Brachycephalic airway obstructive syndrome: epidemiological study and its relation with anatomic abnormalities
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2015
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Introdução A síndrome respiratória obstrutiva braquicefálica corresponde a uma obstrução multifocal causada em primeiro lugar pelo encurtamento marcado do aspecto rostral do crânio de animais braquicéfalos, o que leva à estenose e obstrução das vias aéreas superiores. O número e o grau de severidade das alterações anatómicas presentes, cuja anatomia se apresenta vastamente caracterizada na literatura, variam individualmente. No entanto, cada indivíduo é caracterizado pelas variáveis epidemiológicas. Identificar o papel da presença de determinadas alterações anatómicas no prognóstico de determinado animal ou, por outro lado, antever o resultado ou possíveis complicações após as técnicas cirúrgicas standard tornou-se uma tarefa frustrante para cirurgiões. Deste modo, é extremamente importante a elaboração de um estudo em que se associe a presença de alterações anatómicas com variáveis que caracterizem a população (sexo, raça e idade). Materiais e Métodos Os ficheiros médicos de animais que foram submetidos ao tratamento cirúrgico standard na clínica veterinária Gran Sasso, em Milão, Itália, entre 2003 e 2014, foram consultados para obter dados epidemiológicos e informações sobre as alterações anatómicas presentes. A análise estatística foi realizada usando o software SPSS versão 22.0 (IBM Corporation, 2013). Resultados Sessenta e seis animais das raças Bulldog inglês, Bulldog francês e pug apresentaram-se com dispneia obstrutiva e estertor respiratório. Os Bulldogs ingleses apresentaram-se em maioria (39 de 66 animais, 59.1%), assim como os machos (48 de 66 casos, 72.7%), o que pode explicar o facto de a maioria dos animais com idade inferior a 1 ano serem Bulldogs ingleses machos (13 cães, 86.7% dentro da idade). Metade das fêmeas apresentaram-se com 4 ou mais anos (9 cães, 50% dentro do género). Do mesmo modo, este género apresentou uma maior prevalência de animais afectados por hipertrofia das amígdalas (6 animais, 33.3%. dentro do género) e por colapso laríngeo de 3º grau (5 cães, 27.8% dentro do género). Grande parte da população apresentou estenose das narinas (61 cães, 92.4%) e eversão dos ventrículos laríngeos (48 cães, 72.7%). Verificou-se um número inesperado de animais com menos de 1 ano com eversão dos ventrículos laríngeos (12 animais, 80% dentro da idade). Além disso, toda a população apresentou palato mole longo. Os Bulldogs franceses apresentaram uma elevada prevalência de animais afectados por conchas aberrantes rostrais (11 cães, 64.7%. dentro da raça), hipertrofia das amígdalas (6 cães, 35.3%. dentro da raça), colapso laríngeo de 2º grau (5 cães, 29.4% dentro da raça) e colapso laríngeo de 3º grau (4 cães, 23.5%. dentro da raça). Conclusão As diferentes raças braquicéfalas apresentam variações morfológicas cranianas, levando a uma predisposição racial diferente para certas alterações anatómicas. Os
Bulldogs franceses apresentaram-se gravemente afectados por alterações secundárias, pelo que a idade média a que esta raça se apresentou para tratamento foi considerada um factor de agravamento. Machos e Bulldogs ingleses apresentaram menos alterações anatómicas secundárias, o que pode dever-se à idade mais precoce de apresentação. No entanto, esta raça apresentou-se afectada em maior grau em comparação com a literatura. Os resultados relativos ao pug não foram considerados fiáveis devido ao reduzido tamanho de sua população.
