Nasopharyngeal Dimensions From Computed Tomography of Pugs and French Bulldogs With Brachycephalic Airway Syndrome

Non-brachycephalic dogs with stertor have higher nasopharyngeal collapsibility compared with dogs without stertor and foramen lacerum level is ideal for evaluating nasopharyngeal collapse on dynamic CT

Stertor, a clinical sign associated with obstructive airway syndrome, is often observed in non-brachycephalic dogs. This prospective, case-control study aimed to compare soft palate dimensions, nasopharyngeal cross-sectional area (CSA), and nasopharyngeal collapsibility at various locations in non-brachycephalic dogs with and without stertor. A total of 50 dogs were recruited and stratified into control (n = 34) and stertor (n = 13) groups. Static and dynamic computed tomography was conducted without tracheal intubation, and the following variables were calculated: normalized soft palate length and thickness, normalized maximum and minimum nasopharyngeal CSAs (rCSAmax and rCSAmin), and nasopharyngeal collapsibility at the level of the cranial end of the soft palate, pterygoid hamulus, foramen lacerum, bony labyrinth, and caudal end of the soft palate. The stertor group demonstrated significantly lower rCSAmax and rCSAmin, as well as higher nasopharyngeal collapsibility compared with the control group, while no significant differences were noted in the soft palate dimension. Evaluating nasopharyngeal collapse at the foramen lacerum level was recommended due to the clear presence of identifiable bony landmarks and lower overlap in the nasopharyngeal collapsibility between dogs with and without stertor. Physical dimensions of the soft palate may not be the primary contributing factor to nasopharyngeal collapse and clinical signs in non-brachycephalic dogs.

Breed-Specific Skull Morphology Reveals Insights into Canine Optic Chiasm Positioning and Orbital Structure through 3D CT Scan Analysis

This study's CT scan-based morphometric analysis of 50 adult dogs explored the relationship between skull shape variations (determined by the skull index, SI), optic chiasm, optic canals, and orbital shape. Dogs were classified as brachycephalic (SI ≥ 59), mesocephalic (SI ≥ 51 but <59), and dolichocephalic (SI < 51). No significant age or weight differences were observed. Skull lengths (brachycephalic: 11.39 ± 1.76 cm, mesocephalic: 15.00 ± 2.96 cm, dolichocephalic: 17.96 ± 3.44 cm) and facial lengths (brachycephalic: 3.63 ± 1.00 cm, mesocephalic: 6.46 ± 1.55 cm, dolichocephalic: 8.23 ± 1.03 cm) varied significantly, with shorter orbital depths (brachycephalic: 2.58 ± 0.42 cm, mesocephalic: 3.19 ± 0.65 cm, dolichocephalic: 3.61 ± 0.77 cm) in brachycephalic dogs. The optic chiasm-to-inion horizontal length ratio to cranial horizontal length positively correlated with the SI (r = 0.883, p < 0.001), while the ratio to neurocranial length showed no SI correlation (range: 55.5-75.0). Brachycephalic breeds had a significantly wider optic canal angle (93.74 ± 16.00°), along with broader lacrimal-zygomatic and zygomatic frontal process angles. These findings highlight the zygomatic bone's role in influencing breed-specific orbital variations by connecting the face to the neurocranium, projecting the orbital rim outward and forward with facial shortening.

Rostral nasopharyngeal CT measurements in Chihuahuas and Pomeranians are smaller than those measured in Dachshunds

Chihuahuas and Pomeranians are often afflicted with obstructive upper respiratory tract disease. Previous computed tomographic (CT) studies have described the dimensions and abnormalities of different parts of the upper respiratory tract in brachycephalic dogs. However, Chihuahuas and Pomeranians were not included. The objective of this study was to determine the transverse-sectional (TSA) dimensions of the nasopharynx, cricoid, and trachea of Chihuahuas and Pomeranians, and investigate whether or not Chihuahuas and Pomeranians had smaller airway dimensions than another non-brachycephalic breed (Dachshund). A retrospective, descriptive, single-center cross-sectional cohort study was performed. CT studies of 88 dogs were included (42 Chihuahuas, 29 Dachshunds, and 17 Pomeranians). The TSA of the rostral, mid, and caudal aspect of the nasopharynx, the cricoid and trachea at the level of C4 were determined. For all these locations, TSA/weight, nasopharynx/cricoid, nasopharynx/trachea, and cricoid/trachea ratios were determined. The rostral nasopharynx was the smallest part of the upper airways in Chihuahuas and Pomeranians. Chihuahuas had significantly smaller rostral nasopharynx TSA/weight ratios compared to Dachshunds (P < 0.0001). The rostral nasopharynx TSA/cricoid ratio and the rostral nasoharynx/trachea ratio for Chihuahuas were significantly smaller than both that of Pomeranians (P < 0.0001 and P = 0.00027) and Dachshunds (P < 0.0001 and P = 0.00084). Pomeranians had significantly smaller cricoid TSA/weight ratios compared to Chihuahuas (P = 0.0014) and Dachshunds (P = 0.00028). This study demonstrated that the nasopharynx is narrow in Chihuahuas and Pomeranians, with the smallest dimensions located at the rostral part of the nasopharynx.

CT volumetric analysis permits comparison of tongue size and tongue fat in different canine brachycephalic and mesaticephalic breeds

While macroglossia is a newly accepted component of brachycephalic obstructive airway syndrome (BOAS) in dogs, macroglossia with increased tongue fat is a well-known cause for obstructive sleep apnea (OSA) in people, and targeted reduction procedures such as midline glossectomy are used to treat people with OSA. While midline glossectomy has been described in dogs, tissue contributions to macroglossia have not been characterized. The purpose of this retrospective, descriptive, case-control study was to describe and compare volumetric dimensions of the tongue and tongue fat in brachycephalic (BC) and mesaticephalic (MC) dogs using CT images. Data collected included head and neck CT images from 17 BC and 18 control MC dogs. Multiplanar reformatted and 3D reconstructed images were created using image segmentation and specialized visualization software to calculate volumetric dimensions of the total tongue, tongue fat, and tongue muscle. Rostral and caudal topographical distributions of fat were compared. Total tongue and tongue muscle volume (P < 0.0001) and tongue fat volume (P = 0.01) normalized to body weight (BW) were greater in BC dogs. More fat was localized in the caudal tongue in both groups (P < 0.04). In regression analysis, BC conformation and increased weight were significant predictors of increased tongue fat volume. As in people, increased tongue fat may contribute to macroglossia and sleep-disordered breathing in BC dogs. Use of CT volumetry to identify tongue fat deposits may permit targeted surgical reduction of tongue volume in BC dogs and contribute substantially to treatment of BOAS.

