Transcript Brachycephalic Syndrome

Brachycephalic
Syndrome
Danielle Forbes, DVM
Veterinary Specialists
of South Florida
Meet Molly
 7 month FI English Bulldog
 History of Demodex and pneumonia
 Since have resolved
 Chronic entropion
 Subsequent corneal ulcers and eye infections
 Atropine, BNP ointment, serum
 Ophthalmologist will not do surgery until soft palate
evaluated for anesthesia
 Excessive amount of upper airway noise since
acquired
Physical exam findings
 Bilateral entropion
 Blepharospasm OD
 Loud referred upper airway sounds
 Stridor
 Stertor
 Stenotic nares
Anesthesia for oral exam
 Anesthesia for oral exam with surgery to
follow if indicated
 Elongated soft palate was partially obstructing
the dorsal trachea
 Saccules were both everted and partially
blocking the ventral trachea
 Stenotic nares
Endoscopy
Surgery
 Laryngeal sacculectomy
 Soft palate resection
 Stenotic nares resection
 Other congenital disorders cannot be
augmented such as hypoplastic trachea
Surgery
 Dexamethasone SP
 0.25 mg/kg IV
 Intra-operatively and 6 hours post-op
 Cefazolin
 20 mg/kg IV
 Cephalexin
 25 mg/kg PO q8h x 5 days
Brachycephalic Syndrome
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Soft palate elongation
Stenotic nares
Everted laryngeal saccules
Hypoplastic trachea
Aryepiglottic/corniculate collapse
All can contribute to respiratory distress
Signalment
 Brachycephalic breeds
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English bulldogs
Boston terriers
Pugs
Pekingese
 Congenital
 Animals usually don’t present until 2-3 yrs
for evaluation
Stenotic Nares
 Nostrils with abnormally narrow openings
 Due to congenital malformations of the nasal cartilage
 Lack normal rigidity and collapse medially
 Causes partial occlusion of the external nares
Elongated Soft Palate
 Extends > 1-3 mm caudal to the tip of the epiglottis
 Congenital abnormality
 The tip of the soft palate is blown into the nasopharynx
during expiration
 May have trouble swallowing, resulting in aspiration
pneumonia
Everted Laryngeal Saccule
 Prolapse of mucosa lining laryngeal crypts
 First stage of laryngeal collapse
 ↑ airflow resistance and ↑ neg pressure
generated to move air past obstructed areas
 Pulls saccules from their crypts
 Obstruct ventral aspect of the glottis and further
inhibit airflow
Laryngeal Collapse
 Progressive disease
 Advanced form of brachycephalic syndrome
 Prognosis worsens with time
 Follows eversion of saccules
History
 Exercise intolerance
 Cyanosis
 Restlessness during
sleep
 Collapse
 Stridor
 Stertor
 Inspiratory difficulty
Physical Examination
 Stenotic nares
 Increased inspiratory effort
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Retraction of lip commisures
Open mouth breathing
Constant panting
Forelimb abduction
Exaggerated use of abdominal muscles
 Prominent stertor can mask other respiratory
sounds during exam
Physical Examination
 Paradoxical movement of thorax and abdomen
 Inward collapse of intercostal spaces and
thoracic inlet
 Orthopneic posture
 Extended head and neck
Physical Examination
 Full oral examination not possible w/o anesth
 Elongated soft palate
 Overlies epiglottis > 1 cm
 Thick with roughened, inflamed tip
 Saccules may be everted
 Thickened arytenoid cartilages
Diagnostics
 Thoracic radiographs
 Lateral views of the upper airways may be
helpful
Differentials
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Aryepiglottic collapse
Corniculate collapse
Tracheal collapse
Tracheal hypoplasia
Laryngeal paralysis
Mass obstructing glottis, larynx, or trachea
Traumatic disruption of the airway.
Treatment
 Medical management:
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Weight management for obese animals
Exercise restriction
Elimination of precipitating causes may be beneficial
Sedation
Corticosteroids
Supplemental oxygen
Cooling
Treatment
 Surgical management
 Multiple procedures are usually required to
alleviate signs
 Anesthetic and postoperative risks
Anesthesia
 Laryngeal examination premeds
 Oxymorphone 0.05-0.1 mg/kg IM
 Butorphanol 0.2-0.4 mg/kg IM or SC
 Buprenorphine 0.005-0.015 mg/kg IM
 Supplement oxygen during exam
 Monitor SpO2
 After airway exam, intubate for any surgery
Stenotic nares resection
 Resection of a portion of the
dorsolateral nasal cartilage to
widen nares
 Other techniques include
resection of horizontal, lateral
tissue wedges
Post operative care
 Constant monitoring during recovery
 Keep intubated as long as possible
Soft Palate Resection
 Tracheostomy tube usually unnecessary
 Best performed on young animal
Soft Palate Resection
 Post operative care
 Corticosteroids to reduce inflammation
 Oxygen if necessary
Everted Saccules
 Handle the tissues gently
 Excessive manipulation can cause obstructive
edema postoperatively
Complications
 Resection of soft palate
 Too little palate does not relieve respiratory
distress
 Too much results in nasal regurgitation,
rhinitis and sinusitis
 Dehiscence of nares may occur if sutured
 Respiratory distress if other areas of
airway not addressed/obstructed
Prognosis
 > 2 years
 Guarded prognosis even with treatment
 < 2 years
 Favorable prognosis
QUESTIONS??
References
 Fossum, Theresa W. Small Animal Surgery. 2nd Edition. 2002, Mosby,
pp 717-8, 727-34
 Riecks, Todd. Birchard, Stephen. Stephens, Julie. Surgical Correction
of Brachycephalic Syndrome in Dogs: 62 cases. JAVMA, Vol 230, No.
9, May 1, 2007 pp1324-8
 Slatter, Douglas. Textbook of Small Animal Surgery. 3rd Edition, USA.
2003, Saunders pp 808-13
 David J. Brdecka, Clarence A. Rawlings, Amanda C. Perry, Jonathon R.
Anderson. Use of an electrothermal, feedback-controlled, bipolar sealing
device for resection of the elongated portion of the soft palate in dogs
with obstructive upper airway disease. JAVMA; Vol 233; No. 8: pp.
1265-9