Laser-Assisted Turbinectomy in Dogs.

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.

[Nasal obstruction: Odontogenic cysts in 4 brachycephalic dogs]. / Nasale Obstruktion: Odontogene Zysten bei 4 brachyzephalen Hunden.

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.

Alar fold resection in 25 horses: Clinical findings and effect on racing performance and airway mechanics (1998-2013).

OBJECTIVE: To report clinical findings and performance in horses in which alar fold collapse (AFC) had been diagnosed and surgically treated and to assess form and degree of respiratory obstruction. STUDY DESIGN: Retrospective case series. ANIMALS: Twenty-one standardbreds, 2 coldblooded trotter racehorses, 1 thoroughbred, and 1 Icelandic horse. METHODS: Alar fold collapse was diagnosed on the basis of continuous abnormal expiratory flutter noise coinciding with filling of the false nostrils during exercise on a high-speed treadmill that was alleviated by suturing the alar folds (AF) temporarily in a dorsal position. In 5 cases, nasopharyngeal airway pressures were assessed. Performance after complete, bilateral AF resection was assessed by reviewing career race records and by owner or trainer telephone interviews. RESULTS: Horses presented because of poor performance, abnormal respiratory noise, or both. Additional dynamic disorders were identified in 12 of 21 standardbreds (intermittent dorsal displacement of the soft palate: n = 10; collapse of the roof of the nasopharynx: n = 2). Expiratory nasopharyngeal pressures seemed elevated in horses with AFC (range, +10.8 to +21.8 cm H2 O) compared with normal reference values. Dorsal fixation as well as complete surgical resection of the AF improved expiratory nasopharyngeal pressures to reported normal levels. At a mean of 68 months (range, 7-121) follow-up, 20 of 25 horses had competed after surgery, and 13 of 17 of the harness racehorses had established or improved their kilometer racing time marks. CONCLUSION: Alar fold collapse caused mild to moderate expiratory obstruction and may have contributed to secondary nasopharyngeal collapse in this population. CLINICAL SIGNIFICANCE: Complete surgical resection seems effective for treating AFC. Nasopharyngeal pressure measurement is a potential tool for confirming the diagnosis of AFC.

Severe brachycephalic obstructive airway syndrome is associated with hypercoagulability in dogs.

We evaluated whether dogs with severe brachycephalic obstructive airway syndrome (BOAS) developed a hypercoagulable state similar to people with obstructive sleep apnea. Five dogs with grade 3 BOAS were included as well as 5 healthy control Labrador Retrievers. Venous blood samples were collected from each dog for performance of thromboelastography and determination of hematocrit and platelet count. Groups were compared using a t-test, with p < 0.05 considered significant. Thromboelastography results identified that all BOAS dogs were hypercoagulable compared to the Labradors, having significantly shortened clotting time with increased angle, maximal amplitude, and clot rigidity. BOAS dogs also had evidence of delayed fibrinolysis. These results are consistent with, but more severe than, those previously documented in apparently healthy Bulldogs. Together, these findings support the presence of a hypercoagulable state in brachycephalic dogs, and suggest that this state is amplified by increasing severity of BOAS.

A novel approach to brachycephalic syndrome. 3. Isolated laser-assisted turbinectomy of caudal aberrant turbinates (CAT LATE).

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.

Oestrose: uma parasitose emergente em pequenos ruminantes no Nordeste do Brasil / Nasal bot: an emerging parasitic disease in small ruminants in the Brazilian Northeast

No período de janeiro de 2011 a dezembro de 2014 foram diagnosticados 9 surtos (A, B, C, D, E, F, G, H e I) de Oestrus ovis em pequenos ruminantes no estado da Bahia. No surto A obteve-se 0,5% (1/200); B 2,2% (2/90); C 0,8% (1/120); D 2% (2/100); E 1% (1/100); F 3% (1/33); G 0,6% (1/150); H 2,5% (5/200); I com 11,4% (8/70) em ovinos e 5% (2/40) em caprinos. Os sinais clínicos associados ao parasitismo pelas larvas nos surtos foram respiração ruidosa, espirro seguido de secreção nasal catarral, inquietação, movimentação excessiva da cabeça e andar em círculo. Macroscopicamente havia nos seios e conchas nasais hiperemia, edema da mucosa e presença de larvas. Todas as larvas coletadas dos cornetos e conchas nasais variavam desde o primeiro ao terceiro estágio de desenvolvimento. Algumas larvas L3 coletadas nas necropsias foram incubadas e o imago obtido das pupas mediram aproximadamente 10mm de cor acinzentada e abdômen escurecido. Realizada análise descritiva das condições climáticas, ano e positividade de casos de oestrose, demonstrou que a ocorrência tem tendência de crescimento com os anos (p˂0,001) e que houve casos com menor média de temperatura mínima (p˂0,001), possibilitando o desenvolvimento da mosca de O. ovis, demonstrando que houve a introdução da mosca enTtre o rebanho de ovinos e caprinos do estado da Bahia, e que as condições climáticas são ideais para perpetuação da espécie.(AU)