Wound healing complications following folded flap palatoplasty in brachycephalic dogs

OBJECTIVE

To determine the incidence and characteristics of wound healing complications after folded flap palatoplasty (FFP).

METHODS

Prospective study of 25 dogs that underwent FFP as a component of corrective multilevel surgery for brachycephalic obstructive airway syndrome. Oropharyngeal re-examination was conducted after a minimum of 28 days post-operatively, unless indicated earlier by the onset of clinical signs.

RESULTS

Wound healing complications occurred in nine dogs (36%). Minor and major wound complications were diagnosed at a median of 36 days (1.5-51 days) post-operatively. Eight dogs had major wound complications, four of which showed no associated clinical signs. Two patterns of major wound complications were observed: incisional dehiscence (ID) with caudal retraction of the soft palate mucosa and development of a full-thickness defect (FTD) in the centre of the soft palate. Revision of the soft palate surgery was performed in five dogs, failing again in one dog with ID. Clinical signs resolved in symptomatic dogs after revision surgery to close FTD.

CONCLUSION

In this study, wound healing complications were common after FFP and were not associated with significant clinical deterioration. Further research is necessary to determine the value and timing of routine post-operative oropharyngeal examination for assessment of soft palate healing after FFP as well as the indication for and success of approaches to the management of wound healing complications. The two distinct patterns of FFP failure recognised may provide insight into the underlying causes and lead to refinements in folded flap palatoplasty technique.

Severity of nasopharyngeal collapse before and after corrective upper airway surgery in brachycephalic dogs

OBJECTIVE

To determine the severity of nasopharyngeal collapse in brachycephalic dogs before and after corrective airway surgery.

ANIMALS

Twenty-three brachycephalic dogs (21 with clinical signs referrable to the upper airway) and nine clinically normal nonbrachycephalic dogs (controls).

METHODS

Dogs were evaluated with fluoroscopy awake and standing with the head in a neutral position. The magnitude of nasopharyngeal collapse was measured as the maximum reduction in the dorsoventral dimension of the nasopharynx during respiration and expressed as a percentage. Brachycephalic dogs were anesthetized, the airway evaluated, and corrective upper airway surgery (alaplasty, staphylectomy, sacculectomy, tonsillectomy) was performed. A cohort (n = 11) of the surgically treated brachycephalic dogs had fluoroscopy repeated a minimum of 6 weeks after surgery.

RESULTS

Median preoperative reduction in the dorsoventral dimensions of the nasopharynx was greater in brachycephalic dogs (65%; range: 8-100%) than in controls (10%; range: 1-24%, p = .0001). Surgery did not improve the reduction in dorsoventral diameter of the nasopharynx during respiration in brachycephalic dogs (n = 11) postoperatively (p = .0505).

CONCLUSION AND CLINICAL SIGNIFICANCE

Nasopharyngeal collapse was a common and sometimes severe component of brachycephalic airway obstruction syndrome in the cohort of dogs evaluated. The lack of significant postoperative improvement may represent a type II error, a failure to adequately address anatomical abnormalities that increase resistance to airflow, or inadequate upper airway dilator muscle function in some brachycephalic dogs.

The Shape of the Nasal Cavity and Adaptations to Sniffing in the Dog (Canis familiaris) Compared to Other Domesticated Mammals: A Review Article

Simple Summary

Modern dogs are the most morphologically diverse group of mammals. Numerous studies have shown that dogs and their olfactory abilities are of great importance to humans. It was found that the changes within the skull have had a significant impact on the structure of the initial sections of the respiratory system, including the turbinates of the nasal passages. Congenital defects, defined as brachycephalic syndrome, are currently a significant problem in dog breeding as they can affect animal welfare and even lead to death; therefore this manuscript also focuses on this topic. After identifying the subject, we believe that further characteristics of the nasal turbinates and in-depth research related to their hypertrophy are needed. The study also summarized the state of knowledge about the structure of the respiratory system and nasal cavity in dogs compared to other species of domestic animals.

Abstract

Dogs are a good starting point for the description and anatomical analysis of turbinates of the nose. This work aimed at summing up the state of knowledge on the shape of the nasal cavity and airflow in these domestic animals and dealt with the brachycephalic syndrome (BOAS) and anatomical changes in the initial airway area in dogs with a short and widened skull. As a result of artificial selection and breeding concepts, the dog population grew very quickly. Modern dog breeds are characterized by a great variety of their anatomical shape. Craniological changes also had a significant impact on the structure and physiology of the respiratory system in mammals. The shape of the nasal cavity is particularly distinctive in dogs. Numerous studies have established that dogs and their olfactory ability are of great importance in searching for lost people, detecting explosives or drugs as well as signaling disease in the human body. The manuscript describes the structure of the initial part of the respiratory system, including the nasal turbinates, and compares representatives of various animal species. It provides information on the anatomy of brachycephalic dogs and BOAS. The studies suggest that further characterization and studies of nasal turbinates and their hypertrophy are important.

Split staphylectomy to address soft palate thickness in brachycephalic dogs: 75 cases (2016-2018)

OBJECTIVES

Describe the split staphylectomy procedure to address soft palate thickness and assess the complications and long-term outcome of this procedure as a part of multi-level surgery for brachycephalic obstructive airway syndrome. To consider whether same-day discharge following this surgery can be recommended.

MATERIALS AND METHODS

Medical records of dogs treated for brachycephalic obstructive airway syndrome using the split staphylectomy were reviewed. Owners were contacted to complete a questionnaire assessing initial postoperative concerns, the long-term outcome and the effect of surgery on their dog's quality of life.

RESULTS

Seventy-five dogs underwent split staphylectomy during the study period. The overall complication rate was 8.3%, of which 2.7% were considered major. No life-threatening complications occurred, and no complications were related to the staphylectomy. The questionnaire was completed by 66.7% of owners (median follow-up 459 days), of which 88% felt that surgery had improved the quality of life for their dog. The majority (88%) of dogs were discharged from hospital on the day of surgery. Of the surveyed owners, 14% sought veterinary attention between their dog leaving the hospital and the scheduled postoperative reassessment 2 weeks after surgery. Four dogs were presented for veterinary intervention during this time period, but no intervention was related to the staphylectomy or for a life-threatening condition.

