Brachycephalic Care Unit | VSS | Brisbane & Gold Coast Vets

BRACHYCEPHALIC CARE UNIT JINDALEE

THE JINDALEE BRACHYCEPHALIC CARE UNIT (BCU)

BCU was set up as an exclusive brachycephalic precinct, with the specific goal of reducing the number of stress-inducing visits a brachycephalic patient may need to make to a specialist hospital. Furthermore, the risk of anaesthetising a brachycephalic patient is around 20x that of a non- brachycephalic patient. In some instances, we can reduce the number of anaesthetics required, by proactively involving more specialty services from the outset. In some patients, two shorter anaesthetics are preferable to a single long one. We can discuss all the pros and cons with owners.

We also believe in owners having maximal information about their brachycephalic pet subsequent to a visit with us. This allows owners to make ongoing decisions that they feel are in the best interest of their pet. Information is a powerful tool. Some owners of brachycephalic pets may believe that some, or all, of the clinical symptoms their pet are displaying are normal for the breed, when indeed the pet is suffering from exercise intolerance, sore eyes or regurgitation. These misconceptions are never intentional. Often owners, once they are fully informed, want to know what the options are to improve their pet’s quality of life.

A further goal of ours, is to integrate the brachycephalic pet owner into the health team. In 2023, a scientific paper published in the Journal of Small Animal Practice, revealed that brachycephalic patients recover from airway surgery with a lower risk of complications, if the owner is present at recovery time. Since this publication, we have exclusively allowed owners behind the scenes into our brachycephalic recovery space, to sit with them for a few hours in the post-operative period. Thus far, this has been highly successful in terms of reducing patient stress on recovery from airway surgery.

Finally, in everything BCU does, it aims to improve the quality of life of the Brachycephalic pet and reduce complications associated with surgery or hospitalisation. This is an area VSS have been involved in researching, for the past 20 years.

The following information outlines the common conditions we see these patients for, and importantly, how BCU will aim to capture other health conditions at the time of visit.

Conditions in brachycephalic dogs commonly treated by our various departments:

Surgery

Surgery Department

Spinal Disorders

Brachycephalic dogs are prone to a variety of spinal conditions. One prevalent spinal disorder seen in brachycephalic breeds is intervertebral disc disease (IVDD). IVDD occurs when the discs between the vertebrae degenerate then herniate, causing compression of the spinal cord or nerve roots. This can result in pain, weakness, and even paralysis in affected dogs. These dogs need to be seen as soon as possible and the sooner we see them, typically the more favourable the prognosis and the speedier their recovery is.

A neurological examination will tell us how severely affected a patient is, and we will also be able to localise the problem to a region(s) of the spinal cord.

Grade 1 neurological injury is where a patient experiences pain, but no neurological deficits.

Grade 2 neurological injury is where a patient has neurological deficits such as paresis (weakness), decreased proprioception and changes in ability to ambulate (walk).

Grade 3 is where the paresis is severe enough that the patient is non-ambulatory (unable to walk) and has significant neurological deficits.

Grade 4 is where additionally the patient is paralysed in the affected limbs. This describes where they have no ability to consciously move the limbs, which we call absence of motor function. A grade 4 patient however, has pain sensation. This is a test where we apply a painful stimulus to the toes and watch to see whether the patient reacts. It is important to note, that withdrawal of the limb is not the same as a reaction, as this can occur as part of a reflex.

Grade 5 patient is where this pain sensation is lost. They have a complete paralysis and can’t feel anything. We call this ‘Deep Pain Negative’. This is the most severe injury, and these patients should be operated on within 12-24 hours. Brachycephalic breeds may be prone to other spinal abnormalities, such as hemivertebrae, where the vertebrae develop abnormally. These can be asymptomatic or can contribute to spinal instability or disc degeneration.

The BCU is committed to treating spinal conditions in brachycephalic dogs, and all dogs treated for a spinal condition will receive an airway examination and report.

Orthopaedic Disorders

Brachycephalic dog breeds are prone to musculoskeletal disorders including hip and elbow dysplasia, condylar fractures and humeral intercondylar fissures (which can cause pain and lameness).

