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von Doernberg MC, von Rechenberg B, Richter H. Retrospective evaluation of radiofrequency volumetric tissue reduction for hypertrophic turbinates in dogs with brachycephalic obstructive airway syndrome. PLoS One 2024; 19:e0306391. [PMID: 38950052 PMCID: PMC11216595 DOI: 10.1371/journal.pone.0306391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 06/14/2024] [Indexed: 07/03/2024] Open
Abstract
OBJECTIVE The objective of this study was to retrospectively assess the effect of Radiofrequency Volumetric Tissue Reduction (RFVTR) on hypertrophic turbinates and clinical outcome in brachycephalic dogs when included in multi-level surgery (MLS). STUDY DESIGN Clinical retrospective multicenter study. ANIMALS 132 client-owned brachycephalic dogs. METHODS 132 brachycephalic dogs with high-grade Brachycephalic Obstructive Airway Ayndrome (BOAS) and hypertrophic turbinates were treated with RFVTR as part of MLS of the upper airways. Intranasal obstruction was evaluated by computer tomography (CT) and antero-/retrograde rhinoscopy before and 6 months after RFVTR. The clinical records, the CT images and the rhinoscopy videos were reviewed and clinical evolution was evaluated using a standardized questionnaire. The data was scored semi-quantitatively. RESULTS In this study, 132 patients were included for a follow-up period of 120 weeks. RFVTR resulted in minor complications, including serous nasal discharge within the first postoperative week in all dogs, and intermittent nasal congestion between 3-8 weeks after treatment in 24.3% of the patients. Rhinoscopy and CT follow-ups were available for 33 patients. Six months after treatment intranasal airspace was increased (p = 0.002) and the presence and overall amount of mucosal contact points was reduced (p = 0.039). CONCLUSION MLS with RFVTR led to a significant reduction in turbinate volume at the 6-month follow-up examination and significant clinical improvement over a long-term period of 120 weeks. This suggests the viability of RFVTR as a turbinate-preserving treatment for intranasal obstruction in dogs with BOAS. CLINICAL SIGNIFICANCE RFVTR is a minimally invasive turbinoplasty technique for intranasal obstruction in dogs with BOAS and can be included in MLS without increasing complication rates.
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Affiliation(s)
| | - Brigitte von Rechenberg
- Center for Applied Biotechnology and Molecular Medicine (CABMM), University of Zurich, Zurich, Switzerland
| | - Henning Richter
- Center for Applied Biotechnology and Molecular Medicine (CABMM), University of Zurich, Zurich, Switzerland
- Diagnostic Imaging Research Unit (DIRU), Clinic for Diagnostic Imaging, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
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Phillips H. Laser-Assisted Turbinectomy in Dogs. Vet Clin North Am Small Anim Pract 2024; 54:615-636. [PMID: 38521665 DOI: 10.1016/j.cvsm.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/25/2024]
Abstract
This article discusses the laser-assisted turbinectomy (LATE) procedure and indications for its performance in dogs suffering from brachycephalic obstructive airway syndrome (BOAS). The article summarizes landmark works that reported, for the first time, endoscopic-assisted identification and treatment of structures within the brachycephalic nose that contribute to intranasal obstruction and resistance to breathing, specifically hypertrophic and aberrant nasal turbinates. Brachycephaly is discussed in the context of how these aberrations form and how definitive treatments such as LATE and adjunctive treatments such as ala vestibuloplasty, folded flap palatoplasty, and others may ameliorate the negative effects and improve patient outcomes associated with aberrant intranasal conchal configurations.
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Affiliation(s)
- Heidi Phillips
- Department of Veterinary Clinical Medicine, Small Animal Surgery, University of Illinois College of Veterinary Medicine, 1008 West Hazelwood Drive, Urbana, IL 61802, USA.
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3
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Wallace ML. Surgical management of brachycephalic obstructive airway syndrome: An update on options and outcomes. Vet Surg 2024. [PMID: 38952039 DOI: 10.1111/vsu.14131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 05/22/2024] [Accepted: 06/08/2024] [Indexed: 07/03/2024]
Abstract
Dogs with a brachycephalic conformation often experience a collection of abnormalities related to their craniofacial conformation, which can lead to a variety of clinical signs such as stertor, exercise intolerance, respiratory distress, and gastrointestinal signs such as regurgitation, among others. This collection of abnormalities is termed brachycephalic obstructive airway syndrome (BOAS). With the rise in popularity of several brachycephalic breeds, veterinarians and veterinary surgery specialists are seeing these dogs with increasing frequency for surgical and medical treatment of these clinical signs, leading to an increased interest in developing surgical techniques for dogs with BOAS and evaluating objective methods of determining outcome after surgery. Advances in anesthetic management including standardized protocols and use of local nerve blocks to decrease opiate use may decrease postoperative complications. A variety of new or modified surgical techniques to manage hyperplastic soft palate and stenotic nares, among other BOAS components, have been developed and studied in recent years. Newer studies have also focused on risk factors for development of major complications in the postoperative period and on objective measurements that may help determine which patients will receive the most benefit from BOAS surgery. In this review, the newest studies focused on updates in anesthetic management, surgical techniques, and postoperative care will be discussed. Additionally, updated information on complication rates and outcomes for dogs undergoing surgical management of BOAS will be included.
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Affiliation(s)
- Mandy L Wallace
- Department of Small Animal Medicine and Surgery, University of Georgia, Athens, Georgia, USA
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Filipas MC, Owen L, Adami C. A retrospective observational cohort study on the postoperative respiratory complications and their risk factors in brachycephalic dogs undergoing BOAS surgery: 199 cases (2019-2021). J Small Anim Pract 2024; 65:329-337. [PMID: 38413137 DOI: 10.1111/jsap.13707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 01/11/2024] [Accepted: 01/17/2024] [Indexed: 02/29/2024]
Abstract
OBJECTIVES To observe the occurrence of postanaesthetic respiratory complications and to determine their prevalence and risk factors in dogs undergoing brachycephalic obstructive airway syndrome surgery. MATERIALS AND METHODS Data from 199 clinical records were retrospectively analysed. Univariable logistic regression followed by multivariable logistic regression was used to identify associations between the dependent variables (set as the postoperative respiratory complications observed in the study dogs) and various independent covariates. The quality of model-fit was assessed using the likelihood ratio test. P≤0.05 was considered statistically significant. RESULTS Four postoperative respiratory complications were observed: hypoxaemia (n=10/199; 5%), dyspnoea requiring tracheal re-intubation (n=13/199, 7%), dyspnoea requiring tracheostomy (n=10/199, 5%) and aspiration pneumonia (n=12/199, 6%). Univariable logistic regression showed an association between postoperative aspiration pneumonia and increasing body condition score and American Society of Anaesthesiology classification; however, when these covariates were evaluated in the multivariable model significance was not maintained. Risk factors for tracheostomy were preoperative and postoperative aspiration pneumonia (odds ratio: 9.52, 95% confidence interval: 1.56 to 57.93) and increasing brachycephalic obstructive airway syndrome grade (odds ratio: 4.65, 95% confidence interval: 0.79 to 27.50). CLINICAL SIGNIFICANCE High brachycephalic obstructive airway syndrome grade and aspiration pneumonia, either developing peri-operatively or as pre-existing condition, may represent risk factors for postoperative tracheostomy. Preoperative diagnosis of aspiration pneumonia may further increase the risk of postoperative complications.
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Affiliation(s)
- M C Filipas
- Department of Veterinary Medicine, University of Cambridge, Madingley Road, Cambridge, CB3 OES, UK
| | - L Owen
- Department of Veterinary Medicine, University of Cambridge, Madingley Road, Cambridge, CB3 OES, UK
| | - C Adami
- Department of Veterinary Medicine, University of Cambridge, Madingley Road, Cambridge, CB3 OES, UK
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Žgank Ž, Nemec Svete A, Lenasi H, Vodičar J, Erjavec V. The effect of the surgical treatment of brachycephalic obstructive airway syndrome on the thermoregulatory response to exercise in French bulldogs: a pilot study. Front Vet Sci 2023; 10:1229687. [PMID: 37901097 PMCID: PMC10601647 DOI: 10.3389/fvets.2023.1229687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 09/21/2023] [Indexed: 10/31/2023] Open
Abstract
Introduction Due to altered anatomy of the upper respiratory tract, brachycephalic dogs exhibit increased airway resistance and reduced surface area for evaporative heat loss, predisposing them to respiratory and thermoregulatory problems, a syndrome referred to as Brachycephalic Obstructive Airway Syndrome (BOAS). Compared to non-brachycephalic dogs, brachycephalic breeds are more susceptible to heat-related injuries even at low ambient temperatures and relatively low physical activity levels. Surgical treatment alleviates clinical signs, potentially improving dogs' thermoregulatory ability with BOAS. Our study aimed to investigate the thermoregulatory response in French bulldogs before and after the surgical correction of BOAS, respectively. Methods Thirteen dogs were exposed to dynamic exercise on a treadmill and the dynamics of their rectal temperature (RT) and heart rate (HR) was measured. The experiment was performed in two independent sessions, before and after the surgical treatment. The test consisted of two consecutive 5-min walks at a speed of 2.5 km/h, first at an inclination of 0% and the second at an inclination of 5%, and a 30-min recovery period. Rectal temperature and HR were measured before the start of the test (t0), at the end of the first (t1) and the second part (t2), and 15 min (t3) and 30 min (t4) in the recovery. Results A significant increase in RT and HR was observed during exercise and recovery compared to the resting values, implying that the exercise intensity was sufficient to challenge the thermoregulatory response. The increase of RT was significantly lower during both parts (t1: p = 0.004; t2: p < 0.001) of exercise after the surgical treatment than before the treatment. Although a trend of lower RT after recovery was observed compared to before the surgery, it did not reach statistical significance. Similarly to RT, the HR was significantly lower during exercise after the first (p = 0.020) and the second part (p = 0.011) of exercise after the surgery compared to before the surgery but did not reach significance in the recovery. Conclusion Surgical treatment of BOAS can improve thermoregulation during exercise in French bulldogs with BOAS.
