CGSF CTD - CAPDouleur

04/12/2020

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LE CHAT DOULOUREUXCGSF

Thierry Poitte DMV DIU Douleur CES Traumatologie et Chirurgie Ostéo-Articulaire île de Ré 2021

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Stomatite ulcéreuse alvéolaire

Stomatite labio-jugale

Lésions situées en regard des prémolaires et molaires

D’après Philippe Hennet

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Lésions concernant la zone rétromolairecaudalement aux dernières molaires,

latéralement au arcs palatoglosses et médialement à la joue


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Affection inflammatoire buccale o Gingivite o Parodontite,o Palato-glossite ulcérative o Bucco-stomatite

Douleur omniprésenteo Anorexieo Ptyalismeo Mâchonnements

Troubles comportementauxo Dépression o Anxiétéo Séquences d’agression fréquentes

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Origine multifactorielle:

o Prolifération bactérienne anaérobie

o Surinfection virale

o Dysfonctionnement immunitaire Hypersensibilité aux antigènes bactériens et viraux

Tannerella forsythia Pasteurella multocida

FIV FeLV 80-100% Calicivirus

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Options Thérapeutiques

Contrôle de la plaque dentaire

Détartrage PolissageExtraction dentaire60-80%% amélioration clinique50% de guérison à 6 mois

Antibiothérapie

î Inflammation

CorticoïdesAINSARA 3000

î Réponse immunitaire

CyclosporineInterféron ω VirbagenInterféron α Roféron

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Radiographies pré-opératoires


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Ropivacaïne 1% 10mg/ml 2mg/kg

CT 5kg max 10mg = 1ml 0,2 ml/bloc Durée: 4-6h

Anesthésie infraorbitaire

Anesthésie maxillaire Anesthésie mandibulaire

Anesthésies Loco-régionales

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Anesthésie infraorbitaire: Blocage partie rostrale

Foramen infraorbitaire Processus angulaire

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Insertion of the needle in the oral mucosais between the second and third premolar teeth.

Advancement of the needle intothe infraorbital canal (very short: 0.4 cm long)

The needle reaches the area of the first molar tooth. Longer catheters can be used

2019 Ana C. Castejon-Gonzalez and Alexander M. Reiter

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Anesthésie maxillaire

L’aiguille est placée en arrière de la dernière molaire perpendiculairement au palais et est introduite de quelques millimètres

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Position of the bent needle in a feline skull.

Placement of the needle in the pterygopalatinefossa in a cat caudal to the first molar tooth


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Anesthésie mandibulaire

Foramen infraorbitaire Processus angulaire

Aiguille placée en arrière de la dernière molaire en direction de l’apophyse angulaire, le foramen mandibulaire est situé à mi-distance

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The needle is advanced from the end of the mandibular body (hash mark)

toward the angular process of the mandibular ramus (asterisk)

up to the mandibular foramen

Approximate angle between the needle and the mandible

Insertion of the needle in the mucosa caudal and lingual to the mandibular first molar tooth.

Do not traumatize the linguomolar salivary gland (S).


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Extraoral inferior alveolar nerve blockThe needle is advanced from the unnamed notch (asterisk)

caudally toward the mandibular foramen (MF)The solution is placed caudal and dorsal to the MF

in the area where the nerve runs before it enters thecanal.

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Lambeau mucogingival autour des dents à extraire

Extractions multiples chez le chat


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Décollement avec un élévateur à périoste de Molt



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Exposition de l’os alvéolaire



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Section des dents avec une fraise dentaire


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Aspect des dents mandibulaires sectionnées

(séparation radiculaire)



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Luxation des racines avec un élévateur dentaire



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Extraction de la racine luxée avec

un davier dentaire



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Aspect clinique après suture des sites opératoires



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Radiographies post-opératoires


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Extractions dentaires multiples associées à des besoins en opioïdes ↑ 3j

Nécessité d’une analgésie prolongée 3 j

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Analgésie per et post-opératoire