From January 2011 to December 2014 were diagnosed 9 outbreaks of Oestrus ovis infection in small ruminants (Outbreaks A-I) in the State of Bahia. The incidence of oestrosis in sheep in outbreak A was 0.5% (1/200), in B 2.2% (2/90), in C 0.8% (1/120), in D 2% (2/100), in E 1% (1/100), in F 3% (1/33), in G 0.6% (1/150), in H 2.5% (5/200), and in I 11.42% (8/70), and 5% (2/40) in goats. Clinical signs associated with parasitism were wheezing, sneezing followed by catarrhal nasal secretion, some restlessness, excessive head movement and walking in circles. The breasts and turbinates were hyperemic, with mucosal edema and presence of O. ovis larvae. All larvae collected from the turbinates ranged from the first to the third stage of development. Some L3 larvae collected at necropsy were incubated and the gray colored Imago with dark abdomen obtained from the pupae measured about 10mm. A descriptive analysis of the climatic conditions was carried out; in the year of investigation the incidence of O. ovis infection has grown (p<0.001), and the lowest mean minimum temperature (p<0.001) caused the development the O. ovis fly, so that there was an introduction of an increased number of these flies into the sheep and goat flocks in state of Bahia with the ideal climatic conditions for their perpetuation.(AU)

Ventral rhinotomy in a pet rabbit (Oryctolagus cuniculus) with an odontogenic abscess and sub-obstructive rhinitis.

A rabbit was presented for severe dyspnea and was diagnosed with an odontogenic abscess obstructing the rostral nasopharynx using CT scan and oral endoscopy. The offending tooth was extracted intraorally, but due to persistent dyspnea, an endoscopic-guided ventral rhinotomy was performed. The dyspnea subsequently resolved, but the rabbit died 5 weeks later from a seemingly unrelated cause.

Rhinotomie ventrale chez un lapin de compagnie(Oryctolagus cuniculus)atteint d'un abcès odontogène et d'une rhinite causant une subocclusion. Un lapin a été présenté pour une dyspnée grave et a été diagnostiqué avec un abcès odontogène bloquant le nasopharynx rostral par tomodensitométrie et endoscopie orale. La dent en cause a été extraite intra-oralement, mais, en raison d'une dyspnée persistante, une rhinotomie ventrale guidée par endoscopie a été réalisée. La dyspnée s'est subséquemment résorbée, mais le lapin est mort 5 semaines plus tard d'une cause apparemment non reliée.(Traduit par Isabelle Vallières).

A Novel Approach to Brachycephalic Syndrome. 1. Evaluation of Anatomical Intranasal Airway Obstruction.

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.

A Novel Approach to Brachycephalic Syndrome. 2. Laser-Assisted Turbinectomy (LATE).

OBJECTIVE: To introduce a new surgical procedure based on interventional, laser-assisted removal of obstructing turbinate tissue to improve endonasal airway patency in brachycephalic dogs and to confirm the short and long term results using computed tomography (CT) and rhinoscopy. STUDY DESIGN: Prospective clinical study. ANIMALS: Brachycephalic dogs (n = 158; 70 Pugs, 77 French Bulldogs, 11 English Bulldogs) referred for treatment of severe respiratory distress because of brachycephalic syndrome. METHODS: Computed tomography and anterior and posterior rhinoscopy were performed to evaluate endonasal obstruction. Laser-assisted turbinectomy (LATE) using a diode laser was performed as part of a multilevel surgery. Nasal conchae that were causing airway obstruction were removed. RESULTS: The obstructing parts of the conchae were safely and efficiently removed by LATE, shaping a patent nasal airway in all dogs. The newly developed surgical procedure involved 3 steps: turbinectomy of the (1) concha nasalis ventralis; (2) rostral aberrantly growing turbinates (RAT); and (3) caudal aberrantly growing turbinates (CAT). Complications of the procedure included transient intraoperative hemorrhage in 51 of 158 dogs (32.3%); however, a temporary tamponade was necessary in only 2/158 dogs (1.3%). After 6 months, regrowth of turbinates required resection of possibly re-obstructing tissue in 25/158 dogs (15.8%; 1 Pug and 24 French Bulldogs). CONCLUSION: LATE is an effective method for creating a patent nasal airway in brachycephalic dogs with intranasal obstruction.