CLINICAL SIGNIFICANCE

The split staphylectomy offers a safe, straightforward method of addressing both excess thickness and length of soft palate in dogs with brachycephalic obstructive airway syndrome. Dogs can be discharged on the same day as brachycephalic obstructive airway syndrome surgery including split staphylectomy without an increased risk of complications.

Abnormal hyoid conformation in French Bulldogs: case report and computed tomographic anatomical comparison

BACKGROUND

Brachycephalic obstructive airway syndrome (BOAS) is common in brachycephalic breeds and comprises multiple anatomic characteristics. Computed tomography (CT) is increasingly used in the preoperative assessment of dogs presenting with BOAS. We describe the case of a French Bulldog with a presumed congenital hyoid malformation and anatomic comparison of hyoid morphology between French Bulldogs and mesaticephalic dogs using CT.

METHODS

Skull CT studies of French Bulldogs and mesaticephalic dogs presenting to two referral hospitals between 2013 and 2020 were collected. The degree of curvature of the basihyoid bone and the relative ventrodorsal thickness (RVD) were determined using a novel measurement technique. A circle of best fit was applied to the inside arc of the basihyoid bone, and the radius and sector angle within the basihyoid bone were recorded. The RVD was defined by the ventrodorsal thickness divided by the width in the frontal plane.

RESULTS

The basihyoid bone of French Bulldogs had a greater mean ± SD RVD of 0.23 ± 0.04 compared to 0.16 ± 0.03 in mesaticephalic dogs (P < 0.01). The sector angle was also greater in French Bulldogs, measuring 144.08 ± 20.88° compared to 103.94 ± 16.49° in mesaticephalic dogs (P < 0.01).

CONCLUSION

This case of hyoid malformation in a French Bulldog reports a rarely documented condition that complicated the management of BOAS. Comparative assessment of hyoid conformation revealed more acute curvature and greater RVD in French Bulldogs than in mesaticephalic dogs. This may represent an additional distorted anatomic component of brachycephalic skull morphology.

Dynamic computed tomography evaluation of the nasopharynx in normal Beagle dogs

Pharyngeal collapsibility has been used as diagnostic criteria in dogs, whereas the normal range and quantitative method have not been studied. Dynamic and static computed tomography (CT) was performed in 23 normal Beagle dogs to quantify the nasopharyngeal collapsibility at different locations. Using dynamic CT, maximum and minimum nasopharyngeal cross-sectional areas (CSAs) were measured at the level of the cranial end of the soft palate, pterygoid hamulus, foramen lacerum, bony labyrinth, and caudal end of the soft palate. The ratio of all maximum and minimum CSA to nasopharyngeal CSA at the level of the caudal hard palate (rCSAmax and rCSAmin) and the nasopharyngeal collapsibility were calculated. The differences of rCSAmax, rCSAmin, and nasopharyngeal collapsibility were analyzed at various locations. The nasopharyngeal collapsibility at the level of foramen lacerum, bony labyrinth, and caudal end of soft palate were higher than the others. At the level of the caudal end of the soft palate, rCSAmin was lower than that of the foramen lacerum and bony labyrinth, whereas rCSAmax at foramen lacerum was higher than that of the caudal end of the soft palate. These results indicated that the nasopharynx at the level of foramen lacerum and caudal end of the soft palate were considered notable locations for evaluating collapsibility. Dynamic CT could show the nasopharyngeal dynamic profile and will be an adequate modality for evaluating nasopharynx. Our results will be helpful for further comparative studies in dogs with and without nasopharyngeal collapse.

Tongue and Upper Airway Dimensions: A Comparative Study between Three Popular Brachycephalic Breeds

Simple Summary

Brachycephalic obstructive airway syndrome is a debilitating disease complex, that affects severely brachycephalic dogs, impairs their quality of life and shortens life expectancy. Macroglossia has been identified as part of the soft tissue conditions that characterize brachycephalic breeds. Despite similar degrees of brachycephalism comparing the common breeds French bulldogs, English bulldogs and pugs, several breed specific characteristics contributing to brachycephalic obstructive airway syndrome have been described in the past. The present study aimed to examine the tongue volume and at three levels cross-sectional areas of the tongue, oropharyngeal airways, soft palate and nasopharyngeal airways in the aforementioned breeds. Assessment of computed tomography scans revealed smaller tongues in pugs compared to French and English bulldogs, with values being close to previously published data in mesaticephalic breeds. Comparing the cross-sectional areas between breeds, several differences were identified, however, calculating the impact of soft tissue on total airways areas uncovered only differences between pugs and French bulldogs at the most caudal location, where the latter breed had a greater ratio, presumably in consequence to a significantly larger oropharyngeal airway area. These findings corroborate the importance of respecting breed specific differences in regard to surgical treatment of brachycephalic obstructive airway syndrome.

Abstract

Relative macroglossia has been identified in brachycephalic compared to mesaticephalic dogs. This study assessed the tongue volume comparing three common brachycephalic breeds, including 30 French bulldogs, 30 pugs, and 15 English bulldogs. Computed tomography scans of intubated dogs with the hard palate suspended were examined for total tongue volume and cross-sectional areas (CSAs) of the tongue, oropharynx, soft palate, and nasopharyngeal airways at three levels: 1, caudal tip of the hard palate; 2, caudal tip of the hamulus; 3 cranial to the basihyoid bone. Tongue volume normalized to bodyweight, was significantly higher in English and French bulldogs than in pugs. Normalized to skull length, CSA of the tongue was smaller in pugs than in French and English bulldogs. At level 3, French bulldogs had larger oropharyngeal CSA than English bulldogs and pugs. Soft palate CSA was the largest in English bulldogs at level 3. At levels 1 and 2, soft palate and nasopharyngeal CSA was the smallest in pugs. At level 3, French bulldogs had higher total airway/soft tissue ratios than pugs. The smaller tongue volume in pugs questions the accuracy of the term macroglossia in this breed and these findings should be considered if surgical correction is sought.

Owner reported breathing scores, accelerometry and sleep disturbances in brachycephalic and control dogs: A pilot study

OBJECTIVES

To compare physical activity and length and quality of sleep between brachycephalic dogs and a control population.