Sédationo Médétomidine + Méthadone + Midazolam

Inductiono Kétamine Propofol

Per-opératoireo CRI Méthadone + Kétamine

Post-opératoireo CRI Méthadone + Kétamineo Méloxicam IV. Relais vo 4-7jo Gabapentineo Tramadol (Antalgique de secours)

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Therapeutic Efficacy of Fresh, AllogeneicMesenchymal Stem Cells for Severe Refractory FelineChronic GingivostomatitisBOAZ ARZI ,a KAITLIN C. CLARK ,b AYSWARYA SUNDARAM,b MATHIEU SPRIET,aFRANK J.M. VERSTRAETE,a NAOMI J WALKER,b MEGAN R. LOSCAR,c NASIM FAZEL,dWILLIAM J MURPHY,d NATALIA VAPNIARSKY,e DORI L. BORJESSONbKey Words. Adipose-derived stem cells • Fresh • Allogeneic • Cats • Gingivostomatitis •

Oral Mucosa • ImmunomodulationABSTRACTMesenchymal stem cells (MSCs) have potent immunomodulatory functions and are a promisingtherapy for immune-mediated inflammatory disorders. We previously demonstrated the efficacyof fresh, autologous, adipose-derived MSCs (ASCs) to treat feline chronic gingivostomatitis (FCGS),a chronic oral mucosal inflammatory disease similar to human oral lichen planus. Here, we investi-gate the use of fresh allogeneic ASCs for treatment of FCGS in seven cats. Radiolabeled ASCs werealso tracked systemically. Each cat received two intravenous injections of 20 million ASCs, 1 monthapart. Oral inflammation, blood lymphocyte subsets, anti-fetal bovine serum antibody levels, ASCcrossmatching and serum proteins and cytokine concentrations were determined. Four of the 7cats (57%) responded to treatment [complete clinical remission (n 5 2) or substantial clinicalimprovement (n 5 2)]. Three cats were nonresponders. Prior to therapy, most cats had increasedcirculating CD81 T cells, decreased CD8lo cells, and a decreased CD4/CD8 ratio, however clinicalresolution was not associated with normalization of these parameters. Nonresponders showedmore severe systemic inflammation (neutrophilia, hyperglobulinemia and increased interferongamma and tumor necrosis factor alpha concentration) prior to ASC therapy. Clinical remissiontook up to 20 months and no clinical relapse has occurred. A higher fraction of radiolabeled ASCswere identified in the oral cavity of FCGS affected cats than the control cat. The administration offresh, allogenic ASCs appeared to have lower clinical efficacy with a delayed response as comparedto the fresh, autologous ASCs. In addition, the mechanism(s) of action for autologous and allogenicASCs may differ in this model of oral inflammation. STEM CELLS TRANSLATIONAL MEDICINE2017;00:000–000SIGNIFICANCE STATEMENTThis study is the first to demonstrate the safety and efficacy of fresh, allogeneic adipose derivedstem cells systemic therapy for a naturally occurring, inflammatory disease in cats. We demon-strate that this therapy resulted in delayed clinical and histological resolution and immune mod-ulation as compared to autologous therapy. We also demonstrated that the mechanism(s) ofaction for autologous and allogenic adipose-derived MSCs (ASCs) may differ in this model oforal inflammation. Finally, we show that ASC in cats are initially engrafted to the lungs and thata higher fraction of cells were identified in the oral cavity of feline chronic gingivostomatitisaffected cats than control.INTRODUCTIONStem cell-based therapy and research have madeexceptional progress in the last decade. Apartfrom their capacity to regenerate damaged tis-sues, mesenchymal stem cells (MSCs) possessunique immunomodulatory capabilities and haveimproved the outcome of clinical diseases withaberrant immune responses [1–4]. We recentlypublished on the safety and efficacy of autologous

adipose-derived mesenchymal stem cells (ASCs)to treat naturally occurring feline chronic gingivos-tomatitis (FCGS). FCGS is a large animal model ofimmune-mediated oral mucosal inflammatory dis-eases of humans including oral lichen planus(OLP), recurrent aphthous stomatitis, pemphigus,and pemphigoid [1]. In both human and cats,these diseases result in painful mucosal lesionsthat markedly reduce quality of life and oftenrequire long-term immunosuppressive therapy

aDepartment of Surgical andRadiological Sciences,bDepartment of Pathology,Microbiology andImmunology, School ofVeterinary Medicine,cWilliam R. PritchardVeterinary Medical TeachingHospital, dDepartment ofDermatology, School ofMedicine, eDepartment ofBiomedical Engineering,University of California,Davis, California, USA