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Affiliation(s)
- Žiga Žgank
- Small Animal Clinic, Veterinary Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Alenka Nemec Svete
- Small Animal Clinic, Veterinary Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Helena Lenasi
- Faculty of Medicine, Institute of Physiology, University of Ljubljana, Ljubljana, Slovenia
| | - Janez Vodičar
- Faculty of Sports, Institute of Sport, University of Ljubljana, Ljubljana, Slovenia
| | - Vladimira Erjavec
- Small Animal Clinic, Veterinary Faculty, University of Ljubljana, Ljubljana, Slovenia
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Rösch S, Schreyer J, Oechtering G. [Nasal obstruction: Odontogenic cysts in 4 brachycephalic dogs]. TIERARZTLICHE PRAXIS. AUSGABE K, KLEINTIERE/HEIMTIERE 2023; 51:301-312. [PMID: 37956662 DOI: 10.1055/a-2157-1370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
OBJECTIVE Odontogenic cysts may be of developmental or inflammatory origin. They are frequently observed in brachycephalic dogs. Due to their expansive growth, cysts in the maxilla may extend into the nasal cavity, obstruct the nasal airway and cause nasal discharge. Epithelial cysts may lead to a comparable clinical picture. A new endonasal endoscopic intervention for the removal of these cysts is described. MATERIAL AND METHODS Four brachycephalic dogs (Boxer, Chihuahua, French bulldog, Pug) with unilateral cysts obstructing the nasal cavity were included in the study. The animals underwent clinical examination, computed tomography (CT) imaging and rhinoscopy examination. Histopathologic evaluation of the cyst wall was performed. In addition to dental surgery and conventional extraction of the involved tooth, the cyst wall was removed by endoscopic intervention via the physiologic nasal opening. Clinical course following treatment was assessed by rhinoscopy and CT. RESULTS The main clinical signs were unilateral or bilateral serous to hemorrhagic nasal discharge. Nasal airflow was restricted in all patients. Removal of the cysts and involved teeth did not lead to any intra- and postoperative complications. No recurrence of the cysts was observed. Histologic diagnosis consisted of an epidermoid cyst, a follicular cyst, a radicular cyst, and a canine odontogenic parakeratinized cyst (COPC). Neoplastic transformation was excluded in all cases. CONCLUSIONS Removal of the cyst wall may be performed by means of minimally invasive endoscopic intervention via the physiologic nasal entrance. The procedure is curative and carries the risk of only few complications. In cases in which treatment is restricted to extraction of the affected tooth, the nasal airway may remain obstructed due to a calcified cyst wall. CLINICAL RELEVANCE In brachycephalic dogs, oronasal defects due to dental pathology are the most common reason for chronic nasal discharge, whereas in normocephalic dogs nasal neoplasia are. Odontogenic cysts carry importance as differential diagnosis of nasal discharge.
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Affiliation(s)
- Sarah Rösch
- Klinik für Kleintiere, HNO-Abteilung, Veterinärmedizinische Fakultät, Universität Leipzig
| | - Jan Schreyer
- Tierärztliche Gemeinschaftspraxis am Kaßberg, Chemnitz
| | - Gerhard Oechtering
- Klinik für Kleintiere, HNO-Abteilung, Veterinärmedizinische Fakultät, Universität Leipzig
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Gleason HE, Phillips H, McCoy AM. Influence of feline brachycephaly on respiratory, gastrointestinal, sleep, and activity abnormalities. Vet Surg 2023; 52:435-445. [PMID: 36582029 DOI: 10.1111/vsu.13931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 08/10/2022] [Accepted: 12/08/2022] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To determine the influence of brachycephaly on respiratory, gastrointestinal, sleep, and activity-related parameters in cats. STUDY DESIGN Prospective questionnaire-based study. ANIMALS A total of 194 BC and 1003 non-BC cats. METHODS Owners completed an online questionnaire regarding respiratory, gastrointestinal, sleep, and activity-related parameters. Response options were scored, and individual scores summed to give a total clinical severity score for each cat. RESULTS Brachycephalic cats had more frequent snoring (odds ratio [OR] 6.89; 95% confidence interval [CI]: 5.06-9.41), sneezing (OR 6.52; CI: 4.75-8.98), nasal discharge (OR 8.26; 95% CI 5.77-11.85), coughing (OR 1.75; CI: 1.17-2.59), and dyspnea (OR 5.32; CI: 3.42-8.28); shorter activity before becoming dyspneic (OR 2.71; CI: 1.93-3.79), slower recovery from activity (OR 3.17; CI: 2.19-4.57), lower activity levels (OR 2.16; CI: 1.59-2.95), and increased respiratory noise (OR 6.68; CI: 4.71-9.52); and more hypersalivation (OR 2.50; CI: 1.47-4.16), halitosis (OR 1.40; CI: 1.00-1.95), and difficulty chewing (OR 5.19; CI: 3.65-7.38). Median clinical severity scores were higher for BC cats than non-BC cats (p < .0001). CONCLUSIONS Brachycephalic cats (BC) were at risk for respiratory, gastrointestinal, and activity-related symptoms compared to non-BC cats. CLINICAL RELEVANCE Some BC cats exhibit clinically relevant symptoms and behaviors as reported by owners. Medical or surgical interventions may improve these symptoms and warrant investigation.
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Affiliation(s)
- Hadley E Gleason
- Department of Veterinary Clinical Medicine, College of Veterinary Medicine, University of Illinois, Urbana, Illinois, USA
| | - Heidi Phillips
- Department of Veterinary Clinical Medicine, College of Veterinary Medicine, University of Illinois, Urbana, Illinois, USA
| | - Annette M McCoy
- Department of Veterinary Clinical Medicine, College of Veterinary Medicine, University of Illinois, Urbana, Illinois, USA
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8
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Gleason HE, Phillips H, Fries R, Keating S, Hamel P, McCoy A. Ala vestibuloplasty improves cardiopulmonary and activity-related parameters in brachycephalic cats. Vet Surg 2023; 52:575-586. [PMID: 36882053 DOI: 10.1111/vsu.13948] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 12/08/2022] [Accepted: 02/15/2023] [Indexed: 03/09/2023]
Abstract
OBJECTIVE To evaluate the effects of ala vestibuloplasty on cardiopulmonary and lifestyle-related parameters in brachycephalic (BC) cats. STUDY DESIGN Prospective cohort. ANIMALS Client-owned BC cats (n = 19). METHODS Cats were assessed preoperatively by airway computed tomography (CT), endoscopy, contrast echocardiography, cardiac biomarkers, and structured owner questionnaire. Ala vestibuloplasty was performed bilaterally, and blood values, imaging, and owner questionnaire responses were re-evaluated 8-20 weeks postoperatively. RESULTS Cats were presented for predominantly respiratory clinical signs attributable to brachycephaly. Preoperatively, all cats had stenotic nares, prolonged normalized pulmonary transit time (nPTT) (mean 5.43 ± 1.10 s), and a hyperattenuating pulmonary pattern. No complications occurred following surgery. Postoperatively, nPTT (mean 3.89 ± 0.74 s, p < .001) and frequencies of sneezing (p = .002), snoring (p = .006), open-mouth breathing (p = .0004), and nasal discharge (p = .019) were decreased. Cats exhibited increased activity (p = .005), less frequent dyspnea during activity (p < .001), longer duration of activity before becoming dyspneic (p = .002), faster recovery from activity (p < .001), and decreased respiratory noise (p < .001). Median questionnaire scores improved from preoperative to postoperative (p < .001). CONCLUSION Anatomic, echocardiographic, and CT changes were common in this cohort of clinically affected BC cats. Pulmonary blood flow and respiratory function were improved after surgery. CLINICAL SIGNIFICANCE Stenotic nares are the predominant airway abnormality in BC cats. Ala vestibuloplasty is a safe procedure that improves cardiac and CT abnormalities and respiratory and other clinical signs in BC cats.