All dogs that are anaesthetised to investigate an orthopaedic disorder will receive an airway exam and report. In reverse, patients anaesthetised for their airway surgery, will have a CT scan that examines the joints.

Humeral condylar fractures are a fracture configuration we commonly see in French Bulldogs. These are complex fractures to repair and are important for us to see as soon as possible. This is because the fracture involves the joint surface, and delay in repair can result in difficulty reducing the fracture perfectly due to callus (early healing) formation. When we are repairing fractures that involve the joint, careful attention is paid to anatomical alignment and rigid fixation. Unfortunately, with these fractures, some degree of osteoarthritis is common.

Brachycephalic Obstructive Airway Syndrome

Brachycephalic Obstructive Airway Syndrome is a term that describes the primary and secondary airway abnormalities that lead to a disrupted normal airflow. The symptoms of this can be related to the airway obstructive disease or gastrointestinal disease (which is often exacerbated by airway disease). There is a wide range of clinical signs that our surgeons see associated with this disease, however the main ones include gagging while eating, regurgitation of food, snoring, intolerance to normal amounts of exercise or heat, and sleep apnoea. Affected dogs may not have all of these symptoms.

We address as many issues as possible, without increasing patient morbidity/risk of complication. An individualised approach is taken, after a careful examination of the airway. Possible surgical interventions include; staphylectomy (shortening of the soft palate), tonsillectomy (resection of everted tonsils), sacculectomy (resection of laryngeal saccules, when everted), alaplasty (to widen the nares) and less commonly; other palatoplasty procedures (to modify the thickness or shape of the palate), arytenoid lateralisation (to permanently open the larynx), laser assisted turbinectomy and tracheostomy (temporary or permanent bypass of air via the trachea).

One of the key things we want owners of brachycephalic dogs to be aware of is that brachycephalic airway syndrome is progressive - it only gets worse. We really want to intervene surgically in these patients as early as possible to prevent chronic and in some cases, irreversible airway pathology.

How we aim to capture other health conditions in these patients referred to us for airway surgery is;

We perform a full-body Computed Tomography (CT). This is a very quick procedure (<60 seconds) and gives us additional information. Specifically, we look at the patient’s spine, oesophagus, middle ear, chest, nasal turbinates, and especially for French Bulldogs, we look at their elbows for signs of humeral intercondylar fissure.
Skull CT also allows us to look at dentition. Brachycephalic patients have an increased risk of some dental conditions. See the information below for common dental conditions. Each patient anaesthetised for airway surgery with us will receive a dental examination and report under the guidance of Advanced Animal Dentistry.
Each patient anaesthetised with us for airway surgery will receive an Ophthalmic report. See the information below for common ophthalmic conditions. The perfect stress-free time to perform an eye exam on a brachycephalic patient is whilst under anaesthesia.
Active follow-up for resolution of both airway signs but also gastrointestinal signs following surgery. Our goal is to ensure our brachycephalic patients are not lost to follow-up.

Ophthalmology

Ophthalmology Department

Brachycephalic dogs often have under-recognised uncomfortable ophthalmic disease. These include;

abnormally prominent eyes, that are insufficiently protected by their eyelids (lagophthalmos)
increased incidence of hairs contacting the cornea from nasal fold trichiasis (normal hairs orientated towards the eye), medial canthal entropion (lids rolling in), and hairy caruncles (hair growing from conjunctiva at the medial canthus)
Persistently overexposed cornea from macroblepharon (oversized opening between the upper and lower eyelids)
increased risk of traumatic proptosis (eyeball prolapse out of the eye socket getting trapped in front of the eyelids)
distichiasis and ectopic cilia (extra lashes implanted in the wrong location and causing direct trauma to the cornea)
reduced corneal innervation and sensitivity which reduces blinking, tear production and impedes corneal healing
prolapsed gland (cherry eye)and folded cartilage of the third eyelids

The frequent combination of the above disorders leads to an increased incidence of ocular surface disease such as dry eye, ulcerative keratitis (corneal ucleration with inflammation) and pigmentary keratitis (inflammation of the cornea with pigment). These ophthalmic disorders often go undetected by owners, however they can be painful and lead to loss of vision or even the eye.

