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Trauma | Dysphagia | The Feline Oral Cavity


Dysphagia
Unwillingness or inability to eat is a common complaint heard by a veterinary dentist. Now that veterinary dentistry is being recognized as a separate discipline, many animals are sent to veterinary dentists suspecting that the animals' problems are "dental" in nature.

While the list of problems causing anorexia is almost endless the most common nondental "dental" problems include myopathy, neurorpathy, sialadenopathy, endocrinopathy and neoplasia. Frequently animals are presented with the assumption that the animal has "sore teeth," because the animal has recently had its teeth cleaned and has not responded.

Myopathies include masticatory myositis. This may be spontaneous or the result of overextension of the masticatory muscles. Animals present with moderate to severe pain when opening their mouths. While the definitive cause is not clearly understood, spontaneous bouts of masticatory myositis can be confirmed with the 2M antibody titers. The prognosis is usually good provided aggressive threapy is started and the animal has a reasonable range of motion. Attempts to force the fibrosed mouth open are discouraged and salvage surgical intervention may be the animal's only hope.

Neuropathies include those following trauma, trigeminal neuropathy, and central nervous system disorders. Trauma issues should be obvious based on history and clinical signs. Prognosis is dependant on the severity and extent of injury. Occasionally chieloplasty is indicated to help control a disabled tongue. Trigeminal neuropathy is an "idiopathic" condition that resolves spontaneously after two to four weeks. The affected dog presents with a "dropped jaw" and extreme difficulty eating or drinking. Occasionally the degree of dehydration requires intravenous fluid therapy to restore normal physiology. In any event, hand feeding, elevating food dishes, and time are generally curative. Central nervous system disorders include tumors, encephalitis, and trauma. Many animals will present staring at food appearing to "think about eating" but in reality are not interested at all. CT scans reveal space occupying masses that explain the behavior. While not an everyday occurrence, intracranial neoplasia occurs at an alarming rate and should always be considered when evaluating dysphagias.

Sialoadenopathies include inflammatory disease, atrophy and secondary problems. Salivary mucoeles, or sialoadenties should be obvious. Primary or secondary xerostomia may not be so subtle. As animals age the salivary glands atrophy with concurrent decline in saliva production. This state is most annoying to animals in that nothing tastes good any more. As the baby boomers will soon learn, they are not immune from this problem either. Spontaneous xerostomia is a frustrating condition in that little is available to help stimulate salivary production. This is a great area for investigational research. Secondary xerostomia resulting from chronic renal disease will resolve if adequate hydration is maintained. Unfortunately a downward spiral occurs as the renal situation worsens and the mouth becomes dryer. The animal is less willing to eat and drink and parenteral administration of fluids and food becomes necessary. Finally, xerostomia most always occurs following radiation therapy of the neck for any form of neoplasia. The post radiation complications can sometimes be a bigger challenge than dealing with the primary problem.

The most common endocrinopathy associated with anorexia and dysphagia is hyperthyroidism. The author has seen countless cats present with hyperthyroidism, hypertrophic cardiomyopathy, and dysphagia. For whatever reason, the cats appear to be hungry but shun food. Successful control of their primary disease(s) generally results in return to normal eating behavior.

Other metabolic disorders are ruled out based on laboratory data and physical examination.



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