Inside the brachycephalic nose: conchal regrowth and mucosal contact points after laser-assisted turbinectomy.

This prospective observational study analyzed conchal regrowth after laser-assisted turbinectomy (LATE) in brachycephalic dogs and the mucosal contact of regrown conchae. Eighty brachycephalic dogs (41 pugs, 39 French bulldogs [FBs]) that underwent LATE because of obstructing conchae were evaluated by endoscopy 7 days and 6 mo after surgery. At 6 mo, 96% of FBs' and 65% of pugs' nasal cavities showed regrowth of turbinates. FBs showed higher growth grades than pugs. Revision surgery because of reobstructing regrowth was required in the nasal cavities of 17% of FBs and 3% of pugs. The mean number of contact points reduced from 3.0 in FB and 1.7 in pugs before surgery to 1.2 in FB and 0.2 in pugs after conchal regrowth. Recollapse of nares after surgery significantly influenced the frequency of reoccurrence of contact points. LATE was proven to be an effective treatment of intranasal obstruction caused by mucosal contact between conchae. Conchal regrowth commonly occurs after surgical removal, but the new conchae cause less obstruction due to a significant reduction in number of contact points. Revision surgery because of reobstruction is rarely necessary. The important physiologic functions of conchae make nonobstructing regrowth desirable.

Intranasal epidermoid cyst causing upper airway obstruction in three brachycephalic dogs.

This case report describes three brachycephalic dogs with intranasal epidermoid cysts that were causing additional upper airway obstruction. Although epidermoid cysts have been described in several locations in dogs, to the authors' knowledge intranasal epidermoid cysts have not been previously reported. All dogs had mucopurulent to haemorrhagic nasal discharge. Magnetic resonance imaging of the head revealed the presence of unilateral or bilateral intranasal cystic lesions obstructing the nasal cavities partially or completely, with atrophy of the ipsilateral nasal turbinates. The cystic lesions were surgically excised in all dogs using a modified lateral alveolar mucosal approach to the affected nasal cavity. Aerobic, anaerobic and fungal culture of the cystic contents were negative and histology of the excised tissue was consistent with a benign intranasal epidermoid cyst in each dog. Upper airway obstruction was clinically improved in two dogs.

Inside the brachycephalic nose: intranasal mucosal contact points.

The purpose of this study was to evaluate the prevalence of intranasal mucosal contact points in brachycephalic and normocephalic dogs. In total, 82 brachycephalic dogs (42 pugs and 40 French bulldogs) were evaluated by rhinoscopy for their intranasal mucosal contact and 25 normocephalic dogs were evaluated as a control group. Of those, 162 brachycephalic nasal cavities were evaluable and 140 had contact between intranasal structures (87%). Intraconchal and septoconchal mucosal contact points were the most commonly detected sites of contact. French bulldogs had a significantly higher prevalence of mucosal contact and had 3 mean contact points compared with 1.7 mean contact points per nasal cavity in pugs. Septal deviations were present in 62% of brachycephalic dogs. In the control group, mucosal contact points were present in only 7 of 50 nasal cavities (14%), and septal deviations occurred in 16% of those cases. Contact point average was 0.1 in large and 0.3 in small normocephalic dogs. Intranasal mucosal contact was identified as a common and previously unreported problem in brachycephalic dogs. Numerous contact points reduce the lumen of the intranasal passageways and indicate potential intranasal obstruction. Affected dogs might benefit from removal of obstructing conchae, potentially using laser-assisted turbinectomy.

Radiographic appearance of maxillary sinus feed impaction in a horse.

A 15-year-old Belgian gelding presented in respiratory distress, with bilateral mucopurulent nasal discharge, and right-sided epistaxis. The horse had a 5-year history of dental disease and had been recently losing weight. Radiographs indicated tooth root abscessation of the right maxillary third molar tooth and probable maxillary sinus feed impaction. These findings were confirmed at surgery and necropsy. The stippled, granular radiographic appearance described here is highly characteristic of sinus feed impaction.