METHODS

Brachycephalic and control dogs were prospectively enrolled. Length of activity and sleep were determined via accelerometer use. Owners completed a questionnaire regarding typical daily activity, sleep patterns and an 'owner reported breathing score (ORBS)'. One hour of normal home sleep was recorded for each dog, and a veterinary observer subjectively scored the dogs' sleep quality.

RESULTS

Twenty brachycephalic and 15 control dogs were included. There were no differences between age and weight. Owners reported brachycephalic dogs to be less active (p = 0.022) and have higher ORBS (p < 0.001) compared to control dogs. Brachycephalic dogs had increased sleep disturbances compared to control dogs (p = 0.001), and video sleep score was positively correlated with increased sleep disturbances (r² = 0.47, p = 0.007). There were no differences in active and sleep times based on accelerometry between groups.

CONCLUSION

Brachycephalic dogs have more disturbed sleep, which may have negative implications on welfare, but there were no differences in activity or length of sleep between groups. There is evidence that signs suggestive of brachycephalic obstructive airway syndrome (BOAS) as assessed by ORBS is correlated with poorer sleep quality, indicating that reduced sleep quality is part of BOAS. Owners may underestimate disturbed sleep or may perceive disturbed sleep to be normal.

Canine DVL2 variant contributes to brachycephalic phenotype and caudal vertebral anomalies

A frameshift deletion variant in the Wnt pathway gene dishevelled 2 (DVL2) is associated with a truncated, kinked tail (“screw tail”) in English Bulldogs, French Bulldogs and Boston Terriers. These breeds are also characterized by distinctive morphological traits, including a wide head, flat face and short-limbed dwarfism, which are characteristic of Robinow syndrome in humans, caused by defects in genes such as DVL1 and DVL3. Based on these phenotypic and genetic similarities, it has previously been hypothesized that the canine DVL2 variant results in a syndromic phenotype called the Robinow-like syndrome. In our study, we investigated the distribution of the DVL2 variant in 1954 dogs from 15 breeds, identifying breeds with allele variation and enabling the dissection of the genotype–phenotype correlation for the first time. With CT examinations in American Staffordshire Terriers, we confirmed that the DVL2 allele is associated with caudal vertebral malformations and a brachycephalic phenotype. We also hypothesize that the variant may be linked to additional health conditions, including brachycephalic obstructive airway syndrome and congenital heart defects. Altogether, our study strengthens the role of DVL2 as one of the contributors to the “bulldog type” morphology and features on the spectrum of human Robinow syndrome.

Influence of computed tomographic dimensions of the nasopharynx on middle ear effusion and inflammation in pugs and French bulldogs with brachycephalic airway syndrome

OBJECTIVE

To compare the prevalence of middle ear abnormalities in pugs and in French bulldogs and evaluate the influence of nasopharyngeal dimensions on middle ear effusion.

STUDY DESIGN

Retrospective study.

ANIMALS

Thirty pugs and 30 French bulldogs with brachycephalic airway syndrome and no known history of ear disease.

METHODS

Computed tomographic (CT) studies were reviewed for middle ear effusion, mucosal contrast enhancement, signs of osteitis, and tympanic wall thickness. Soft palate thickness and cross-sectional areas of the nasopharynx at the opening of the auditory tube were measured and normalized to each individual's skull index before statistical comparison between breeds. Statistical dependence of middle ear abnormalities and nasopharyngeal dimensions was assessed by using Spearman's rank correlation tests.

RESULTS

Middle ear effusion was observed in 17 of 30 (56.7%) French bulldogs and five of 30 (16.7%) pugs. Contrast enhancement of the tympanic bulla was noted in 25 of 60 (41.6%) French bulldog ears and three of 60 (5.0%) pug ears. The cross-sectional airway dimensions (difference [Δ] = 0.31 cm² , P < .0001) and soft palate thickness (Δ = 0.44 cm, P < .0001) were reduced in pugs compared with in French bulldogs. Weak correlations were detected between soft palate thickness and nasopharyngeal dimensions and presence of tympanic bulla effusion (r = 0.324 and r = 0.198, respectively) or contrast enhancement (r = 0.270 and r = 0.199, respectively).

CONCLUSION

Middle ear effusion and inflammation were more common in French bulldogs than in pugs and did not seem related to nasopharyngeal dimensions.

CLINICAL SIGNIFICANCE

French bulldogs with brachycephalic airway syndrome seem predisposed to middle ear effusion and inflammation.

Histological and mechanical comparisons of arytenoid cartilage between 4 brachycephalic and 8 non-brachycephalic dogs: A pilot study

Brachycephalic airway syndrome (BAS) is a well-established cause of respiratory distress in dogs. BAS without surgical correction results in eventual laryngeal collapse. Arytenoid lateralization has been used to treat severe laryngeal collapse with some highly variable results. Chondromalacia and decreased stiffness of the arytenoid cartilage has been postulated a source of failure after arytenoid lateralization but no report of the histological characteristics and mechanical strength of arytenoid cartilage in brachycephalic dogs has been reported. Here we report histological and mechanical features in arytenoid cartilage of brachycephalic dogs. We identified the arytenoid cartilage in brachycephalic dogs presented degenerative histological characteristics and decreased load to failure and stiffness compared to that in non-brachycephalic dogs. Together, these observations suggest that degenerative condition of arytenoid cartilage in brachycephalic dogs could contribute to chondromalacia and mechanical weakness of arytenoid cartilage and result in cause of failure after arytenoid lateralization.

Diagnosis of a sublaryngeal abscess in a Japanese Black calf using computed tomography

A 76-day-old Japanese Black calf presented with severe stridor, resenting palpation of the laryngeal region. Endoscopic examination revealed an expansile process restricting the esophageal and tracheal lumina caudal to the arytenoid cartilage, hyperemia and edema of the pharyngeal mucosa, right arytenoid cartilage swelling and displacement, and marked airway obstruction. The absence of an endotracheal wall abnormality impeded a definitive diagnosis. Computed tomography (CT) revealed a mass (CT value: 40–45 HU) caudal to the arytenoid cartilage, causing tracheal stenosis and esophageal displacement. The presence of gas in the mass suggested the presence of an abscess. Diagnosis of deep retropharyngeal lesions by conventional endoscopic and ultrasonographic examinations may be challenging; CT can then provide more comprehensive diagnostic information on a lesion.