Introduction Brachycephalic airway obstructive syndrome (BAOS) corresponds to a multifocal obstruction caused in first place by a shortened skull, which narrows the lumen of the upper respiratory tract. The diversity and the severity of the anatomic abnormalities present, whose anatomy is vastly described in the literature, depend on each individual case. Moreover, each individual case is characterized by epidemiological variables. Identify the role of the several anatomic anomalies in the prognosis of a certain dog, or patients that will have limited improvement or complications from standard surgical management are currently frustrating tasks for surgeons. Therefore, it was mandatory to study the association between epidemiological variables, as breed, gender and age, and the anatomical abnormalities present. Material and Methods Medical files from all cases that underwent surgical treatment of BAOS at the Gran Sasso clinic, Milan, Italy, between 2003 and 2014 were consulted for epidemiological data and anatomic abnormalities present. Statistical analysis was performed on SPSS version 22.0 (IBM Corporation, 2013). Results Sixty-six brachycephalic dogs from three different breeds (English bulldog, French bulldog and pug) presented at the veterinary practice mainly due to obstructive dyspnoea and respiratory stertor. English bulldogs were overrepresented (39 of 66 cases, 59.1%), as well as males (48 of 66 cases, 72.7%), which may justify the fact that most dogs aged less than 1 year old were male English bulldogs (13 dogs, 86.7% within age). Nevertheless, the earlier age of presentation of this breed and gender seemed to provide some protection effect from secondary anatomic abnormalities. On the other hand, half of the females group was presented at 4 or more years old (9 dogs, 50%. within gender). This gender presented a higher prevalence of animals affected by tonsillar hypertrophy (6 dogs, 33.3%. within gender) and 3rd LC (5 dogs, 27.8% within gender) with an 18 times higher risk of presenting this secondly referred anatomic abnormality than males. The majority of dogs presented stenotic nares (61 dogs, 92.4%) and everted saccules (48 dogs, 72.7%). There was a more than expected presence of everted saccules in young animals (12 dogs, 80% within age). Furthermore, elongated soft palate was observed in the entire population (66 dogs, 100%). French bulldog presented the highest prevalence of animals affected by RAC (11 dogs, 64.7%. within breed), tonsillar hypertrophy (6 dogs, 35.3%. within breed), 2nd LC (5 dogs, 29.4% within breed) and 3rd LC (4 dogs, 23.5%. within breed). Conclusion Some skull characteristics differ between each brachycephalic breed and the anatomic abnormalities presented seem to reflect it. French bulldogs were severely affected, especially by secondary changes, and age of presentation to surgery was considered a worsening factor. Males and English bulldogs seemed to be more protected which can be attributable to an earlier age of presentation. However, this previously referred breed appears to be more affected than what it is indicated in the literature by some anatomic abnormalities. Conclusions about pug population were not reliable due to its small size.
Introduction Brachycephalic airway obstructive syndrome (BAOS) corresponds to a multifocal obstruction caused in first place by a shortened skull, which narrows the lumen of the upper respiratory tract. The diversity and the severity of the anatomic abnormalities present, whose anatomy is vastly described in the literature, depend on each individual case. Moreover, each individual case is characterized by epidemiological variables. Identify the role of the several anatomic anomalies in the prognosis of a certain dog, or patients that will have limited improvement or complications from standard surgical management are currently frustrating tasks for surgeons. Therefore, it was mandatory to study the association between epidemiological variables, as breed, gender and age, and the anatomical abnormalities present. Material and Methods Medical files from all cases that underwent surgical treatment of BAOS at the Gran Sasso clinic, Milan, Italy, between 2003 and 2014 were consulted for epidemiological data and anatomic abnormalities present. Statistical analysis was performed on SPSS version 22.0 (IBM Corporation, 2013). Results Sixty-six brachycephalic dogs from three different breeds (English bulldog, French bulldog and pug) presented at the veterinary practice mainly due to obstructive dyspnoea and respiratory stertor. English bulldogs were overrepresented (39 of 66 cases, 59.1%), as well as males (48 of 66 cases, 72.7%), which may justify the fact that most dogs aged less than 1 year old were male English bulldogs (13 dogs, 86.7% within age). Nevertheless, the earlier age of presentation of this breed and gender seemed to provide some protection effect from secondary anatomic abnormalities. On the other hand, half of the females group was presented at 4 or more years old (9 dogs, 50%. within gender). This gender presented a higher prevalence of animals affected by tonsillar hypertrophy (6 dogs, 33.3%. within gender) and 3rd LC (5 dogs, 27.8% within gender) with an 18 times higher risk of presenting this secondly referred anatomic abnormality than males. The majority of dogs presented stenotic nares (61 dogs, 92.4%) and everted saccules (48 dogs, 72.7%). There was a more than expected presence of everted saccules in young animals (12 dogs, 80% within age). Furthermore, elongated soft palate was observed in the entire population (66 dogs, 100%). French bulldog presented the highest prevalence of animals affected by RAC (11 dogs, 64.7%. within breed), tonsillar hypertrophy (6 dogs, 35.3%. within breed), 2nd LC (5 dogs, 29.4% within breed) and 3rd LC (4 dogs, 23.5%. within breed). Conclusion Some skull characteristics differ between each brachycephalic breed and the anatomic abnormalities presented seem to reflect it. French bulldogs were severely affected, especially by secondary changes, and age of presentation to surgery was considered a worsening factor. Males and English bulldogs seemed to be more protected which can be attributable to an earlier age of presentation. However, this previously referred breed appears to be more affected than what it is indicated in the literature by some anatomic abnormalities. Conclusions about pug population were not reliable due to its small size.
Descrição
Dissertação de Mestrado Integrado em Medicina Veterinária
Palavras-chave
Vias respiratórias , Síndrome obstrutiva , Anormalidades , Epidemiologia , Cães braquicéfalos