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Affiliation(s)
- Hadley E Gleason
- Department of Veterinary Clinical Medicine, College of Veterinary Medicine, University of Illinois, Urbana, Illinois, USA
| | - Heidi Phillips
- Department of Veterinary Clinical Medicine, College of Veterinary Medicine, University of Illinois, Urbana, Illinois, USA
| | - Ryan Fries
- Department of Veterinary Clinical Medicine, College of Veterinary Medicine, University of Illinois, Urbana, Illinois, USA
| | - Stephanie Keating
- Department of Veterinary Clinical Medicine, College of Veterinary Medicine, University of Illinois, Urbana, Illinois, USA
| | - Phillip Hamel
- Boundary Bay Veterinary Specialty Hospital, Langley, British Columbia, Canada
| | - Annette McCoy
- Department of Veterinary Clinical Medicine, College of Veterinary Medicine, University of Illinois, Urbana, Illinois, USA
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Song A, Phillips H, Oliveira CR, McCoy AM. CT volumetric analysis permits comparison of tongue size and tongue fat in different canine brachycephalic and mesaticephalic breeds. Vet Radiol Ultrasound 2023. [PMID: 36787184 DOI: 10.1111/vru.13221] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 12/15/2022] [Accepted: 12/28/2022] [Indexed: 02/15/2023] Open
Abstract
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.
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Affiliation(s)
- Ava Song
- Department of Veterinary Clinical Medicine, College of Veterinary Medicine, University of Illinois, Urbana, Illinois, USA
| | - Heidi Phillips
- Department of Veterinary Clinical Medicine, College of Veterinary Medicine, University of Illinois, Urbana, Illinois, USA
| | - Cintia R Oliveira
- Department of Veterinary Clinical Medicine, College of Veterinary Medicine, University of Illinois, Urbana, Illinois, USA
| | - Annette M McCoy
- Department of Veterinary Clinical Medicine, College of Veterinary Medicine, University of Illinois, Urbana, Illinois, USA
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Mayhew PD, Marks SL, Pollard R, Balsa IM, Culp WTN, Giuffrida MA. Effect of conventional multilevel brachycephalic obstructive airway syndrome surgery on clinical and videofluoroscopic evidence of hiatal herniation and gastroesophageal reflux in dogs. Vet Surg 2023; 52:238-248. [PMID: 36273378 DOI: 10.1111/vsu.13906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 08/25/2022] [Accepted: 09/15/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To evaluate the effect of conventional multilevel surgery (CMS) for brachycephalic obstructive airway syndrome (BOAS) on associated sliding hiatal hernia (SHH) and/or gastroesophageal reflux (GER). STUDY DESIGN Prospective clinical trial. ANIMALS Sixteen client-owned dogs with clinical signs consistent with BOAS and associated SHH and GER. METHODS All dogs were treated with 1 or more components of CMS including soft palate resection, laryngeal ventriculectomy, and alaplasty. A standardized Dog Swallowing Assessment Tool (Dog SAT) questionnaire was completed by owners preoperatively and postoperatively. Videofluoroscopic swallow studies (VFSS) were used to evaluate esophageal motility, gastroesophageal reflux, and hiatal herniation preoperatively, and in a subset of dogs postoperatively. Upper gastrointestinal endoscopic studies were performed to document esophagitis and lower esophageal sphincter pathology. RESULTS All dogs were discharged from the hospital. One dog experienced aspiration pneumonia immediately postoperatively. Owner-assigned clinical scores improved in scores related to regurgitation after eating and regurgitation (P = .012) during increased activity/exercise (P = .002) between preoperative and postoperative time points. However, no improvement was detected in masked assessment of preoperative and postoperative VFSS studies in terms of GER frequency (P = .46) or severity (P = .79), SHH frequency (P = .082) or severity (P = .34) scores. CONCLUSION Owners of dogs treated with CMS perceived an improvement in clinical signs of SHH and GER that was not confirmed by VFSS studies. CLINICAL SIGNIFICANCE Conventional multilevel surgery in dogs with BOAS does not appear to consistently resolve SHH and GER, although clinical signs may improve.
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Affiliation(s)
- Philipp D Mayhew
- The Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, California, USA
| | - Stanley L Marks
- The Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California-Davis, Davis, California, USA
| | - Rachel Pollard
- The Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, California, USA
| | - Ingrid M Balsa
- The Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, California, USA
| | - William T N Culp
- The Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, California, USA
| | - Michelle A Giuffrida
- The Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, California, USA
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Clarke DL, Reetz JA, Drobatz KJ, Holt DE. Severity of nasopharyngeal collapse before and after corrective upper airway surgery in brachycephalic dogs. Vet Surg 2022; 51:982-989. [PMID: 35733394 DOI: 10.1111/vsu.13841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 02/28/2022] [Accepted: 05/21/2022] [Indexed: 11/28/2022]
Abstract
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.
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Affiliation(s)
- Dana L Clarke
- From the Department of Clinical Sciences and Advanced Medicine, University of Pennsylvania School of Veterinary Medicine, Philadelphia, Pennsylvania, USA
| | - Jennifer A Reetz
- From the Department of Clinical Sciences and Advanced Medicine, University of Pennsylvania School of Veterinary Medicine, Philadelphia, Pennsylvania, USA
| | - Kenneth J Drobatz
- From the Department of Clinical Sciences and Advanced Medicine, University of Pennsylvania School of Veterinary Medicine, Philadelphia, Pennsylvania, USA
| | - David E Holt
- From the Department of Clinical Sciences and Advanced Medicine, University of Pennsylvania School of Veterinary Medicine, Philadelphia, Pennsylvania, USA
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12
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Villedieu E, Robinson W, Shales C. Suspected Obstructive Sleep Apnea Successfully Treated with Ondansetron in a Pug. J Am Anim Hosp Assoc 2022; 58:152-155. [PMID: 35576395 DOI: 10.5326/jaaha-ms-7190] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2021] [Indexed: 11/11/2022]
Abstract
Obstructive sleep apnea (OSA) has been uncommonly reported in dogs and is often associated with brachycephalic obstructive airway syndrome (BOAS). OSA independent from BOAS has been rarely reported. Treatment of OSA with ondansetron has only been reported in one dog and has not been reported in a breed commonly affected by BOAS. Here, we report the case of a pug with episodes of OSA despite appropriate treatment of BOAS. Administration of ondansetron led to a rapid and near-complete resolution of the clinical signs, with a follow-up of 3 mo. OSA independent of BOAS should be considered as a differential diagnosis in dogs that present for sleep-disordered breathing without exercise intolerance after appropriate treatment for BOAS. Use of certain serotonin antagonists may be useful as a treatment option for these cases.
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Affiliation(s)
- Erika Villedieu
- From the Department of Soft Tissue Surgery, Willows Veterinary Centre and Referral Service, Solihull, United Kingdom
| | - William Robinson
- From the Department of Soft Tissue Surgery, Willows Veterinary Centre and Referral Service, Solihull, United Kingdom
| | - Chris Shales
- From the Department of Soft Tissue Surgery, Willows Veterinary Centre and Referral Service, Solihull, United Kingdom
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13
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Brachycephalic Obstructive Airway Syndrome. Vet Clin North Am Small Anim Pract 2022; 52:749-780. [DOI: 10.1016/j.cvsm.2022.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Töpfer T, Köhler C, Rösch S, Oechtering G. Brachycephaly in French bulldogs and pugs is associated with narrow ear canals. Vet Dermatol 2022; 33:214-e60. [PMID: 35293639 DOI: 10.1111/vde.13067] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 10/04/2021] [Accepted: 12/21/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Brachycephalic dog breeds have multiple skull malformations which may lead to anatomical changes in the external auditory canal. It is our frequent observation that in the otoscopic examination of the external ear in these breeds we are unable to visualise the tympanic membrane as a consequence of extreme narrowing of the proximal ear canal. Additionally brachycephalic dogs reportedly are predisposed to otitis externa (OE) and otitis media. OBJECTIVES To characterizse the transition of the cartilaginous ear canal to the bony meatus acusticus externus using computed tomography (CT) and to investigate a possible association with OE in brachycephalic dogs. MATERIALS AND METHODS Seventy-five client-owned dogs [pugs (n = 20), French bulldogs (n = 55)] were included and assessed for OE using an owner questionnaire and otoscopic and cytological examinations. In dorsal plane CT scans, the diameter of the porus acusticus externus was measured using novel methodology. The results were compared with a normocephalic control group without preexisting otological disorders. RESULTS Brachycephalic dogs had a significantly smaller porus acusticus externus diameter (2.6 mm) than normocephalic dogs (5.0 mm). Of the brachycephalic dogs, 32% had OE yet this was not statistically significantly related to the diameter of the porus acusticus externus. Middle ear effusion (44%) and narrowing of the external ear canal (82.6%) were significantly more frequent in brachycephalic dogs. Only five of 150 eardrums could be visualised otoscopically. CONCLUSIONS AND CLINICAL RELEVANCE Malformation of the porus acusticus externus causes severe stenosis of the proximal ear canal in brachycephalic dogs. A connection between stenosis of the external auditory canal and OE could not be confirmed.