Prognostic indicators of short-term outcome in dogs undergoing surgery for brachycephalic obstructive airway syndrome

BACKGROUND

The aims of this study were to assess the impact of epidemiological variables, severity of presurgical respiratory signs, diagnostic findings from pharyngeal and laryngeal examination using a new grading scheme and CT scan images, on postsurgical outcome in dogs undergoing surgery for brachycephalic obstruction airway syndrome (BOAS).

METHODS

An owner-based questionnaire was used to grade dogs based on their respiratory signs before surgery and at least six weeks after surgery. Epidemiological data and results from presurgical pharyngeal and laryngeal examination and CT scan findings for 75 dogs undergoing airway surgery were collected from the medical records.

RESULTS

70.7 per cent of dogs showed an improvement in respiratory signs following rhinoplasty and palatoplasty. This improvement was associated with the severity of inspiratory efforts and the Poncet score on presentation, but not with any other clinical sign or anatomical abnormality found during BOAS assessment, nor by the degree of craniofacial shortening as determined by CT-scan. Presurgical snoring was positively associated with the degree of narrowing of pharyngeal dimensions.

CONCLUSIONS

Dogs presenting with clinical signs of BOAS benefit from rhinoplasty and palatoplasty alone. The degree of narrowing of pharyngeal dimensions appears to be associated with severity of snoring while soft palate length alone was not.

"Forever young"-Postnatal growth inhibition of the turbinal skeleton in brachycephalic dog breeds (Canis lupus familiaris)

In short snouted (brachycephalic) dogs (Canis lupus familiaris), several genetic mutations cause postnatal growth inhibition of the viscerocranium. Thus, for example, the pug keeps a snub nose like that observed in neonate dogs in general. However, little is known how far intranasal structures like the turbinal skeleton are also affected. In the present study, we provide the first detailed morphological and morphometric analyses on the turbinal skeleton of pug, Japanese chin, pekingese, King Charles spaniel, and Cavalier. In order to elucidate how a shortened snout affects turbinal shape, size, and density, our sample covers different degrees of brachycephaly. Macerated skulls of 1 juvenile and 17 adult individuals were investigated by μCT and virtual 3D reconstructions. In addition, histological serial sections of two prenatal and one neonate whippet were taken into account. All investigated postnatal stages show three frontoturbinals and three ethmoturbinals similar to longer snouted breeds, whereas the number of interturbinals is reduced. The shape of the entire turbinal skeleton simplifies with decreasing snout length, that is, within a minimized nasal cavity the turbinals decrease proportionally in surface area and surface density due to a looser arrangement. We interpret these apparent reductions as a result of spatial constraint which affects postnatal appositional bone growth and the position of the turbinals inside the nasal cavity. The turbinal skeleton of brachycephalic dogs arrests at an early ontogenetic stage, corresponding with previous studies on the dermal bones. Hence, we assume an association between the growth of intranasal structures and facial elongation.

Intraobserver and interobserver reliability of computed tomography measurements of the soft palate in French bulldogs

Background

CT imaging has been used to document the soft palate dimensions in brachycephalic dogs but reliability of such measurements has not been evaluated. The aims of this study were to propose a method of measurements of the soft palate in French bulldogs and determine its reliability.

Methods

Thirty French bulldogs were prospectively included. Five measurements of the soft palate were performed on soft tissue and bone window mid-sagittal images: length, thickness at 25, 50 and 75 per cent of its length and sagittal plane cross-sectional area. Three sets of data were separately acquired by three observers. Intraobserver and interobserver reliability for all measurements was assessed using intraclass correlation coefficient (ICC).

Results

The median ICCs showed excellent reliability (0.90 to 0.99) for all intraobserver measurements except for thickness at 75 per cent which showed good (0.80 to 0.89) to excellent reliability. The median ICC showed excellent reliability for all interobserver measurements.

Conclusion

The soft palate measurements on a single CT image are reproducible and repeatable. Further study is needed to assess the reliability of these measurements in the same patient with different endotracheal tube positions.

Facial changes related to brachycephaly in Cavalier King Charles Spaniels with Chiari-like malformation associated pain and secondary syringomyelia

BACKGROUND

Recent studies including an innovative machine learning technique indicated Chiari-like malformation (CM) is influenced by brachycephalic features.

OBJECTIVES

Morphometric analysis of facial anatomy and dysmorphia in CM-associated pain (CM-P) and syringomyelia (SM) in the Cavalier King Charles Spaniel (CKCS).

ANIMALS

Sixty-six client-owned CKCS.

METHODS

Retrospective study of anonymized T2W sagittal magnetic resonance imaging of 3 clinical groups: (1) 11 without central canal dilation (ccd) or SM (CM-N), (2) 15 with CM-P with no SM or <2 mm ccd (CM-P), and (3) 40 with syrinx width ≥4 mm (SM-S). Morphometric analysis assessed rostral skull flattening and position of the hard and soft palate relative to the cranial base in each clinical group and compared CKCS with and without SM-S.

RESULTS

Sixteen of 28 measured variables were associated to SM-S compared to CM-N and CM-P. Of these 6 were common to both groups. Predictive variables determined by discriminant analysis were (1) the ratio of cranial height with cranial length (P < .001 between SM-S and CM-N) and (2) the distance between the cerebrum and the frontal bone (P < .001 between SM-S and CM-P). CM-P had the lowest mean height of the maxillary area.

CONCLUSIONS AND CLINICAL IMPORTANCE

CKCS with CM-P and SM-S have cranial brachycephaly with osseous insufficiency in the skull with rostral flattening and increased proximity of the hard and soft palate to the cranial base. Changes are greatest with CM-P. These findings have relevance for understanding disease pathogenesis and for selection of head conformation for breeding purposes.

Evaluation of metabolic profile and C-reactive protein concentrations in brachycephalic dogs with upper airway obstructive syndrome

Background

Brachycephalic dogs have abnormal breathing patterns similar to those in humans with obstructive sleep apnea syndrome. Obstructive sleep apnea syndrome is associated with dyslipidemia, hyperglycemia, and insulin resistance. Despite the fact that anatomic and functional alterations are well described in brachycephalic dogs, little is known about the consequences of upper airway obstruction on systemic inflammatory response and metabolic profile.

Objectives

To describe history, clinical presentation, and anatomic abnormalities; to evaluate systemic inflammatory response and metabolic profile; and to identify possible associations among clinical signs, anatomic abnormalities, inflammatory response, and metabolic profile in brachycephalic dogs with airway obstruction.