Correspondence: Boaz ArziDVM, DAVDC, DEVDC, AssociateProfessor, Department ofSurgical and RadiologicalSciences, School of VeterinaryMedicine, University ofCalifornia, Davis, One GarrodDrive, Davis, California, 95616,USA. Telephone: (530) 752-2470;Fax: (530) 754-5739; e-mail:[email protected]

The work was performed atthe Department of Surgicaland Radiological Sciences andthe Department of Pathology,Microbiology and Immunology,School of Veterinary Medicine,University of California, Davis.

Received February 15, 2017;accepted for publication May 9,2017

Oc AlphaMed Press1066-5099/2017/$30.00/0

http://dx.doi.org/10.1002/sctm.17-0035

This is an open access articleunder the terms of the CreativeCommons Attribution-NonCommercial-NoDerivsLicense, which permits use anddistribution in any medium,provided the original work isproperly cited, the use is non-commercial and no modificationsor adaptations are made.

STEM CELLS TRANSLATIONAL MEDICINE 2017;00:00–00 www.StemCellsTM.com Oc 2017 The AuthorsSTEM CELLS TRANSLATIONAL MEDICINE published by Wiley Periodicals, Inc. on behalf of AlphaMed Press

ENABLING TECHNOLOGIES FOR CELL-BASED CLINICALTRANSLATIONCELLULES SOUCHES MESENCHYMATEUSES

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POTENTIEL BIOLOGIQUE

CS NEONATALES CS ADULTES

• Cellules du sang du cordon☞ CSH Hématopoïétiquesü Hémopathiesü Tr immunitaires

• Moelle osseuse☞ CSH HématopoïétiquesLignée myéloïde: GR, PN, Mono, PlaquettesLignée lymphoïde: Lymphocytes B☞ CSM: 0,01%

• Cellules de la paroi du cordonGelée de Warthon

☞ CSM

• Graisse: 100 à 1000 fois + abondantes

☞ CSM

☞ Homéostasie tissulaire:Remplacement des cellules mortes par apoptose ou par nécrose. ☞ Quiescentes☞ Activation si lésionVieillesse:☞ Sénescence

Multipotentes Multipotentes ou Unipotentes

Prolifération +++ +

Différenciation +++ +

Immuno-modulation +++ +

Réaction inflammatoire + ☞ utilisation allogénique ++

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+ 4 Mois

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LASER

Contrôle de la plaque dentaire

o Oxygénation des tissus o Activité antibactérienne anaérobie

↓ Inflammation

o ↓ Cytokineso ↓ Prostaglandineso ↑ Macrophages

Antalgique

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PROCEDURE

A travers la joue:6-10J/cm2

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PROCEDURE

Bouche ouverte:3-4 J/cm2

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Chipie CT Européen F 14ans CGSF

2013-2014

13 Séances Laser

0

1

2

3

janv-13

févr-13

mars-13

avr-13

mai-13

juin-13

juil-13

août-13

sept-13

oct-13

nov-13

déc-13

janv-14

févr-14

mars-14

avr-14

mai-14

juin-14

juil-14

août-14

sept-14

oct-14

nov-14

déc-14

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+ 10 MOIS

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+ 16 MOIS

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+ 36 MOIS

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Marcel CT Européen M 5ans CGSF

J0 J21

6h post Laser

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Pimprenelle CT Européen

F 11ans CGSF

J0 J21

2h post Laser

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Doudou CT Européen M 15ans CGSFExtraction dentaire

J0 J8 J16

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