Documentos de Académico
Documentos de Profesional
Documentos de Cultura
of the Dog
M. J. Bojrab, DVM, MS, PhD, Larry A. Nafe, DVM
Some of our readers may wonder at the subject of this article, and TRACHEAL COLLAPSE
think that it somehow crept into the wrong journal. However, every Incidence
now and then it seems good policy to lift one's eyes from the work at
A number of cases of trachéal collapse in the dog have
hand to appreciate the breadth of influence of the modern suppor¬
tive techniques that we have become familiar with. Increased been recorded. Baumann (1941)' was the first to describe
future communication between the disciplines of veterinary and the condition. No further reports were published until 1960,
human surgery can lead to nothing but benefit to both parties.- when Leonard- mentioned a case. Since that time, over 40
Richard Warren, MD cases of trachéal collapse have been reported.:1 The cause of
collapsed trachea is unknown. Although obesity and head
conformation have been mentioned as predisposing causes,
\s=b\ Major surgical procedures in veterinary medicine have it is usually described as an acquired lesion found in
increased in sophistication and number. An area that has middle-aged dogs of miniature and toy breeds.1 In these
received much attention recently is surgery of the head and neck cases, there is no loss of potential trachéal ring size,
of the dog. This article discusses some new techniques that have
although the rings do lose their ability to remain firm, and,
gained popular usage in recent years. Repair of tracheal subsequently, collapse. To date, there is no published
collapse, treatment of salivary mucoceles, pharyngostomy, and information to our knowledge on the chemical contents of
atlantoaxial subluxation are the procedures reviewed.
trachea! rings in dogs with normal vs collapsed tracheas.
(Arch Surg 112:1013-1018, 1977) This condition has also been described in young dogs as a
congenital lesion.
progressed tremendously in the
surgery has Clinically, both the acquired and congenital conditions
Veterinary
past
seeking
are
increasing number of veterinarians
ten years. An
advanced training in veterinary surgery. The
have the same presenting signs.5 The condition causes
respiratory embarrassment due to dorsoventral narrowing
recent trend toward specialization is reflected in the of the trachéal lumen. Its major pathological feature is a
growth of membership in the American College of Veteri¬ weakened, flaccid trachealis muscle and annular trachéal
nary Surgeons. This specialty group, founded in 1965 by a ligaments that connect the cartilaginous rings dorsally in a
few charter members, presently has over 100 members. bowstring effect. This weakening and stretching of the
Paralleling this increased interest in surgery as a specialty soft tissues allow the rings to flatten and the trachea to
is an increase in the veterinary literature of new surgical assume a lunate rather than circular shape (Fig 1). The
techniques, as well as modifications of existing surgical major clinical sign associated with trachéal collapse is a
techniques. This article discusses a few techniques that continual honking cough. In severe trachéal collapse, the
have recently gained widespread utilization in appropriate animal may have persistent respiratory infections. The
canine cases. diagnosis is confirmed by palpation of the cervical trachea,
tracheoscopy (endoscopie), and cervical as well as thoracic
roentgenograms." These roentgenograms must be taken on
Accepted forpublication Dec 23, 1976. both inspiration and expiration in order to illustrate the
From the Department of Veterinary Medicine and Surgery, College of
Veterinary Medicine, University of Missouri, Columbia (Dr Bojrab), and the trachéal collapse."
Animal Medical Center, New York (Dr Nafe).
Reprint requests to Veterinary Teaching Hospital; Department of Medi- Indications
cine and Surgery; College of Veterinary Medicine; University of Missouri,
Columbia, MO 65201 (Dr Bojrab). Surgical correction is currently being performed on only
Fig 2.—Plication of dorsal soft tissue struc¬ Fig 3.—Representation of mattress suture
ture with Allis tissue forceps to determine placement in trachea (from Rubin et al6).
amount of eversión required (from Rubin
et al6).
Fig 5.—Lateral view of head of dog. Skin Fig 6.—Mandibular salivary gland is Fig 7.—Hemostat is placed across sublin¬
incision (arrow) for salivary gland resec¬ grasped with Allis tissue forceps and gual gland as far rostrally as possible prior
tion is shown in relation to mandibular sublingual salivary gland is dissected with to ligation (from Harvey16).
salivary gland (from Harvey16). Metzenbaum scissor (from Harvey16).
(Fig 7). Care is taken to make sure that the rostral rapid, and consists of making an incision caudal to the
polystomatic sublingual glands are retracted and removed. angle of the mandible into the pharyngeal recess (Fig 8). A
The duct is then ligated rostral to the hemostat with 2-0 flexible plastic tube is then grasped with forceps and
chromic gut, and the duct is then replaced in the incision. drawn into the pharynx through the incision. The
The subcutaneous tissue and skin are closed in the normal previously measured tube is passed down to the stomach
manner.1" and the external end is sutured to the skin of the pharyn¬
The mucocele itself is aspirated or drained by a ventral gostomy incision (Fig 9).s·21-' The tube must project only a
incision to remove the accummulated saliva. Postoperative few centimeters exterior to the incision. Capping of the
care consists of supportive treatment. tube when not in use is necessary to avoid loss of gastric
contents and inflow of air. The skin edges of the incision
PHARYNGOSTOMY TUBE will begin to granulate, but will not close due to the
Anorexia is a serious complication of many diseases of presence of the tube. However, once the tube is removed,
dogs and cats seen by the veterinary practitioner. Labora¬ healing is rapid, and rarely does the incision require
tory dogs and cats often become stressed from shipping, surgical closure.
and upper respiratory infections develop and they stop
BULLA OSTEOTOMY
eating. The success of the treatment regimen often is Incidence
dependent on fulfilling the nutritional needs of the animal
until the specific therapy becomes effective.-" In these Ear infection is widespread in the canine population
animals, a pharyngostomy tube is indicated, through which throughout the world. It has been reported at one univer¬
the caloric requirements can easily be administered. sity veterinary teaching hospital that one out of eight
Other indications for a pharyngostomy tube are postop¬ animals brought to the hospital are clinically affected with
eratively, after oral or esophageal surgery, and to remove otitis.-4
gas fluid accumulation from the stomach, such as in the
or Otitis media in the dog is commonly caused by an
gastric dilation and torsion syndrome. The technique is extension of otitis externa. Often, standard medical treat-
Thyroid cartilage
*ç~ Cricoid cartilage
Trachea
Fig 11.—Congenital absence of odontoid Fig 12.—Rupture of ligaments with sublux¬ Fig 13.—Fractured odontoid process with
ation of atlantoaxial joint. Arrows indicate subluxation of atlantoaxial joint. Arrows
(dens) with lack of joint support and abnormal rotational relationship between indicate abnormal rotational relationship
subluxations. Arrows indicate abnormal
rotational relationship between atlas and atlas and axis (from Gage28). between atlas and axis (from Gage28).
axis (from Gage28).
Fig 16.—Two drill holes being placed in dorsal spine of axis (from
Gage28).
References
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