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Affiliation(s)
- Tanja Töpfer
- Small Animal Department, College of Veterinary Medicine, University of Leipzig, Leipzig, Germany
| | - Claudia Köhler
- Small Animal Department, College of Veterinary Medicine, University of Leipzig, Leipzig, Germany
| | - Sarah Rösch
- Small Animal Hospital, University of Veterinary Medicine, Hannover, Germany
| | - Gerhard Oechtering
- Small Animal Department, College of Veterinary Medicine, University of Leipzig, Leipzig, Germany
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Buzek A, Serwańska-Leja K, Zaworska-Zakrzewska A, Kasprowicz-Potocka M. The Shape of the Nasal Cavity and Adaptations to Sniffing in the Dog ( Canis familiaris) Compared to Other Domesticated Mammals: A Review Article. Animals (Basel) 2022; 12:517. [PMID: 35203225 PMCID: PMC8868339 DOI: 10.3390/ani12040517] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 02/18/2022] [Accepted: 02/18/2022] [Indexed: 11/25/2022] Open
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.
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Affiliation(s)
- Anna Buzek
- Department of Animal Nutrition, Faculty of Veterinary Medicine and Animal Sciences, Poznan University of Life Sciences, Wołyńska 33, 60-637 Poznań, Poland; (A.B.); (A.Z.-Z.); (M.K.-P.)
| | - Katarzyna Serwańska-Leja
- Department of Animal Anatomy, Faculty of Veterinary Medicine and Animal Sciences, Poznan University of Life Sciences, Wojska Polskiego 71c, 60-625 Poznań, Poland
| | - Anita Zaworska-Zakrzewska
- Department of Animal Nutrition, Faculty of Veterinary Medicine and Animal Sciences, Poznan University of Life Sciences, Wołyńska 33, 60-637 Poznań, Poland; (A.B.); (A.Z.-Z.); (M.K.-P.)
| | - Małgorzata Kasprowicz-Potocka
- Department of Animal Nutrition, Faculty of Veterinary Medicine and Animal Sciences, Poznan University of Life Sciences, Wołyńska 33, 60-637 Poznań, Poland; (A.B.); (A.Z.-Z.); (M.K.-P.)
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Phillips H. Updates in Upper Respiratory Surgery. Vet Clin North Am Small Anim Pract 2022; 52:339-368. [DOI: 10.1016/j.cvsm.2021.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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de Bruyn BW, Hosgood G. Abnormal hyoid conformation in French Bulldogs: case report and computed tomographic anatomical comparison. Aust Vet J 2021; 100:63-66. [PMID: 34528244 DOI: 10.1111/avj.13120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 04/16/2021] [Accepted: 08/12/2021] [Indexed: 11/29/2022]
Abstract
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.
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Affiliation(s)
- B W de Bruyn
- College of Veterinary Medicine, Murdoch University, Murdoch, Western Australia, 6150, Australia
| | - G Hosgood
- College of Veterinary Medicine, Murdoch University, Murdoch, Western Australia, 6150, Australia
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Sahr S, Dietrich A, Oechtering G. Evaluating malformations of the lacrimal drainage system in brachycephalic dog breeds: A comparative computed tomography analysis. PLoS One 2021; 16:e0257020. [PMID: 34492067 PMCID: PMC8423249 DOI: 10.1371/journal.pone.0257020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 08/20/2021] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES This study aimed to investigate and compare the anatomical features of the nasolacrimal drainage system (NDS) in three brachycephalic dog breeds with those of normocephalic dogs, taking into account how the NDS was related to the malformed brachycephalic head. ANIMALS Fifty-one brachycephalic dogs were examined, comprising 23 Pugs, 18 French Bulldogs, and 10 English Bulldogs. Six normocephalic dogs of different breeds served as a comparison. METHODS Computed tomographic dacryocystography was performed. Parameters such as length, angulation, and gradient were determined. Crossing of the nasolacrimal duct (NLD) beneath the maxillary canine root, as well as the incidence of an accessory opening, were also analyzed. RESULTS AND CONCLUSIONS In all three brachycephalic breeds, the NDS was grossly malformed. We regard this as a further consequence of exaggerated breeding for a short head conformation. While the length of the NLD was substantially reduced by 41 to 57 percent in brachycephalic dogs, their lacrimal canaliculi were two to three times as long as those of normocephalic dogs. Varying parts of the nasolacrimal drainage system followed an inverse direction in short-headed dogs, giving the entire nasolacrimal apparatus an anomalous U- or V-shaped appearance. The NLD exhibited a three to five times steeper alignment in brachycephalic dogs than in normocephalic ones. Obviously, this strong slope did not cause clinical symptoms only because there was an aberrant outflow pathway. The brachycephalic dogs consistently exhibited an accessory opening, through which most of fluid escaped into the posterior nasal cavity instead of through the common route into the nasal vestibule via the nasolacrimal ostia.
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Affiliation(s)
- Sabine Sahr
- Small Animal Department, Faculty of Veterinary Medicine, University of Leipzig, Leipzig, Germany
| | - André Dietrich
- Department of Computer Science, Technische Universität Bergakademie Freiberg, Freiberg, Germany
| | - Gerhard Oechtering
- Small Animal Department, Faculty of Veterinary Medicine, University of Leipzig, Leipzig, Germany
- * E-mail:
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Moore AH. Performing minimally invasive soft tissue surgery in dogs and cats. IN PRACTICE 2021. [DOI: 10.1002/inpr.52] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Doyle CR, Aarnes TK, Ballash GA, Wendt-Hornickle EL, Baldo CF, Johnson RA, Wittum TE, McLoughlin MA. Anesthetic risk during subsequent anesthetic events in brachycephalic dogs that have undergone corrective airway surgery: 45 cases (2007-2019). J Am Vet Med Assoc 2021; 257:744-749. [PMID: 32955391 DOI: 10.2460/javma.257.7.744] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine whether previous corrective upper airway surgery in brachycephalic dogs would decrease perianesthetic complications in subsequent anesthetic events. ANIMALS 45 client-owned dogs. PROCEDURES Brachycephalic dogs undergoing any combination of staphylectomy, nasal alaplasty, or laryngeal sacculectomy that were anesthetized at a later date for additional surgical procedures or imaging from August 2, 2007, to February 8, 2019, had their medical records reviewed during both anesthetic events for signalment, American Society of Anesthesiologists status, perianesthetic drug administration, anesthetic duration, presence and total time of positive-pressure ventilation, procedure invasiveness, and perianesthetic complications such as bradycardia, hypothermia, hypotension, cardiac arrhythmias, hypertension, vomiting or regurgitation, dysphoria, respiratory distress, hypoxemia, reintubation, and prolonged periods of recovery. RESULTS The odds of having complications during the postanesthetic period following subsequent anesthetic events were decreased by 79% in dogs having previous surgical intervention to correct clinical signs of brachycephalic airway syndrome. Intra-anesthetic bradycardia increased the odds of developing a postanesthetic complication by 4.56 times. Every 15-minute increase in anesthetic duration increased the odds of having a postanesthetic complication by 12% and having an intra-anesthetic complication by 11%. CONCLUSIONS AND CLINICAL RELEVANCE Previous corrective upper airway surgery decreased odds of postanesthetic complications in brachycephalic dogs that underwent subsequent anesthetic events. Findings in this study indicated that corrective upper airway surgery for brachycephalic dogs may reduce postanesthetic complications following subsequent anesthetic events, which may reduce perianesthetic morbidity in patients undergoing multiple surgical or diagnostic imaging procedures.
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21
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Krainer D, Dupré G. Influence of computed tomographic dimensions of the nasopharynx on middle ear effusion and inflammation in pugs and French bulldogs with brachycephalic airway syndrome. Vet Surg 2021; 50:517-526. [PMID: 33595152 DOI: 10.1111/vsu.13588] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 12/02/2020] [Accepted: 12/20/2020] [Indexed: 11/28/2022]
Abstract
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.
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Affiliation(s)
- Dorothee Krainer
- Department of Small Animals and Horses, Clinic for Small Animal Surgery, Ophthalmology, Dentistry, Physiotherapy and Rehabilitation, University of Veterinary Medicine Vienna, Vienna, Austria
| | - Gilles Dupré
- Department of Small Animals and Horses, Clinic for Small Animal Surgery, Ophthalmology, Dentistry, Physiotherapy and Rehabilitation, University of Veterinary Medicine Vienna, Vienna, Austria
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Seneviratne M, Kaye BM, Ter Haar G. Prognostic indicators of short-term outcome in dogs undergoing surgery for brachycephalic obstructive airway syndrome. Vet Rec 2020; 187:403. [PMID: 32764033 DOI: 10.1136/vr.105624] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 03/23/2020] [Accepted: 06/28/2020] [Indexed: 11/03/2022]
Abstract
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.