Animals

Thirty purebred brachycephalic dogs with brachycephalic airway obstructive syndrome (BAOS).

Methods

Prospective study. The following information was recorded and studied: respiratory and digestive signs, airway and digestive endoscopic anomalies, presence or absence of tracheal hypoplasia, histologic evaluation of gastrointestinal tract biopsy specimens, serum concentrations of C‐reactive protein (CRP), fructosamine, insulin, glucose, triglyceride, cholesterol, and plasma concentrations of lipoprotein classes.

Results

A high proportion of dogs (76.7%) had gastrointestinal signs. Esophageal deviation, atony of the cardia of the stomach, and distal esophagitis were the most common endoscopic anomalies detected. Twenty‐six (86.6%) dogs had different degrees of laryngeal collapse. Gastrointestinal histologic evaluation identified mostly chronic inflammation. Glucose, fructosamine, triglycerides, cholesterol, CRP, pre‐beta, beta lipoproteins, and chylomicrons were increased to a variable extent. Significant associations among clinical signs, anatomic abnormalities, CRP, and metabolic profile were not found.

Conclusion and Clinical Importance

Despite the presence of inflammation and some mild metabolic derangements, the clinicopathological variables evaluated did not offer valuable information in dogs with BAOS.

The impact of tongue dimension on air volume in brachycephalic dogs

OBJECTIVE

To compare the dimensions and density of the tongue in brachycephalic and mesaticephalic dog breeds and to document the relative extents of the nasopharyngeal and oropharyngeal airways occupied by the tongue and palatal tissues.

STUDY DESIGN

Case control study.

ANIMALS

Sixteen brachycephalic dogs and 12 mesaticephalic dogs.

METHODS

The volume of the tongue was measured with computed tomography in all dogs. Cross-sectional areas of tongue, oropharynx, nasopharynx, and palatal soft tissue were evaluated at two levels, the caudal aspect of the hard palate and the level of the hamulae of the pterygoid. Density of the tongue and soft palate were measured. All variables were compared between brachycephalic and mesaticephalic dogs (P ≤ .05).

RESULTS

Absolute tongue volumes did not differ between groups, the volume of the tongue was greater in brachycephalic dogs than in mesaticephalic dogs when expressed relative to (a) body weight (median 5650, interquartile range [IQR] 4833-6522 vs median 4454, IQR 4309-4743, respectively), (b) ratio between skull length/width (70 833, IQR 62490-126 209 vs 48 064, IQR 22984-64 279, respectively), and (c) skull length (689.93, IQR 618.55-970.61 vs 460.04, IQR 288.77-561.69, respectively). The proportion of air (oropharyngeal and nasopharyngeal)/soft tissue (tongue and palatal tissue) in brachycephalic dogs was decreased by approximately 60%, and the tongue was approximately 10 times denser in brachycephalic dogs than in mesaticephalic dogs.

CONCLUSION

A relative macroglossia was detected in brachycephalic dogs along with reduced air volume in the upper airway. Tongues of brachycephalic dogs were denser than those of mesaticephalic dogs.

CLINICAL SIGNIFICANCE

The relative macroglossia in brachycephalic breeds may contribute to upper airway obstruction.

An ADAMTS3 missense variant is associated with Norwich Terrier upper airway syndrome

In flat-faced dog breeds, air resistance caused by skull conformation is believed to be a major determinant of Brachycephalic Obstructive Airway Syndrome (BOAS). The clinical presentation of BOAS is heterogeneous, suggesting determinants independent of skull conformation contribute to airway disease. Norwich Terriers, a mesocephalic breed, are predisposed to Upper Airway Syndrome (UAS), a disease whose pathological features overlap with BOAS. Our health screening clinic examined and scored the airways of 401 Norwich terriers by laryngoscopy. Genome-wide association analyses of UAS-related pathologies revealed a genetic association on canine chromosome 13 (rs9043975, p = 7.79x10^-16). Whole genome resequencing was used to identify causal variant(s) within a 414 kb critical interval. This approach highlighted an error in the CanFam3.1 dog assembly, which when resolved, led to the discovery of a c.2786G>A missense variant in exon 20 of the positional candidate gene, ADAM metallopeptidase with thrombospondin type 1 motif 3 (ADAMTS3). In addition to segregating with UAS amongst Norwich Terriers, the ADAMTS3 c.2786G>A risk allele frequency was enriched among the BOAS-susceptible French and (English) Bulldogs. Previous studies indicate that ADAMTS3 loss of function results in lymphoedema. Our results suggest a new paradigm in the understanding of canine upper airway disease aetiology: airway oedema caused by disruption of ADAMTS3 predisposes dogs to respiratory obstruction. These findings will enhance breeding practices and could refine the prognostics of surgical interventions that are often used to treat airway obstruction.

Respiratory diseases are prevalent across dog breeds, particularly in brachycephalic breeds such as the Bulldog and French bulldog. The flat facial conformation of these breeds has long been assumed to be the major predisposing factor, however, the underlying genetics of their respiratory condition has never been elucidated. We became interested in the Norwich Terrier, a breed presenting with many of the same respiratory disease symptoms as the Bulldog. A distinction, however, is that the Norwich terrier is not considered to be a brachycephalic breed and so presented an opportunity to dissociate respiratory disease from head conformation. We performed a genome-wide association analysis for respiratory disease severity in the Norwich Terrier and resolved an association on chromosome 13 to a missense mutation in ADAMTS3. Variants in this gene were previously shown to cause an oedematous phenotype–a disease characteristic in the airways of affected Norwich Terriers and brachycephalic dogs alike. We screened over 100 breeds for the ADAMTS3 variant and found that it is enriched in the Norwich Terrier, Bulldog and French Bulldog. This discovery changes how we view respiratory disease predisposition in the dog, offers potential genetic screens and highlights a new biological function for ADAMTS3.

