =====Gross=====
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| − | #Initially - hyperaemia of mucosa (e.g. catarrhal inflammation) then within 12 hours produces fluid filled vesicles on dorsum of [[Oral Cavity - Tongue - Anatomy & Physiology|tongue]], may be other places
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| − | #Small vesicle coalesce to produce big ones -i.e. Bullae
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| − | #Very quickly rupture; epithelium appears dirty grey in colour because of necrosis - sloughed skin, very good for diagnosis
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| − | #Leave painful, hyperaemic epithelium
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| − | #Looks like "ulcer "with ragged edge but not a true ulcer as stratum germinativum retained and will rapidly heal completely in about 2 weeks unless becomes secondarily infected
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| − | | |
| − | =====Microscopic lesions=====
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| − | *Degeneration of prickle cells
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| − | *Cells "balloon" as fill with fluid and then die to produce vesicle containing straw coloured or clear fluid
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| − | | |
| − | ===[[Swine Vesicular Disease]]===
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| − | *May produce vesicles in mouth that are indistinguishable from foot and mouth disease
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| − | *Swine vesicular disease produces sporadic large outbreaks
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| − | **Approximately 5% have lesions in mouth, foot lesions much more common
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| − | ===Vesicles in dogs===
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| − | *Vesicles in mouth are often caused by hot food - especially in dogs.
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| − | *Can produce quite big vesicles, but will heal.
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| − | *No major problems associated with vesicles on [[Oral Cavity - Tongue - Anatomy & Physiology|tongue]] in dogs (except if due to drinking battery acid, but this also produces vomiting).
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| − | ==Catarrhal Stomatitis==
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| − | *Non-specific, general stomatitis
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| − | ===Pathology===
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| − | *Starts as hyperaemia and oedema of [[Oral Cavity - Tongue - Anatomy & Physiology|tongue]] or pharynx with mucoid exudate on surface.
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| − | *Lymphoid follicles on [[Soft Palate - Anatomy & Physiology|soft palate]] may enlarge and proliferate.
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| − | *Often see white spots due to epithelial hyperplasia and increased mucous secretion.
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| − | **(can be scraped off to leave ordinary mucosa underneath).
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| − | *May produce bad smell.
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| − | *Resolves normally if not secondarily infected.
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| − | ===Pathogenesis===
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| − | *May be caused by:
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| − | **Low grade [[Streptococci|streptococcal]] infection
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| − | **Ingestion of toxins
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| − | **Result of other more systemic diseases
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| − | ==Granulomatous and pyogranulomatous Inflammation==
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| − | ==Eosinophilic Inflammation==
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| − | ===Eosinophilic granuloma===
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| − | This is a complex of diseases affecting skin and [[Oral Cavity Overview - Anatomy & Physiology|oral cavity]] mainly of cat, which include:
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| − | #Oral eosinophilic granuloma | |
| − | #[[Linear granuloma]] of skin
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| − | #[[Eosinophilic plaque]] of skin
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| − | ====Clinical====
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| − | *Any age, but usually young adults.
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| − | *Mainly affects [[Lips - Anatomy & Physiology|lips]], may also occasionally affect '''frenulum of [[Oral Cavity - Tongue - Anatomy & Physiology|tongue]]'''.
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| − | *Sometimes called "rodent ulcer "
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| − | *Not neoplastic - it is an inflammatory disease but is '''progressive and destructive'''.
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| − | *May see small plaque or becomes very '''infiltrative'''.
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| − | *In worst cases may erode away whole nose.
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| − | ====Pathogenesis====
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| − | *Histologically lots of eosinophils, polymorphs.
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| − | *Exaggerated eosinophilic response.
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| − | ==Necrotizing Inflammation==
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| − | ==Lymphocytic and plasmacytic Inflammation==
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| − | ==Immune Mediated Pathology==
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| − | ===Autoimmune===
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| − | *Occasionally see vesicles on the oral mucosa. associated with autoimmune diseases such as [[pemphigus]] vulgaris.
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| − | ===Hypersensitivity===
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| − | ==Proliferative Pathology==
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| − | ===Hyperplastic===
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| − | ====Polychlorinated Napthalene Poisoning====
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| − | *Polychlorinated biphenyl's (PCB's).
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| − | *Used in all sorts of things.
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| − | *Do not break down in environment and very toxic.
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| − | *Poisoning was classically seen as proliferative stomatitis when PCB used to lubricate feed pellet making machine.
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| − | *Vitamin A antagonist produces hyperkeratosis of mouth (like Vitamin A deficiency).