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Affiliation(s)
- Maheeka Seneviratne
- Queen Mother Hospital for Animals, Royal Veterinary College Clinical Services Division, Hatfield, UK
| | - Benjamin Marcus Kaye
- Queen Mother Hospital for Animals, Royal Veterinary College Clinical Services Division, Hatfield, UK
| | - Gert Ter Haar
- Specialistische Dierenkliniek Utrecht, Utrecht, The Netherlands
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23
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Reinero C, Visser LC, Kellihan HB, Masseau I, Rozanski E, Clercx C, Williams K, Abbott J, Borgarelli M, Scansen BA. ACVIM consensus statement guidelines for the diagnosis, classification, treatment, and monitoring of pulmonary hypertension in dogs. J Vet Intern Med 2020; 34:549-573. [PMID: 32065428 PMCID: PMC7097566 DOI: 10.1111/jvim.15725] [Citation(s) in RCA: 122] [Impact Index Per Article: 30.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 01/30/2020] [Indexed: 01/01/2023] Open
Abstract
Pulmonary hypertension (PH), defined by increased pressure within the pulmonary vasculature, is a hemodynamic and pathophysiologic state present in a wide variety of cardiovascular, respiratory, and systemic diseases. The purpose of this consensus statement is to provide a multidisciplinary approach to guidelines for the diagnosis, classification, treatment, and monitoring of PH in dogs. Comprehensive evaluation including consideration of signalment, clinical signs, echocardiographic parameters, and results of other diagnostic tests supports the diagnosis of PH and allows identification of associated underlying conditions. Dogs with PH can be classified into the following 6 groups: group 1, pulmonary arterial hypertension; group 2, left heart disease; group 3, respiratory disease/hypoxia; group 4, pulmonary emboli/pulmonary thrombi/pulmonary thromboemboli; group 5, parasitic disease (Dirofilaria and Angiostrongylus); and group 6, disorders that are multifactorial or with unclear mechanisms. The approach to treatment of PH focuses on strategies to decrease the risk of progression, complications, or both, recommendations to target underlying diseases or factors contributing to PH, and PH‐specific treatments. Dogs with PH should be monitored for improvement, static condition, or progression, and any identified underlying disorder should be addressed and monitored simultaneously.
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Affiliation(s)
- Carol Reinero
- Department of Veterinary Medicine and Surgery, College of Veterinary Medicine, University of Missouri, Columbia, Missouri
| | - Lance C Visser
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis, Davis, California
| | - Heidi B Kellihan
- Department of Medical Sciences, School of Veterinary Medicine, University of Wisconsin, Madison, Wisconsin
| | - Isabelle Masseau
- Department of Sciences Cliniques, Faculté de Médecine Vétérinaire, Université de Montréal, Saint-Hyacinthe, Quebec, Canada
| | - Elizabeth Rozanski
- Department of Clinical Sciences, Cummings School of Veterinary Medicine, Tufts University, Medford, Massachusetts
| | - Cécile Clercx
- Department of Clinical Sciences of Companion Animals and Equine, University of Liège, Liège, Belgium
| | - Kurt Williams
- Department of Pathobiology and Diagnostic Investigation, College of Veterinary Medicine, Michigan State University, East Lansing, Michigan
| | - Jonathan Abbott
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, Tennessee
| | - Michele Borgarelli
- Department of Small Animal Clinical Sciences, Virginia Maryland College of Veterinary Medicine, Blacksburg, Virginia
| | - Brian A Scansen
- Department of Clinical Sciences, Colorado State University, Fort Collins, Colorado
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Lindsay B, Cook D, Wetzel JM, Siess S, Moses P. Brachycephalic airway syndrome: management of post-operative respiratory complications in 248 dogs. Aust Vet J 2020; 98:173-180. [PMID: 32037517 DOI: 10.1111/avj.12926] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Revised: 01/05/2020] [Accepted: 01/07/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE As ownership of brachycephalic dog breeds rises, the surgical correction of components of brachycephalic airway syndrome (BAS) is increasingly recommended by veterinarians. This study's objective was to describe the incidence of, and strategies for the management of post-operative respiratory complications in brachycephalic dogs undergoing surgical correction of one or more components of BAS. METHODS Medical records of 248 brachycephalic dogs treated surgically for BAS were retrospectively reviewed for demographic information, procedures performed, post-operative complications and treatment implemented, hospitalisation time, and necessity for further surgery. RESULTS Pugs, Cavalier King Charles Spaniels and British Bulldogs were the most commonly encountered breeds. Dogs which experienced a complication were significantly older (mean was 5.5 years, compared with 4.1 years [P < 0.01]). Fifty-eight dogs (23.4%) had complications which included: dyspnoea managed with supplemental oxygen alone (7.3%, n = 18), dyspnoea requiring anaesthesia and re-intubation (8.9%, n = 22), dyspnoea necessitating treatment with a temporary tracheostomy (8.9%, n = 22), aspiration pneumonia (4%, n = 10), and respiratory or cardiac arrest (2.4%, n = 6). Five of the 22 dogs requiring anaesthesia and re-intubation deteriorated 12 or more hours after post-surgical anaesthetic recovery. The overall mortality rate in this study was 2.4% (n = 6). Age, concurrent airway pathology, and emergency presentation significantly predicted post-operative complications. CONCLUSION Our data show the importance of close monitoring for a minimum of 24 h following surgery by an experienced veterinarian or veterinary technician. Surgical intervention for BAS symptomatic dogs should be considered at an earlier age as an elective procedure, to reduce the risk of post-operative complications.
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Affiliation(s)
- B Lindsay
- Department of Neurology, Veterinary Specialist Services, Underwood, Queensland, 4119, Australia
| | - D Cook
- Department of Neurology, Veterinary Specialist Services, Underwood, Queensland, 4119, Australia
| | - J-M Wetzel
- Department of Neurology, Veterinary Specialist Services, Underwood, Queensland, 4119, Australia
| | - S Siess
- Department of Neurology, Veterinary Specialist Services, Underwood, Queensland, 4119, Australia
| | - P Moses
- Department of Neurology, Veterinary Specialist Services, Underwood, Queensland, 4119, Australia
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Fernández-Parra R, Pey P, Zilberstein L, Malvè M. Use of computational fluid dynamics to compare upper airway pressures and airflow resistance in brachycephalic, mesocephalic, and dolichocephalic dogs. Vet J 2019; 253:105392. [PMID: 31685131 DOI: 10.1016/j.tvjl.2019.105392] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 09/22/2019] [Accepted: 09/23/2019] [Indexed: 10/25/2022]
Abstract
Brachycephalic dog breeds are prone to breathing difficulties because of their upper airway anatomy. Several surgical techniques exist to correct anatomical pathologies and common surgical approaches aim to correct functional abnormalities in the nares and/or the soft palate. However, further research is needed to improve clinical outcomes. This study evaluated air pressure and airflow resistance in the upper airways and trachea in nine sedated, sternally recumbent dogs of different skull types (dolichocephalic, n=3; mesocephalic, n=3; brachycephalic, n=3). CT images were acquired from the nostrils to the caudal border of the lungs and geometrical reconstruction of the upper airway and trachea was performed. Analysis of computational fluid dynamics was performed using inspiratory flow adapted to bodyweight for each dog. Flow (L/min) and pressure (cmH2O) were computed for the entire upper airway and trachea. Resistance (cmH2O/L/min) was calculated using pressure differences between the nose, larynx, and trachea. In this pilot study, statistical comparisons were not performed. Pressure maps, airflow, and resistance were similar in dolichocephalic and mesocephalic breeds. Median pressure difference (3.76cmH2O) and resistance (0.154cmH2O/L/min) between the nose and larynx were numerically higher in brachycephalic dogs than in other breeds (0.45cmH2O and 0.016cmH2O/L/min, respectively). Median pressure difference (0.205cmH2O) and resistance (0.009cmH2O/L/min) between the larynx and trachea was numerically similar in all dogs, except for the English bulldog. The methodology used in this preliminary study to quantify airflow characteristics such as pressure and resistance could improve the understanding of brachycephalic obstruction airway syndrome.