Consequences and Management of Canine Brachycephaly in Veterinary Practice: Perspectives from Australian Veterinarians and Veterinary Specialists

This article, written by veterinarians whose caseloads include brachycephalic dogs, argues that there is now widespread evidence documenting a link between extreme brachycephalic phenotypes and chronic disease, which compromises canine welfare. This paper is divided into nine sections exploring the breadth of the impact of brachycephaly on the incidence of disease, as indicated by pet insurance claims data from an Australian pet insurance provider, the stabilization of respiratory distress associated with brachycephalic obstructive airway syndrome (BOAS), challenges associated with sedation and the anaesthesia of patients with BOAS; effects of brachycephaly on the brain and associated neurological conditions, dermatological conditions associated with brachycephalic breeds, and other conditions, including ophthalmic and orthopedic conditions, and behavioural consequences of brachycephaly. In the light of this information, we discuss the ethical challenges that are associated with brachycephalic breeds, and the role of the veterinarian. In summary, dogs with BOAS do not enjoy freedom from discomfort, nor freedom from pain, injury, and disease, and they do not enjoy the freedom to express normal behaviour. According to both deontological and utilitarian ethical frameworks, the breeding of dogs with BOAS cannot be justified, and further, cannot be recommended, and indeed, should be discouraged by veterinarians.

Position of maximal nasopharyngeal maximal occlusion in relation to hamuli pterygoidei: use of hamuli pterygoidei as landmarks for palatoplasty in brachycephalic airway obstruction syndrome surgical treatment

OBJECTIVES

To assess the influence of complete nasopharyngeal occlusion on respiratory signs in brachycephalic dogs. To determine the cranio-caudal position of rostral nasopharyngeal occlusion in relation to the hamuli pterygoidei in brachycephalic dogs. To determine whether using the hamuli pterygoidei as anatomical landmarks for palatoplasty results in clinical respiratory improvement.

MATERIALS AND METHODS

Prospective study of dogs diagnosed with brachycephalic obstructive airway syndrome. The dogs were scored according to the severity of their clinical respiratory signs and the nasopharynx was CT scanned. The site of most rostral nasopharyngeal occlusion was measured in relation to the hamuli pterygoidei. Measurements were compared between brachycephalic obstructive airway syndrome group, completely occluded and partially occluded groups. The hamuli pterygoidei were used as the most cranial landmarks for the palatoplasty incision, such that the incision was made at the point of maximal nasopharyngeal occlusion. Owners were interviewed through telephone for the medium-term follow-up.

RESULTS

Thirty-five dogs were included. There was no significant association between the severity of respiratory clinical signs and extent of nasopharyngeal occlusion. Maximal nasopharyngeal occlusion was always located directly caudal to the hamuli pterygoidei (mean ±sd value of 9∙4 ±6∙5 mm). hamuli pterygoidei were easily palpable perioperatively in all cases. There was a significant improvement of clinical grades postoperatively.

CLINICAL SIGNIFICANCE

The hamuli pterygoidei are a reliable landmark for soft palate incision for palatoplasty in these cases but the distance between them and the site of maximal nasopharyngeal occlusion varied greatly.

Evaluation of the diagnostic yield of dental radiography and cone-beam computed tomography for the identification of anatomic landmarks in small to medium-sized brachycephalic dogs

OBJECTIVE To evaluate the diagnostic yield of dental radiography (Rad method) and 3 cone-beam CT (CBCT) methods for the identification of predefined anatomic landmarks in brachycephalic dogs. ANIMALS 19 client-owned brachycephalic dogs admitted for evaluation and treatment of dental disease. PROCEDURES 26 predefined anatomic landmarks were evaluated separately by use of the RAD method and 3 CBCT software modules (serial CBCT slices and custom cross sections, tridimensional rendering, and reconstructed panoramic views). A semiquantitative scoring system was used, and mean scores were calculated for each anatomic landmark and imaging method. The Friedman test was used to evaluate values for significant differences in diagnostic yield. For values that were significant, the Wilcoxon signed rank test was used with the Bonferroni-Holm multiple comparison adjustment to determine significant differences among each of the 6 possible pairs of diagnostic methods. RESULTS Differences of diagnostic yield among the Rad and 3 CBCT methods were significant for 19 of 26 anatomic landmarks. For these landmarks, Rad scores were significantly higher than scores for reconstructed panoramic views for 4 of 19 anatomic landmarks, but Rad scores were significantly lower than scores for reconstructed panoramic views for 8 anatomic landmarks, tridimensional rendering for 18 anatomic landmarks, and serial CBCT slices and custom cross sections for all 19 anatomic landmarks. CONCLUSIONS AND CLINICAL RELEVANCE CBCT methods were better suited than dental radiography for the identification of anatomic landmarks in brachycephalic dogs. Results of this study can serve as a basis for CBCT evaluation of dental disorders in brachycephalic dogs.

Evaluation of the diagnostic yield of dental radiography and cone-beam computed tomography for the identification of dental disorders in small to medium-sized brachycephalic dogs

OBJECTIVE To evaluate the diagnostic yield of dental radiography (Rad method) and cone-beam CT (CBCT) methods for the identification of 31 predefined dental disorders in brachycephalic dogs. ANIMALS 19 client-owned brachycephalic dogs admitted for evaluation and treatment of dental disease. PROCEDURES 31 predefined dental disorders were evaluated separately and scored by use of dental radiography and 3 CBCT software modules (serial CBCT slices and custom cross sections, tridimensional rendering, and reconstructed panoramic views). A qualitative scoring system was used. Dental disorders were grouped into 10 categories for statistical analysis. Point of reference for presence or absence of a dental disorder was determined as the method that could be used to clearly identify the disorder as being present. Accuracy, sensitivity, specificity, and positive and negative predictive values were calculated with the McNemar χ² test of marginal homogeneity of paired data. RESULTS When all 3 CBCT methods were used in combination, the diagnostic yield of CBCT was significantly higher than that of dental radiography for 4 of 10 categories (abnormal eruption, abnormally shaped roots, periodontitis, and tooth resorption) and higher, although not significantly so, for all categories, except for 1 (loss of tooth integrity). CONCLUSIONS AND CLINICAL RELEVANCE CBCT provided more detailed information than did dental radiography. Therefore, CBCT would be better suited for use in diagnosing dental disorders in brachycephalic dogs.

Nasopharyngeal sialoceles in 11 brachycephalic dogs

OBJECTIVE

To report clinical features, diagnosis, surgical treatment, and outcomes of brachycephalic dogs with nasopharyngeal sialoceles (NPS).

STUDY DESIGN

Retrospective case series.

ANIMALS

Eleven brachycephalic dogs with NPS.

METHODS

Diagnosis of NPS was based on identification of cystic nasopharyngeal masses containing saliva-like mucoid material on retroflexed endoscopy. Biopsies were obtained to support the diagnosis. Surgical deroofing was performed under endoscopic guidance, and endoscopic examination was repeated at least 3 months after surgery. The owners rated the outcome of surgery via a follow-up telephone inquiry.

