4. Brachycephalia, the Brachycephalic Syndrome and Anatomical Changes in the Nose Balances in Dogs
Considering the large number of dog breeds, we know that morphological differences of these breeds are highly varied and easily discernible. This is one of the reasons why in cynology three types of dog breeds were established: dolichocephalic, mesocephalic and brachycephalic [
2]. The term “brachycephalic” means literarily “short, wide-headed” [
23]. Brachycephalic breeds are easily recognized by their shortened nose and widely spaced, shallower eye sockets than in the other types of dogs. In dogs, a number of craniofacial anomalies can contribute to brachycephaly, including reduction in bone length, chondrodysplasia of the base of the skull and changes in the position of the palate relative to the base of the skull [
88]. According to many studies, these dogs may suffer from the brachycephalic syndrome and respiratory problems, among others.
Brachycephaly is associated with the modification of the skeleton and skull [
89]. This results in a distinctive short and very often flattened dorso-ventral snout. This is a result of deliberate efforts by breeders to select dogs for breeding so that they develop local chondrodysplasia and generate individuals with an even more shortened facial skeleton [
90,
91]. In recent years, there has been a significant increase in the popularity of brachycephalic breeds. According to the British Kennel Club, registrations of French bulldogs increased by 3104%, pugs by 193% and English bulldogs by 96%. Similarly in Australia, according to the ANKC, in the period of 1987–2017, there was an upward trend in the registration of French bulldogs by 11.3% (percentage of the total number of purebred dog registrations), pugs by 320% and English bulldogs by 324% [
92]. However, it is impossible not to mention the other side of the coin. In 2014, the Dutch government passed a law prohibiting the breeding of dogs with short mouths with features that may adversely affect the health of dogs and their descendants. Therefore this law applies to all races that have an exaggerated appearance. However, it is not about forbidding the reproduction of selected breeds altogether. Dutch law aims to eliminate from further breeding only those individuals whose physique may cause suffering or serious discomfort to dogs [
93].
Despite the growing popularity of these breeds worldwide [
55,
68,
94], it has been shown that the morphological changes are relatively serious and are associated with hereditary head and neck disorders [
55,
56]. In brachycephalic dogs, the shortened base of the skull also includes a reduction in the length of the nasopharynx [
57]. All the congenital anomalies and anatomical abnormalities observed in these breeds, in particular those affecting the respiratory system, but also digestive, eyes, skin and other systems, are described jointly by one term: the brachycephalic syndrome.
The brachycephalic syndrome, also known as the obstructive brachycephalic respiratory syndrome (BAOS or BAS), is a fairly well-described ongoing process of anatomical and functional disorders of the respiratory and digestive systems [
94,
95]. Dogs diagnosed with BAOS tend to have severe breathing problems as a consequence of the anatomical deformities in the head [
96,
97]. The basic conditions of the brachycephalic syndrome include congenital anatomical abnormalities such as narrowed nostrils, an elongated soft palate, hypoplastic trachea and nasopharynx and changes in the structure of the nasal turbinates.
Figure 5 shows an English bulldog with manifestations of the brachycephalic disorders typical of this type of breed, classified as the brachycephalic syndrome.
Figure 5. The figure shows an English bulldog. Visible here are signs that are typical for many brachycephalics, classified as the brachycephalic syndrome, such as narrowed nostrils, hypertrophy of the tongue, soft palate or nasal turbinates. Based on [
10].
The above-mentioned anatomical abnormalities modified the physiology of the respiratory system in brachycephalic breeds [
98]. Primary abnormalities such as narrowed nostrils or enlarged turbinates can lead to a significant increase in breathing effort to overcome airway resistance [
99]. Chronic airway obstruction in brachycephalic dogs can lead to secondary lesions, including soft palate hypertrophy, laryngeal edema, laryngeal sac degeneration and laryngeal collapse [
100].
Clinically, dogs show signs of respiratory distress such as severe dyspnoea, wheezing, coughing, snoring, reluctance to exercise, increased breathing effort, hyperthermia and even collapse [
101]. This condition occurs because, despite a marked reduction in the length of the craniofacial skeleton [
57], the structures of the soft tissues of the oral cavity and nasal cavity (e.g., soft palate, tongue, tonsils) are not proportionally reduced [
102].
In addition to the BAS elements noted above, the authors have observed and documented the presence of the nasal turbinates extending caudally from the nasal cavity to the nasopharynx [
44]. The unique anatomy of the skull in the brachycephalic breeds may explain the development of turbinate hypertrophy. The nasal turbinates, along with most of the other bones in the skull, originate from the ectoderm, while the other bones in the body come from the mesoderm. Some bones are formed by ossification on a membranous substrate and tend to form close to the structures they contain [
43]. In contrast, cartilage bones continue to grow and ossify only after the end of pregnancy. They are less plastic and tend to grow fully. The nasal turbinates are formed precisely as a result of endochondral ossification, and thus they can grow beyond their immediate vicinity [
103,
104]. Therefore, in the brachycephalic breeds, the ethmoid turbinates may show a tendency to significantly overgrow into the nasopharynx due to the limited space in the already ossified nasal cavity [
44]. The resulting contact between the mucosa-covered turbinates hinders the flow of air through the nose [
56]. This is not a normal structure of the initial airway, and studies have shown that turbinate hypertrophy to the pharynx is a common condition in brachycephalic dogs [
44]. Clinical cases with hypertrophy and deformation of the nasal turbinates toward the pharynx have been reported many times, while the influence of these anatomical anomalies on the occurrence of BOAS is not fully understood. The most common brachycephalic breeds around the world are pugs, English bulldogs and French bulldogs. Both pugs and French bulldogs are classified as extremely brachycephalic dogs, but there are differences in these breeds concerning clinical signs and skull structure. In pugs, turbinate hypertrophy is a particularly common disease because, despite the shortening of the facial skeleton, it does not shorten the turbinates [
105]. It is assumed that turbinate hypertrophy affects up to 21% of these dogs. That is why it is so important to evaluate the nasopharynx for turbinate hypertrophy in all brachycephalic dogs using various methods, including upper respiratory endoscopy [
44]. Several other diagnostic methods are also used to assess the anatomical and dynamic changes associated with BOAS, including radiography and computed tomography (CT) [
106], while craniometric measurements are also analyzed. In particular, CT allows the obtained data to be reformatted into multiplanar and three-dimensional images. This allows the entire initial airway and throat structures to be visualized. To date, few studies have been published on the CT assessment of the anatomy of the initial airways in brachycephalic dogs, none of which have looked at the measurement of hypertrophied turbinates in specific breeds such as the pug or the bulldog [
104,
107,
108]. These few studies suggest that further characterization and studies of nasal turbinates and their hypertrophy are important. For this purpose, it is worth using computed tomography and three-dimensional imaging tests, which can additionally help characterize the structure of the nasal turbinates and their anatomical anomalies. Research evaluating the prevalence among the breeds as well as the contribution of these structures to the increase in airway resistance and clinical symptoms of the brachycephalic syndrome is warranted. Further anatomical and histological observations in this direction are recommended, which shows that this topic needs to be investigated further, in more detail [
44].