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Affiliation(s)
- R Fernández-Parra
- Ecole Nationale Vétérinaire d'Alfort, 7 Avenue du General de Gaulle, Maisons-Alfort, Paris, 94704, France; Department of Small Animal Clinical Science, Western College of Veterinary Medicine, University of Saskatchewan, 52 Campus Drive Saskatoon, SK S7N 5B4, Canada; Institut national de la santé et de la recherche médicale (INSERM), U955, Equipe 03, 51 avenue du Maréchal de Lattre de Tassigny, 94010, Créteil cedex, France.
| | - P Pey
- Antech Imaging Services, Fountain Valley, CA, 92708, USA; Department of Veterinary Medical Science, University of Bologna, Ozzano dell'Emilia, Italy
| | - L Zilberstein
- Ecole Nationale Vétérinaire d'Alfort, 7 Avenue du General de Gaulle, Maisons-Alfort, Paris, 94704, France
| | - M Malvè
- Department of Engineering, Public University of Navarre, Campus Arrosadía s/n, 31006, Pamplona, Spain; Aragon Institute of Engineering Research, University of Zaragoza, C/María de Luna s/n, 50018, Zaragoza, Spain; Centro de Investigación Biomédica en Red - Bioingeniería, Biomateriales y Nanomedicina, CIBER-BBN, C/Poeta Mariano Esquillor s/n, 50018, Zaragoza, Spain
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Tamburro R, Brunetti B, Muscatello LV, Mantovani C, De Lorenzi D. Short-term surgical outcomes and histomorphological evaluation of thermal injury following palatoplasty performed with diode laser or air plasma device in dogs with brachycephalic airway obstructive syndrome. Vet J 2019; 253:105391. [PMID: 31685136 DOI: 10.1016/j.tvjl.2019.105391] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 09/21/2019] [Accepted: 09/21/2019] [Indexed: 10/26/2022]
Abstract
Brachycephalic obstructive airway syndrome (BOAS) is a common disorder presenting enlarged soft palate, stenotic nares and abnormal turbinate growth. Surgical correction of BOAS abnormalities with caudal palatoplasty is an elective therapy. This prospective study aimed to compare the effect of an air plasma device and diode laser in dogs undergoing palatoplasty. Outcome measures were as follows: (1) intra-operative and immediate post-operative complications; (2) evaluation of thermal injury in histological tissue sections of the excised soft palate. Twenty dogs with enlarged soft palates underwent palatoplasty, using an air plasma device (n=10) and diode laser (n=10). Soft palate specimens underwent masked histopathological analysis to assess post-operative thermal injury. In this pilot study, no differences were observed in surgical times; all dogs were discharged 24h after surgery and had stable respiration. In the air plasma group, post-operative bleeding occurred in two cases and revision surgery was performed. No difference in thermal injury was observed using the two devices (P>0.05). The air-plasma device was a viable surgical option for palatoplasty in dogs with BOAS.
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Affiliation(s)
- R Tamburro
- University of Teramo, School of Veterinary Medicine, Località Piano d'Accio, 64100 Teramo, Italy.
| | - B Brunetti
- University of Bologna, Department of Veterinary Medical Sciences, via Tolara di Sopra 50, Ozzano Emilia, 40064 Bologna, Italy
| | - L V Muscatello
- University of Bologna, Department of Veterinary Medical Sciences, via Tolara di Sopra 50, Ozzano Emilia, 40064 Bologna, Italy
| | - C Mantovani
- Veterinary Hospital "I Portoni Rossi", via Roma 57, Zola Predosa, 40069 Bologna, Italy
| | - D De Lorenzi
- Veterinary Hospital "I Portoni Rossi", via Roma 57, Zola Predosa, 40069 Bologna, Italy
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Fenner JVH, Quinn RJ, Demetriou JL. Postoperative regurgitation in dogs after upper airway surgery to treat brachycephalic obstructive airway syndrome: 258 cases (2013-2017). Vet Surg 2019; 49:53-60. [PMID: 31332797 DOI: 10.1111/vsu.13297] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 07/01/2019] [Accepted: 07/07/2019] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To determine the incidence of and risk factors for regurgitation in dogs within 24 hours of surgical management of brachycephalic obstructive airway syndrome (BOAS). STUDY DESIGN Retrospective single center study of dogs undergoing BOAS surgery over four years (2013-2017). ANIMALS Two hundred fifty-eight client-owned dogs referred for surgical intervention for BOAS. METHODS Electronic medical records were searched for dogs that had undergone surgery for BOAS at a UK specialist referral hospital. Data were assessed by using univariable binomial logistic regression; confounding factors were then identified in a multivariable model. RESULTS There was an increase in the proportion of dogs that regurgitated while hospitalized preoperatively vs during the first 24 hours postoperatively, from 28 (10.9%) to 89 (34.5%), respectively (P < .0001). History of regurgitation (P = .017, odds ratio [OR] 2.539, 95% confidence interval [CI] 1.178-5.469) and age (P = .008, OR 0.712, 95% CI 0.553-0.916) were detected as risk factors for postoperative regurgitation. For every 1-year increase in age, the odds of experiencing postoperative regurgitation were reduced by 28.8%. CONCLUSION Corrective surgery for BOAS was associated with a marked incidence of postoperative regurgitation. Younger dogs and those with a history of regurgitation were predisposed to postoperative regurgitation. CLINICAL SIGNIFICANCE The increased frequency of regurgitation after surgical treatment of BOAS, especially in younger dogs, provides justification for counseling owners regarding this postoperative complication.
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Affiliation(s)
- Joy V H Fenner
- Surgical Department, Dick White Referrals Station Farm, Six Mile Bottom, Cambridgeshire, United Kingdom
| | - Robert J Quinn
- Surgical Department, Dick White Referrals Station Farm, Six Mile Bottom, Cambridgeshire, United Kingdom
| | - Jackie L Demetriou
- Surgical Department, Dick White Referrals Station Farm, Six Mile Bottom, Cambridgeshire, United Kingdom
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Selba MC, Oechtering GU, Heng HG, DeLeon VB. The Impact of Selection for Facial Reduction in Dogs: Geometric Morphometric Analysis of Canine Cranial Shape. Anat Rec (Hoboken) 2019; 303:330-346. [DOI: 10.1002/ar.24184] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 03/10/2019] [Accepted: 03/20/2019] [Indexed: 11/09/2022]
Affiliation(s)
- Molly C. Selba
- Department of AnthropologyUniversity of Florida Gainesville Florida
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An ADAMTS3 missense variant is associated with Norwich Terrier upper airway syndrome. PLoS Genet 2019; 15:e1008102. [PMID: 31095560 PMCID: PMC6521993 DOI: 10.1371/journal.pgen.1008102] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 03/19/2019] [Indexed: 11/19/2022] Open
Abstract
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.
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Riggs J, Liu N, Sutton DR, Sargan D, Ladlow JF. Validation of exercise testing and laryngeal auscultation for grading brachycephalic obstructive airway syndrome in pugs, French bulldogs, and English bulldogs by using whole‐body barometric plethysmography. Vet Surg 2019; 48:488-496. [DOI: 10.1111/vsu.13159] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 11/28/2018] [Accepted: 12/16/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Julia Riggs
- The Queen's Veterinary School HospitalUniversity of Cambridge Cambridge United Kingdom
| | - Nai‐Chieh Liu
- The Queen's Veterinary School HospitalUniversity of Cambridge Cambridge United Kingdom
| | - Dawn R. Sutton
- The Queen's Veterinary School HospitalUniversity of Cambridge Cambridge United Kingdom
| | - David Sargan
- The Queen's Veterinary School HospitalUniversity of Cambridge Cambridge United Kingdom
| | - Jane F. Ladlow
- The Queen's Veterinary School HospitalUniversity of Cambridge Cambridge United Kingdom
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Hinchliffe TA, Liu NC, Ladlow J. Sleep-disordered breathing in the Cavalier King Charles spaniel: A case series. Vet Surg 2018; 48:497-504. [PMID: 30592314 DOI: 10.1111/vsu.13148] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 10/29/2018] [Accepted: 11/29/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To describe sleep-disordered breathing (SDB) in the Cavalier King Charles spaniel (CKCS). STUDY DESIGN Retrospective case series. ANIMALS Five client-owned dogs referred for SDB. METHODS Medical records were reviewed including recheck appointments and routine preoperative and postoperative questionnaires. Whole-body barometric plethysmography was used to categorize SDB. RESULTS All dogs presented with multiple episodes of stertorous breathing, choking, and apnea during sleep. Severe nasal septal deviation, aberrant nasal turbinates, and soft palate elongation and thickening were noted on computed tomography and rhinoscopy of each dog. Whole-body barometric plethysmography measurements during sleep (in 3 dogs) documented periods of choking, snoring, and apnea. Treatment combined laser turbinectomy, folding flap palatoplasty, tonsillectomy, laryngeal sacculectomy, and cuneiform process resection. All dogs improved in terms of incidence and severity of sleep apnea within 1 week, with 4 of 5 dogs achieving complete resolution. CONCLUSION The objective measurements used to characterize SDB in this population of CKCS provided some evidence to support an obstructive cause for this condition, which improved with surgical treatment. CLINICAL SIGNIFICANCE Sleep-disordered breathing in the CKCS is a different clinical presentation of brachycephalic obstructive airway syndrome. Our finding of intranasal abnormalities in these 5 dogs with SDB provides justification for future research into its clinical significance.
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Affiliation(s)
- Tom A Hinchliffe
- Department of Veterinary Medicine, University of Cambridge, Cambridge, UK
| | - Nai-Chieh Liu
- Department of Veterinary Medicine, University of Cambridge, Cambridge, UK
| | - Jane Ladlow
- Department of Veterinary Medicine, University of Cambridge, Cambridge, UK
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Fawcett A, Barrs V, Awad M, Child G, Brunel L, Mooney E, Martinez-Taboada F, McDonald B, McGreevy P. Consequences and Management of Canine Brachycephaly in Veterinary Practice: Perspectives from Australian Veterinarians and Veterinary Specialists. Animals (Basel) 2018; 9:E3. [PMID: 30577619 PMCID: PMC6356869 DOI: 10.3390/ani9010003] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Revised: 12/11/2018] [Accepted: 12/17/2018] [Indexed: 12/30/2022] Open
Abstract
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.