RESULTS

Pugs (n = 8), French bulldogs (n = 2), and English bulldogs (n = 1) were included in this study. Eight of the NPS were ventral, 6 were obstructive, and 2 were multiple; both the obstructive and the multiple sialoceles were ventral. Surgical deroofing of the sialoceles was performed under endoscopic guidance with biopsy forceps in 5 cases and by diode laser in 6 cases. No recurrence was diagnosed. Ten of 11 owners reported that they were satisfied with the outcome.

CONCLUSIONS AND CLINICAL SIGNIFICANCE

NPS may be an uncommon consequence of chronic nonphysiologic mechanical stress causing changes in minor nasopharyngeal salivary glands. Direct visualization by nasopharyngoscopy is the best technique for detection of NPS, and we advise routine examination of the nasopharynx by endoscope in all brachycephalic dogs before performing surgery. Either endoscopic guided biopsy forceps or diode laser surgery can be used for noninvasive, rapid, and effective resolution of NPS in all of the dogs.

Endotracheal tube placement during computed tomography of brachycephalic dogs alters upper airway dimensional measurements

Computed tomography (CT) is used to document upper airway lesions in dogs with brachycephalic obstructive airway syndrome. The presence of an endotracheal tube during CT scanning is often required for general anesthesia. We hypothesized that the endotracheal tube placement would change the soft tissue dimensions of the upper airway. The aims of this prospective, method comparison study were to evaluate the reliability of the previously reported upper airway CT measurements with endotracheal tube placement, and to propose measurements that are minimally affected by the endotracheal tube. Twenty brachycephalic dogs were included in this study. Each dog underwent head/neck CT with an endotracheal tube, followed by a second scan without the endotracheal tube. Ten measurements of the soft palate, nasopharynx, and trachea were performed. Tracheal dimension was significantly larger with the endotracheal tube compared to without, whereas the soft palate cross-sectional area was significantly smaller with the endotracheal tube than without the endotracheal tube. The influence of the endotracheal tube on the caudal nasopharynx cross-sectional (transverse-sectional) area varied with a mean proportional absolute difference of 35%. Rostral soft palate thickness, tracheal perimeter, and cross-sectional area of the rostral nasopharynx were the measurements least affected by the endotracheal tube (intraclass correlation coefficient = 0.964, 0.967, and 0.951, respectively). Therefore, we proposed that these three measurements may be most useful for future brachycephalic obstructive airway syndrome studies that require CT scanning of intubated animals. However, with endotracheal tube placement, measurements of soft palate length, caudal nasopharyngeal cross-sectional area, and trachea height and width may not be reliable.

Conformational risk factors of brachycephalic obstructive airway syndrome (BOAS) in pugs, French bulldogs, and bulldogs

Extremely brachycephalic, or short-muzzled, dog breeds such as pugs, French bulldogs, and bulldogs are prone to the conformation-related respiratory disorder—brachycephalic obstructive airway syndrome (BOAS). Affected dogs present with a wide range of clinical signs from snoring and exercise intolerance, to life-threatening events such as syncope. In this study, conformational risk factors for BOAS that could potentially aid in breeding away from BOAS were sought. Six hundred and four pugs, French bulldogs, and bulldogs were included in the study. Soft tape measurements of the head and body were used and the inter-observer reproducibility was evaluated. Breed-specific models were developed to assess the associations between the conformational factors and BOAS status based on functional grading. The models were further validated by means of a BOAS index, which is an objective measurement of respiratory function using whole-body barometric plethysmography. The final models have good predictive power for discriminating BOAS (-) and BOAS (+) phenotypes indicated by the area under the curve values of >80% on the receiver operating curves. When other factors were controlled, stenotic nostrils were associated with BOAS in all three breeds; pugs and bulldogs with higher body condition scores (BCS) had a higher risk of developing BOAS. Among the standardized conformational measurements (i.e. craniofacial ratio (CFR), eye width ratio (EWR), skull index (SI), neck girth ratio (NGR), and neck length ratio (NLR)), for pugs EWR and SI, for French bulldogs NGR and NLR, and for bulldogs SI and NGR showed significant associations with BOAS status. However, the NGR in bulldogs was the only significant predictor that also had satisfactory inter-observer reproducibility. A NGR higher than 0.71 in male bulldogs was predictive of BOAS with approximately 70% sensitivity and specificity. In conclusion, stenotic nostrils, BCS, and NGR were found to be valid, easily applicable predictors for BOAS (+).

Assessment of computed tomography derived cricoid cartilage and tracheal dimensions to evaluate degree of cricoid narrowing in brachycephalic dogs

The aims of this observational, analytical, retrospective study were to (i) obtain computed tomographic (CT) cricoid dimensions (height, width, and transverse-sectional area), (ii) compare the cricoid dimensions between brachycephalic and mesaticephalic breeds, and (iii) compare cricoid cartilage dimensions between dogs without and affected with brachycephalic airway syndrome. The study is important to help to further evaluate and understand the anatomical components of brachycephalic airway syndrome. Measurements were performed in 147 brachycephalic and 59 mesaticephalic dogs. The cricoid cartilage was found to be significantly more oval in Pugs and French Bulldogs compared to mesaticephalic breeds. The cricoid cartilage transverse-sectional area was smallest for the Pug and, after adjusting for weight, significantly smaller for Pugs (P < 0.001), Boston Terriers (P = 0.001), and French Bulldogs (P < 0.001) compared to Jack Russell Terriers. The tracheal transverse-sectional area at C4 of English Bulldogs was significantly smaller than for Jack Russell Terriers (P = 0.005) and Labradors (P < 0.001). The cricoid cartilage transverse-sectional area:weight ratio was significantly lower in brachycephalic breeds compared to mesaticephalic breeds (P < 0.001). The cricoid cartilage:trachea at C4 transverse-sectional area for brachycephalic dogs was significantly larger than for mesaticephalic dogs (<0.001), demonstrating that the trachea was the narrowest part of the airway. No significant differences were found for cricoid dimensions between dogs affected with and without brachycephalic airway syndrome. However, large individual variation was found among the brachycephalic breeds and further studies investigating the relationship between cricoid cartilage size, laryngeal collapse, concurrent tracheal hypoplasia, and/or severity of brachycephalic airway syndrome are warranted.