Fluoroscopic evaluation of laryngopharyngeal anatomic variations attributable to head posture in dogs

Background Aerodigestive diseases (AeroD), hybrid disorders between the respiratory and gastrointestinal (GI) tracts, may present without GI signs. Sliding hiatal hernia (sHH) is an important AeroD in brachycephalic dogs linked to respiratory pathology. The spectrum of other AeroD and respiratory clinical signs (CS) in brachycephalic and nonbrachycephalic dogs with sHH is unknown. Objectives Characterize CS of AeroD in dogs with sHH, compare CS between brachycephalic and nonbrachycephalic dogs, and compare thoracic radiographs and videofluoroscopic swallow study (VFSS) for diagnosing sHH. Animals Sixty‐seven client‐owned dogs with sHH. Methods Medical records of dogs with sHH presented to the veterinary teaching hospitals at Auburn University and the University of Missouri between 1 January 2009 and 31 December 2020 were retrospectively reviewed. Between group, comparisons were made using Mann‐Whitney test, Chi‐square analysis, and Spearman correlation ( P < .05). Results Dogs with sHH presented with exclusively GI signs (28/67), mixed respiratory and GI signs (22/67), or with exclusively respiratory signs (17/67). Wheras brachycephalic dogs were not significantly more likely to present with respiratory CS ( P = .145), they were younger ( P < .001), and more likely to present in respiratory distress ( P = .02), and with radiographic evidence of aspiration pneumonia ( P < .001) compared to nonbrachycephalic dogs. Six of 12 dogs with normal thoracic radiographs having sHH presented with respiratory CS. For detection of sHH, VFSS was superior to radiographs ( P < .001). Conclusions and Clinical Importance Dogs with sHH may present with exclusively respiratory signs. Respiratory signs may be more severe in brachycephalic compared to nonbrachycephalic dogs. Videofluoroscopic swallow study was superior to thoracic radiographs for detection of sHH in dogs.

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“… 26 Elongated soft palate and nasopharyngeal collapse were diagnosed as previously described. 27 , 28 , 29 …”

Section: Methodsmentioning

confidence: 99%

“…Pharyngeal weakness was defined as the presence of residual contrast material in the pharynx after an appropriately‐timed pharyngeal swallow 26 . Elongated soft palate and nasopharyngeal collapse were diagnosed as previously described 27‐29 …”

Section: Methodsmentioning

confidence: 99%

Evaluation of aerodigestive disease and diagnosis of sliding hiatal hernia in brachycephalic and nonbrachycephalic dogs

Luciani

Reinero

Grobman

2022

Veterinary Internal Medicne

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“…All dogs underwent video fluoroscopic imaging while fully awake and standing, with the head in a neutral position. 32 Smaller dogs were placed in a radiolucent plastic box open at the front. Larger dogs stood on the radiology or surgical table without manual restraint.…”

Section: Methodsmentioning

confidence: 99%

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

et al. 2022

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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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“…The median age was 8.0 years (range, 1.3-16.8 years). The median BCS was 5 on a 9-point scale (range, [3][4][5][6][7][8][9]. Before acquiring cervical radiographs, thoracic radiographs were obtained to identify the presence of lower airway collapse, cardiac disease, and pulmonary disease.…”

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confidence: 99%

“…Third, all cervical radiographs were acquired using a manual restraint in awake dogs, which might be related to low repeatability. However, a neutral head-neck position can minimize posture-induced changes in the measurement of the pharyngeal anatomic structure [6], and pharyngeal pressure changes due to head rotation is less [26]. In addition, considering that sedatives could affect the respiratory system secondary to central nervous system depression and that pharyngeal muscle relaxation induces upper airway obstruction [5], the results of this study are meaningful because nasopharyngeal collapse can be present even without sedation in brachycephalic dogs without respiratory signs.…”

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confidence: 99%

Nasopharyngeal luminal change on cervical radiography in brachycephalic dogs without respiratory signs

Noh

Shin

et al. 2023

The Journal of Veterinary Medical Science

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This study aimed to prospectively assess nasopharyngeal luminal changes in brachycephalic dogs without respiratory signs using cervical radiography. Forty brachycephalic dogs without cardiopulmonary diseases were included. The nasopharyngeal luminal change was calculated on inspiratory and expiratory cervical lateral radiographs. The median nasopharyngeal luminal change was 21.6% (range, 0.3-85.6%). In five dogs, a nasopharyngeal luminal change of >50% was identified. There was no correlation between nasopharyngeal luminal changes and age, sex, body weight, or body condition score. These results suggest that brachycephalic dogs without cardiopulmonary diseases may be over-diagnosed with partial pharyngeal collapse. Further studies comparing nasopharyngeal luminal changes between clinically healthy brachycephalic dogs and dogs with respiratory signs are warranted.

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Fluoroscopic evaluation of laryngopharyngeal anatomic variations attributable to head posture in dogs

Cited by 5 publications

References 22 publications

Evaluation of aerodigestive disease and diagnosis of sliding hiatal hernia in brachycephalic and nonbrachycephalic dogs

Evaluation of aerodigestive disease and diagnosis of sliding hiatal hernia in brachycephalic and nonbrachycephalic dogs

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

Nasopharyngeal luminal change on cervical radiography in brachycephalic dogs without respiratory signs

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