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Affiliation(s)
- Anne Fawcett
- Sydney School of Veterinary Science, Faculty of Science, University of Sydney, Camperdown, NSW 2006, Australia.
| | - Vanessa Barrs
- Sydney School of Veterinary Science, Faculty of Science, University of Sydney, Camperdown, NSW 2006, Australia.
| | - Magdoline Awad
- PetSure, 465 Victoria Avenue, Chatswood, NSW 2067, Australia.
| | - Georgina Child
- Sydney School of Veterinary Science, Faculty of Science, University of Sydney, Camperdown, NSW 2006, Australia.
| | - Laurencie Brunel
- Sydney School of Veterinary Science, Faculty of Science, University of Sydney, Camperdown, NSW 2006, Australia.
| | - Erin Mooney
- Sydney School of Veterinary Science, Faculty of Science, University of Sydney, Camperdown, NSW 2006, Australia.
| | - Fernando Martinez-Taboada
- Sydney School of Veterinary Science, Faculty of Science, University of Sydney, Camperdown, NSW 2006, Australia.
| | - Beth McDonald
- Sydney School of Veterinary Science, Faculty of Science, University of Sydney, Camperdown, NSW 2006, Australia.
| | - Paul McGreevy
- Sydney School of Veterinary Science, Faculty of Science, University of Sydney, Camperdown, NSW 2006, Australia.
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Liu NC, Genain MA, Kalmar L, Sargan DR, Ladlow JF. Objective effectiveness of and indications for laser-assisted turbinectomy in brachycephalic obstructive airway syndrome. Vet Surg 2018; 48:79-87. [DOI: 10.1111/vsu.13107] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 04/17/2018] [Accepted: 07/06/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Nai-Chieh Liu
- Department of Veterinary Medicine; University of Cambridge; Cambridge UK
| | - Marie-Aude Genain
- Department of Veterinary Medicine; University of Cambridge; Cambridge UK
- Queen's Veterinary School Hospital; University of Cambridge; Cambridge UK
| | - Lajos Kalmar
- Department of Veterinary Medicine; University of Cambridge; Cambridge UK
| | - David R. Sargan
- Department of Veterinary Medicine; University of Cambridge; Cambridge UK
| | - Jane F. Ladlow
- Department of Veterinary Medicine; University of Cambridge; Cambridge UK
- Queen's Veterinary School Hospital; University of Cambridge; Cambridge UK
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Kaye BM, Rutherford L, Perridge DJ, Ter Haar G. Relationship between brachycephalic airway syndrome and gastrointestinal signs in three breeds of dog. J Small Anim Pract 2018; 59:670-673. [DOI: 10.1111/jsap.12914] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 03/18/2018] [Accepted: 06/28/2018] [Indexed: 11/29/2022]
Affiliation(s)
- B. M. Kaye
- Department of Veterinary Clinical Sciences and Services The Royal Veterinary College North Mymms Hertfordshire AL9 7TA UK
| | - L. Rutherford
- Department of Veterinary Clinical Sciences and Services The Royal Veterinary College North Mymms Hertfordshire AL9 7TA UK
| | - D. J. Perridge
- Department of Veterinary Clinical Sciences and Services The Royal Veterinary College North Mymms Hertfordshire AL9 7TA UK
| | - G. Ter Haar
- Department of Veterinary Clinical Sciences and Services The Royal Veterinary College North Mymms Hertfordshire AL9 7TA UK
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Hughes JR, Kaye BM, Beswick AR, Ter Haar G. Complications following laryngeal sacculectomy in brachycephalic dogs. J Small Anim Pract 2017; 59:16-21. [PMID: 29047114 DOI: 10.1111/jsap.12763] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Revised: 06/06/2017] [Accepted: 08/04/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To evaluate the effect of sacculectomy on the immediate postoperative complication rate in dogs affected with brachycephalic obstructive airway syndrome. MATERIALS AND METHODS Retrospective review of clinical records of brachycephalic dogs with everted saccules that underwent surgery for brachycephalic obstructive airway syndrome between 2009 and 2014. Dogs were grouped as those having nares resection and staphylectomy only and those having nares resection, staphylectomy and laryngeal sacculectomy. Complications were scored as mild, moderate or severe. RESULTS In total, 37 dogs were included in the sacculectomy group and 44 in the comparator group. Dogs that had undergone sacculectomy were more likely to develop postoperative complications, with 18 of 37 developing complications, nine of which were moderate to severe. In the group without sacculectomy, nine of 44 dogs developed complications, of which one was severe. Different breed distribution between groups might also impact this outcome. CLINICAL SIGNIFICANCE The results suggest that sacculectomy might increase morbidity following brachycephalic airway surgery, but repeat studies are required to confirm this result. Further information is also required to determine whether the short-term risks of sacculectomy are outweighed by superior long-term functional outcome.
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Affiliation(s)
- J R Hughes
- Department of Veterinary Clinical Sciences, The Royal Veterinary College, North Mymms, Hatfield, Hertfordshire AL9 7TA, UK
| | - B M Kaye
- Department of Veterinary Clinical Sciences, The Royal Veterinary College, North Mymms, Hatfield, Hertfordshire AL9 7TA, UK
| | - A R Beswick
- Department of Veterinary Clinical Sciences, The Royal Veterinary College, North Mymms, Hatfield, Hertfordshire AL9 7TA, UK
| | - G Ter Haar
- Department of Veterinary Clinical Sciences, The Royal Veterinary College, North Mymms, Hatfield, Hertfordshire AL9 7TA, UK
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Hostnik ET, Scansen BA, Zielinski R, Ghadiali SN. Quantification of nasal airflow resistance in English bulldogs using computed tomography and computational fluid dynamics. Vet Radiol Ultrasound 2017; 58:542-551. [PMID: 28718208 PMCID: PMC5597484 DOI: 10.1111/vru.12531] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Revised: 04/17/2017] [Accepted: 05/04/2017] [Indexed: 11/28/2022] Open
Abstract
Stenotic nares, edematous intranasal turbinates, mucosal swelling, and an elongated, thickened soft palate are common sources of airflow resistance for dogs with brachycephalic airway syndrome. Surgery has focused on enlarging the nasal apertures and reducing tissue of the soft palate. However, objective measures of surgical efficacy are lacking. Twenty-one English bulldogs without previous surgery were recruited for this prospective, pilot study. Computed tomography was performed using conscious sedation and without endotracheal intubation using a 128 multidetector computed tomography scanner. Raw multidetector computed tomography data were rendered to create a three-dimensional surface mesh model by automatic segmentation of the air-filled nasal passage from the nares to the caudal soft palate. Three-dimensional surface models were used to construct computational fluid dynamics models of nasal airflow resistance from the nares to the caudal aspect of the soft palate. The computational fluid dynamics models were used to simulate airflow in each dog and airway resistance varied widely with a median 36.46 (Pa/mm)/(l/s) and an interquartile range of 19.84 to 90.74 (Pa/mm)/(/s). In 19/21 dogs, the rostral third of the nasal passage exhibited a larger airflow resistance than the caudal and middle regions of the nasal passage. In addition, computational fluid dynamics data indicated that overall measures of airflow resistance may significantly underestimate the maximum local resistance. We conclude that computational fluid dynamics models derived from nasal multidetector computed tomography can quantify airway resistance in brachycephalic dogs. This methodology represents a novel approach to noninvasively quantify airflow resistance and may have utility for objectively studying effects of surgical interventions in canine brachycephalic airway syndrome.
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Affiliation(s)
- Eric T Hostnik
- Department of Veterinary Clinical Sciences, The Ohio State University, Columbus, OH, 43210
| | - Brian A Scansen
- Department of Veterinary Clinical Sciences, The Ohio State University, Columbus, OH, 43210
| | - Rachel Zielinski
- Department of Biomedical Engineering, The Ohio State University, Columbus, OH, 43210
| | - Samir N Ghadiali
- Department of Biomedical Engineering, The Ohio State University, Columbus, OH, 43210
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Schuenemann R, Pohl S, Oechtering GU. A novel approach to brachycephalic syndrome. 3. Isolated laser-assisted turbinectomy of caudal aberrant turbinates (CAT LATE). Vet Surg 2017; 46:32-38. [PMID: 28052420 DOI: 10.1111/vsu.12587] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 06/17/2016] [Accepted: 07/14/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To describe isolated laser-assisted turbinectomy of caudal aberrant turbinates (CAT LATE) as a new minimally invasive surgical procedure for the treatment of brachycephalic dogs with obstructing caudal aberrant turbinates (CAT). STUDY DESIGN Prospective clinical study. ANIMALS Brachycephalic dogs (24 Pugs, 1 English Bulldog) with CAT but adequate air spaces between the lamellae of the nonobstructing ventral nasal concha. METHODS A rhinoscopically guided diode laser fiber introduced from anterior was used to dissect CAT within the nasopharyngeal meatus, while leaving the intranasal turbinates intact. Small grasping forceps were used to extract the dissected CAT from anterior or to push it through the nasopharyngeal meatus for extraction from posterior. RESULTS Isolated CAT LATE was successfully performed on 32 CAT in 25 dogs. Intranasally applied xylometazoline helped shrink the ventral concha, making the approach and extraction easier. Minor bleeding was the only complication observed. CONCLUSION It is possible to remove CAT with endoscopically applied diode-laser energy while leaving the nonobstructing ventral nasal concha intact.