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| − | ===Papular===
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| − | ====Orf====
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| − | *[[Poxviridae|Pox]] infection
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| − | *Quite a common '''zoonotic''' disease
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| − | =====Clinical=====
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| − | *In sheep produces a proliferative nodule/papular mass on [[Lips - Anatomy & Physiology|lips]]
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| − | *In flocks in which it is endemic it is seen in lamb
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| − | *If flock is non-immune seen in ewes too but much worse in lambs (may spread to inside of mouth)
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| − | *Can spread to udder of ewe
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| − | =====Pathology=====
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| − | *Poxvirus infections produce local infection of [[prickle cells]] in epithelium with proliferation of cells and formation of papule followed by ulceration / necrosis and covered by necrotic epithelium
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| − | *Eventually scabs form and crust drops off
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| − | *Scabs - very infectious ( N.B.if touch -> catch it)
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| − | ====Bovine Papular stomatitis====
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| − | [[Image:BPS.gif|right|thumb|125px|<small><center>Ring Zone Lesions of BPS - Calf (Courtesy of Alun Williams (RVC))</center></small>]]
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| − | *Parapox virus
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| − | *Very similar disease to orf but seen in cattle and generally milder condition.
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| − | *'''Must be differentiated from [[#Foot and Mouth disease|Foot and Mouth Disease]] and [[#Bovine Viral Diarrhoea / Mucosal disease|Mucosal Disease.]]'''
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| − | *Sporadic, in cattle, less than 1 year old.
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| − | *Develop papules on the muzzle, external nares and in the [[Oral Cavity Overview - Anatomy & Physiology|oral cavity]]; the [[Oesophagus - Anatomy & Physiology|oesophagus]] and [[Stomach and Abomasum - Anatomy & Physiology|forestomachs]] may also be affected.
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| − | *Usually heals spontaneously.
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| − | =====Pathogenesis=====
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| − | *The early lesions are round areas of intense congestion up to 1.5 cm in diameter.
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| − | *The centre becomes necrotic and slightly depressed.
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| − | *Slow peripheral extension of this lesion gives a classical ring zone formation with concentric rings of
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| − | **yellow (necrosis),
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| − | **grey (epithelial hyperplasia)
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| − | **red (congestion).
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| − | =====Histology=====
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| − | *There are focal areas of hydropic degeneration in the stratum spinosum
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| − | *Large eosinophilic intracytoplasmic inclusion
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| − | *Epidermis is markedly thickened.
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| − | *The superficial layers of the epithelium become necrotic and slough.
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| − | *''Vesicle formation is not a feature of this disease.''
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| − | ====Papilloma====
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| − | ===Neoplastic===
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| − | ====Squamous cell carcinoma====
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| − | [[Image:oral squamous cell carcinoma.jpg|right|thumb|125px|<small><center>'''Oral squamous cell carcinoma'''. Courtesy of T. Scase</center></small>]]
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| − | ==Degenerative Pathology==
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| − | ==Metabolic Pathology==
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| − | ===Uraemia===
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| − | [[Image:uraemia.gif|right|thumb|125px|<small><center>Lesions due to uraemia associated with pyelonephritis/chronic renal failure (Courtesy of Alun Williams (RVC))</center></small>]]
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| − | *In terminal renal failure animal may present with painful ulcers in mouth, which become secondarily infected with Fusiformis.
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| − | **High concentrations of toxic materials in the blood results in degeneration of small arterioles.
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| − | *In the mouth, this damage to the blood supply can cause epithelial necrosis.
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| − | *Usually seen as erosions along the ventrolateral borders of the [[Oral Cavity - Tongue - Anatomy & Physiology|tongue]] and on the [[Cheeks - Anatomy & Physiology|cheeks]], especially opposite the [[Oral Cavity - Teeth & Gingiva - Anatomy & Physiology|teeth]].
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| − | *In some cases there may be more extensive necrosis which may involve subepithelial tissue
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| − | **for example, the tip of the [[Oral Cavity - Tongue - Anatomy & Physiology|tongue]] may slough.
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| − | *Most commonly seen in dog sometimes in cat.
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| − | ==Nutritional Pathology==
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| − | ===Nicotinic Acid Deficiency===
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| − | *May also cause epithelial necrosis and sloughing.
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| − | ==Traumatic Pathology==
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| − | ===Ulcers Following Trauma===
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| − | *Any animal that is exposed to coarse feed or sharp things in food can suffer from ulcers in mouth.
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| − | *They often become secondarily infected with production of metastatic infection that may result in large abscess on point of jaw.
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| − | **i.e. trauma on [[Oral Cavity - Tongue - Anatomy & Physiology|tongue]] may lead to secondary infection that may lead to abscess in drainage lymph node.
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| − | *Deep ulcers may occur as a result of trauma in any species.
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| − | *These readily become secondarily infected by [[Fusiformis]].
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| − | *Produces a fibrin-covered ulcer.
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| − | *Responds to antibiotics, but may leave a defect or scar in mucosa.
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| − | ==Vascular Pathology==
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| − | ==Learning Tools==
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| − | ::[[Alimentary Flashcards - Pathology#Cavity and Gingiva Flashcards|Cavity and Gingiva Flashcards]]
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