The BCU, will report on any ophthalmic disorders at the same time as airway surgery. Additionally, patients anaesthetised for elective (not emergency) treatment of an eye condition, will receive an airway examination and report.

Internal Medicine

Internal Medicine Department

Brachycephalic breeds are commonly seen by our Internal Medicine Department for investigation of gastrointestinal or neurological symptoms.

With respect to gastrointestinal disease, symptoms can be exacerbated by brachycephalic airway syndrome. Generally, patients receive medical management until their airways can be addressed and then we closely monitor for ongoing gastro-intestinal symptoms. If these symptoms are ongoing, further investigation is indicated.

Medical investigation for gastrointestinal disease may include;

Fluoroscopic swallow study. This is where we observe a bolus of food enter the mouth and watch its transit to the stomach.
Abdominal ultrasound
Gastrointestinal endoscopy and biopsy
Bloodwork, urine analysis

Neurological symptoms are also seen in brachycephalic breeds and one common cause, is inflammatory meningitis. Generally, these dogs require a cerebrospinal fluid tap (CSF tap) which is performed under a brief anaesthetic.

Diagnostic investigations sometimes require a general anaesthetic. If this is the case, we endeavour to have a surgeon perform an airway assessment. This is not always possible if the patient presents in an emergency situation requiring an anaesthetic as soon as possible. Mostly however a surgeon is available to coordinate with, to examine the airway at the time of anaesthesia and issue an airway report.

Advanced Animal Dentistry:

Brachycephalic dogs are prone to several dental issues. These include;

Impacted or unerupted teeth. The concern here is that impacted teeth if not extract can form dentigerous cysts within the jaw. These cysts are expansile and if not treated can result in extensive damage to the surrounding teeth and bone. Extraction of impacted teeth prior to cyst formation is a far less invasive and extensive procedure. Impacted teeth can be identified when combining the results of a CT examination with an oral examination, and this is one of the many reasons we CT our brachycephalic patients prior to airway surgery.

Overcrowding:

Brachycephalic dogs almost always have a degree of dental overcrowding, which can increase their risk of developing periodontal disease. Prevention of periodontal disease involves good oral hygiene practices and homecare. Implementing homecare strategies early can reduce the development and progression of periodontal disease reducing the number of anaesthetics required for professional cleaning and treatment under general anaesthesia. periodontal

Malocclusion:

Brachycephalic dogs often have a class 3 malocclusion (underbite). This type of malocclusion can be traumatic when the upper incisor teeth contact the soft tissue of the floor of the mouth behind the mandibular incisor teeth. This can result in ulceration of the soft tissue and in some cases exposure of the bone and incisor tooth roots. This can be a painful condition and can be difficult to see in the awake patient. This is why we document this condition by photograph, so that this information can be taken to your family veterinarian or Advanced Animal Dentistry.

Anaesthesia

Brachycephalic patients have arisk of anaesthetic-related complications that is higher than for other breeds. However, we work closely with our Specialist Veterinary Anaesthetist to ensure our anaesthetic practices minimise the risk of an adverse event occurring. Our anaesthetist can also consult with you directly, similarly to a human hospital, to discuss the level of anaesthetic risk for your specific pet. Please ask our team if you would like a consultation with the anaesthetist.

Summary BCU

In conclusion, BCU are a highly dedicated facility and team, that are utilised to their full potential to help reduce the number of visits a brachycephalic pet makes to a specialist hospital, potentially reducing costs to owners, stress to patients and increasing patient care and quality of life.

Brachycephalic patients undertaking airway assessment and surgery with BCU receive;

An Ophthalmic Report
A Dentistry Report

Brachycephalic patients undertaking elective eye surgery with us receive;

An Airway Report
A Dentistry Report

Brachycephalic patients undergoing orthopaedic or spinal procedures with us receive

An Airway Report

Brachycephalic Patients undergoing Internal Medicine Procedures with us will receive an airway report where feasible. Internal Medicine Procedures are often urgent, and it therefore may not always be possible to have a surgeon assess the airways at the time of their internal medicine procedure.