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Affiliation(s)
- Riccarda Schuenemann
- Small Animal Department, Ear Nose and Throat Unit, Faculty of Veterinary Medicine, University of Leipzig, Leipzig, Germany
| | - Sabine Pohl
- Small Animal Department, Ear Nose and Throat Unit, Faculty of Veterinary Medicine, University of Leipzig, Leipzig, Germany
| | - Gerhard U Oechtering
- Small Animal Department, Ear Nose and Throat Unit, Faculty of Veterinary Medicine, University of Leipzig, Leipzig, Germany
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Liu NC, Oechtering GU, Adams VJ, Kalmar L, Sargan DR, Ladlow JF. Outcomes and prognostic factors of surgical treatments for brachycephalic obstructive airway syndrome in 3 breeds. Vet Surg 2017; 46:271-280. [PMID: 28146288 DOI: 10.1111/vsu.12608] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 08/16/2016] [Accepted: 10/26/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To determine prognostic indicators for the surgical treatment of brachycephalic obstructive airway syndrome (BOAS) and to compare the prognosis of 2 multilevel surgical procedures. STUDY DESIGN Prospective clinical study. SAMPLE POPULATION Client-owned pugs, French bulldogs, and bulldogs (n = 50). METHODS Noninvasive whole-body barometric plethysmography (WBBP) was used to assess respiratory function before, 1 month and 6 months after upper airway corrective surgery. Postoperatively, BOAS indices (ie, ascending severity score generated from WBBP data, 0%-100%) that equaled to or exceeded the cut-off values of BOAS in the diagnostic models were considered to have a "poor prognosis." A multivariate logistic regression was used to assess predictors for prognosis. RESULTS The median BOAS indices decreased after surgery (from 76% to 63%, P < .0001), although dogs with indices in this range would still be considered clinically affected. Age (odds ratios [OR] = 0.96, 95% confidence interval [CI]: 0.93-0.99, P < .05), body condition (OR = 0.06, 95% CI: 0.01-0.39, P < .01), laryngeal collapse (OR = 6.1, 95% CI: 1-37.22, P < .05), and surgical techniques (OR = 7.94, 95% CI: 1.17-54.01, P < .05) were associated with postoperative prognosis. The multivariate model suggests modified multilevel surgery (MMS) may have a better outcome than traditional multilevel surgery (TMS) (P = .034). The positive predictive value of the logistic model was 84% (95% CI: 68-94%) and the area under the receiver operating characteristic (ROC) curve was 89% (95% CI: 78-99%, P <.0001). CONCLUSIONS Younger age, normal body condition, presence of laryngeal collapse, and treatment with TMS were negative prognostic factors after surgical treatment of BOAS. MMS is recommended, particularly in dogs with a higher probability of poor prognosis.
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Affiliation(s)
- Nai-Chieh Liu
- Department of Veterinary Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Gerhard U Oechtering
- Small Animal Department, Ear Nose and Throat Unit, Faculty of Veterinary Medicine, University of Leipzig, Leipzig, Germany
| | | | - Lajos Kalmar
- Department of Veterinary Medicine, University of Cambridge, Cambridge, United Kingdom
| | - David R Sargan
- Department of Veterinary Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Jane F Ladlow
- Department of Veterinary Medicine, University of Cambridge, Cambridge, United Kingdom.,Queen's Veterinary School Hospital, University of Cambridge, Cambridge, United Kingdom
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How does multilevel upper airway surgery influence the lives of dogs with severe brachycephaly? Results of a structured pre- and postoperative owner questionnaire. Vet J 2016; 210:39-45. [PMID: 26897434 DOI: 10.1016/j.tvjl.2016.01.017] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Revised: 01/20/2016] [Accepted: 01/22/2016] [Indexed: 11/20/2022]
Abstract
Brachycephalic airway syndrome in dogs is typified by a variety of anatomical abnormalities causing a diverse spectrum of clinical signs of varying intensity. This variability makes the assessment of the surgical outcome after upper airway surgery difficult. Using a structured questionnaire, the present study investigated the dog owner-perceived severity and frequency of a broad spectrum of welfare-relevant impairments 2 weeks before and 6 months after brachycephalic dogs underwent a recently developed multi-level upper airway surgery. All dogs underwent surgical treatment of stenotic nares (ala-vestibuloplasty), the nasal cavity (laser-assisted turbinectomy, LATE), the pharynx (palatoplasty and tonsillotomy), and if indicated, laryngeal surgery (laser-assisted ablation of everted ventricles and partial cuneiformectomy). Owners of brachycephalic dogs (n = 102) referred for upper airway surgery were eligible to participate. Questionnaire data from owners of 37 Pugs and 25 French bulldogs were evaluated. In all dogs, the clinical signs associated with brachycephaly improved markedly after surgery. Most encouraging was the striking reduction in life-threatening events by 90% (choking fits decreased from 60% to 5% and collapse from 27% to 3%). The incidence of sleeping problems decreased from 55% to 3%, and the occurrence of breathing sounds declined by approximately 50%. There was a marked improvement in exercise tolerance and a modest improvement in heat tolerance. Dogs with severe brachycephaly benefitted substantially from multi-level surgery, and there were particular improvements in the incidences of severe impairment and life-threatening events. However, despite the marked improvement perceived by dog owners, these dogs remained clinically affected and continued to show welfare-relevant impairments caused by these hereditary disorders.
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Oechtering GU, Pohl S, Schlueter C, Lippert JP, Alef M, Kiefer I, Ludewig E, Schuenemann R. A Novel Approach to Brachycephalic Syndrome. 1. Evaluation of Anatomical Intranasal Airway Obstruction. Vet Surg 2016; 45:165-72. [PMID: 26790550 DOI: 10.1111/vsu.12446] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate airway obstruction due to abnormal intranasal anatomy in 3 brachycephalic dog breeds using computed tomography and rhinoscopy. STUDY DESIGN Prospective clinical study. ANIMALS A total of 132 brachycephalic dogs (66 Pugs, 55 French Bulldogs, and 11 English Bulldogs) with severe respiratory distress due to brachycephalic syndrome. METHODS Computed tomography and anterior and posterior rhinoscopy were performed to evaluate endonasal obstruction. RESULTS All dogs had abnormal conchal growth that obstructed the intranasal airways. Rostral aberrant turbinates (RAT) were common in Pugs (90.9%) but less frequent in French (56.4%) and English (36.4%) Bulldogs. Caudal aberrant turbinates (CAT) obstructing the nasopharyngeal meatus were commonly found in all breeds (66.7%). Deviation of the nasal septum was an almost consistent finding in Pugs (98.5%) but was less common in bulldogs. Obstructing turbinates had multiple points of mucosal contact responsible for obstruction of the intranasal airway. Interconchal and intraconchal mucosal contacts were evident in 91.7% of dogs. CONCLUSION Selective breeding for short head conformation reduces the size of the nasal cavities to such an extent that intranasal structures grow aberrantly and malformed, leading to obstructed air conducting spaces. Intranasal airway obstruction of brachycephalic dogs may contribute to their exercise and heat intolerance because of impaired pulmonary ventilation and compromised thermoregulatory functions of the canine nose. Failure to address intranasal obstruction might be an explanation for lack of therapeutic success after conventional surgery for brachycephalic syndrome. Future consideration should be given to the diagnosis, management, and treatment of this newly described aspect of airway obstruction.
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Affiliation(s)
- Gerhard U Oechtering
- Small Animal Department, Ear, Nose and Throat Unit, Faculty of Veterinary Medicine, University of Leipzig, Leipzig, Germany
| | - Sabine Pohl
- Small Animal Department, Ear, Nose and Throat Unit, Faculty of Veterinary Medicine, University of Leipzig, Leipzig, Germany
| | - Claudia Schlueter
- Small Animal Department, Ear, Nose and Throat Unit, Faculty of Veterinary Medicine, University of Leipzig, Leipzig, Germany
| | - Johanna P Lippert
- Small Animal Department, Ear, Nose and Throat Unit, Faculty of Veterinary Medicine, University of Leipzig, Leipzig, Germany
| | - Michaele Alef
- Small Animal Department, Ear, Nose and Throat Unit, Faculty of Veterinary Medicine, University of Leipzig, Leipzig, Germany
| | - Ingmar Kiefer
- Small Animal Department, Ear, Nose and Throat Unit, Faculty of Veterinary Medicine, University of Leipzig, Leipzig, Germany
| | - Eberhard Ludewig
- Small Animal Department, Ear, Nose and Throat Unit, Faculty of Veterinary Medicine, University of Leipzig, Leipzig, Germany
| | - Riccarda Schuenemann
- Small Animal Department, Ear, Nose and Throat Unit, Faculty of Veterinary Medicine, University of Leipzig, Leipzig, Germany
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