Brachycephalic Syndrome

What and who is affected?

The upper airway of dogs and cats comprises the passages that air moves through on its way to the trachea and lungs and include the nose, sinuses, pharynx, and larynx. There are many different problems that can affect the upper airway and compromise the flow of air. Brachycephalic dogs and cats are prone to upper airway abnormalities, and can often have several different conditions together. A brachycephalic breed is one that has a shortened snout and face such as English Bulldogs, Pugs, Boston Terriers, and Persians. The conditions most often found in these breeds are stenotic nares, everted laryngeal saccules, and elongated soft palate. When these conditions compromise respiration, surgical intervention is necessary.

What are the symptoms?

The symptoms of brachycephalic airway syndrome can include the following:

  • Noisy breathing
  • Excessive snoring
  • Open mouth breathing
  • Gagging and/or choking
  • Exercise intolerance
  • Cyanosis (blue tongue)

These symptoms are exacerbated by hot and humid weather, obesity, exercise, and stress. A diagnosis is confirmed by visual examination of the upper airway. These laryngeal examinations are performed with the aid of sedation or general anesthesia.

Conditions

Stenotic Nares is the medical diagnosis for nostrils that are too narrow to allow normal respiration. These animals tend to breathe through their mouths and wheeze when they try to breathe through their nose. The treatment for this condition is a rhinoplasty. A small wedge of tissue is resected from the side of the nostril and the edges sutured together to widen the nostrils and allow for normal respiration.

Everted Laryngeal Saccules occur in dogs that have compromised upper airway flow. These dogs must work harder to fill their lungs with air, which results in the laryngeal saccules being pulled down into the airway. The laryngeal saccules are small bags of tissue that are positioned in front of the vocal cords. When they are pulled into the airway, they block the opening to the trachea. The treatment for this problem is to remove the saccule tissue.

Elongated Soft Palate can vary from slight to severe. The condition occurs when the soft palate is too long, and if slight, the clinical signs usually consist of snoring. If the soft palate is long enough to hang down into the airway, it can block the opening to the trachea and prevent normal airflow. This is a very serious condition and can sometimes result in a complete obstruction of the airway. The treatment for this condition is to excise the excess tissue to shorten the soft palate.

Post-Operative Care

The post-operative care necessary depends on which procedure, or combination of procedures, were performed. Patients that have only had a stenotic nares repair can often go home the same day. They must wear an Elizabethan collar at all times to prevent them from rubbing or scratching at the sutures in their nose. If everted laryngeal saccules or a soft palate were excised the patient must spend at least one night in the hospital. These surgical procedures can cause inflammation in the throat, which requires supervision. Once home, patients must remain on a soft diet for a minimum of 2 weeks. They must be kept quiet and cool to allow their airways to heal and reduce inflammation.

Complications

The complications involved in upper airway surgery depend on the severity of the patient’s condition. In some cases, additional surgery may be required to resect more tissue if clinical signs persist post-operatively. In very severe cases where a patient has been greatly compromised by their condition, intensive care may be necessary post-operatively, to include a temporary tracheostomy to allow the upper airway to heal.