Evaluation of C-reactive protein, haptoglobin and cardiac troponin 1 levels in brachycephalic dogs with upper airway obstructive syndrome.

BACKGROUND: Brachycephalic dogs have unique upper respiratory anatomy with abnormal breathing patterns similar to those in humans with obstructive sleep apnea syndrome (OSAS). The objective of this study was to evaluate the correlation between anatomical components, clinical signs and several biomarkers, used to determine systemic inflammation and myocardial damage (C-reactive protein, CRP; Haptoglobin, Hp; cardiac troponin I, cTnI), in dogs with brachycephalic upper airway obstructive syndrome (BAOS). RESULTS: Fifty brachycephalic dogs were included in the study and the following information was studied: signalment, clinical signs, thoracic radiographs, blood work, ECG, components of BAOS, and CRP, Hp and cTnI levels. A high proportion of dogs with BAOS (88%) had gastrointestinal signs. The prevalence of anatomic components of BAOS was: elongated soft palate (100%), stenotic nares (96%), everted laryngeal saccules (32%) and tracheal hypoplasia (29.1%). Increased serum levels of biomarkers were found in a variable proportion of dogs: 14% (7/50) had values of CRP > 20 mg/L, 22.9% (11/48) had values of Hp > 3 g/L and 47.8% (22/46) had levels of cTnI > 0.05 ng/dl. Dogs with everted laryngeal saccules had more severe respiratory signs (p<0.02) and higher values of CRP (p<0.044). No other statistical association between biomarkers levels and severity of clinical signs was found. CONCLUSIONS: According to the low percentage of patients with elevated levels of CRP and Hp, BAOS does not seem to cause an evident systemic inflammatory status. Some degree of myocardial damage may occur in dogs with BAOS that can be detected by cTnI concentration.

Expansile, inflammatory middle ear disease causing nasopharyngeal obstruction in a cat.

A 7-year-old, entire female, domestic shorthair cat presented with recurrent upper respiratory tract problems. Infectious otitis media caused expansion of the middle ear which ultimately resulted in complete obstruction of the nasopharynx. A ventral bulla osteotomy was successful in relieving the clinical signs.

[Geometry and function of the dog nose: how does function change when form of the nose is changed?]. / Geometrie und Funktion der Hundenase: Wie ändert sich die Funktion, wenn die Form verändert wird?

Nasal airflow resistance in brachycephalic dogs is significantly elevated compared to normal dogs. LaserAssisted TurbinEctomy (LATE)-surgery as well as xylometazolin were shown to reduce pathologically increased intranasal airway resistance in brachycephalic dogs by approximately 50 %. Impulse oscillometry provides a reliable and sensitive method to examine intranasal stenoses in the canine nose. Acoustic rhinometry allows assessment of changes in cross sectional area and volume of the canine nasal cavity.

[Select changes in the upper airways of the horse - an overview]. / Ausgewählte Veränderungen in den oberen Atemwegen des Pferdes - ein Uberblick.

Horses are obligate nasal breathers and depend on patency of their nasal passages. Several dynamic obstructive diseases in the pharyngeal and laryngeal area can be differentiated by high speed treadmill endoscopy and may be responsible for impaired exercise tolerance in the equine athlete. The anatomical specialty of guttural pouches predisposes the horse to species-specific diseases.

Imaging diagnosis--equine nasal septal thickening due to chronic chondritis.

We describe the use of computed tomography (CT) in a 6-year-old mare with upper airway obstruction due to an abnormally thick nasal septum. Upon CT imaging, multifocal, expansile cyst-like lesions were detected in the nasal septum. The histopathologic diagnosis was chronic dissecting chondritis. Resection of the abnormal nasal septum resulted in resolution of the clinical signs.

Suture exostosis causing obstruction in the nasolacrimal duct in three horses.

CASE HISTORY: Three horses were presented with facial swelling and epiphora. CLINICAL FINDINGS: All horses had facial swellings and radiographic findings consistent with exostosis at the lacrimomaxillary suture, and ipsilateral epiphora. Positive contrast dacryocystorhinography demonstrated that the site of obstruction of the nasolacrimal duct was located where the duct traverses the lacrimomaxillary suture. DIAGNOSIS: Lacrimomaxillary suture exostosis. CLINICAL RELEVANCE: Lacrimomaxillary suture exostosis should be considered as a differential diagnosis in cases of epiphora in horses. Dacryocystorhinography, preferably retrograde and normograde, may be used as an aid to diagnosis.