Primary conditions include elongated soft palate, hypoplastic trachea, and stenotic nares.
Brachycephalic airway syndrome
Primary conditions include elongated soft palate (62 to 100% incidence), hypoplastic trachea (11 to 46%), and stenotic nares (17 to 85%). Secondary conditions include everted laryngeal saccules (48 to 87%), everted tonsils (5 to 21.3%), and laryngeal collapse (8 to 53%).
Breeds include the English Bulldog (61% incidence), Pug (21%), Boston Terrier (9%), French Bulldog, Pekingese, and Shih Tzu, ranging from 0.5 to 4 years of age. Brachycephalic dog breeds have a congenital shortening of the skull.
Pathophysiology
Stenotic nares are nasal cartilage malformations, that collapse. The elongated soft palate causes vibration andinflammation, obstructing the airway and everting the laryngeal saccules. Hypoplastic trachea is a narrowed trachea. With disease progression, laryngeal collapse occurs.
Signs include inspiratory stertor/stridor (69% incidence) and dyspnea (53 to 61%).
Diagnostics
Intra-oral examination, pharyngoscopy, and laryngoscopy is performed under sedation/general anesthesia. Thoracic radiographic findings may include bronchopneumoniaand hypoplastic trachea.
The clinical signs seen with brachycephalic airway syndrome can mimic other conditions in dogs. Online veterinary telemedicine is available for those situations where the additional stress of bringing the pet to the veterinarian could exacerbate these signs.
Treatment
Sedatives, anti-inflammatory drugs, oxygen, body weight management, and decreasing stress and environmental temperature are recommended. The soft palate is shortened. Nares, laryngeal saccules, and tonsils are removed. Depending on the severity, treatment for laryngeal collapse may include the above surgeries plus partial arytenoidectomy and permanent tracheostomy tube placement.
Post-operative complications (12% incidence) include pneumonia, coughing, gagging,nasal discharge, and dysphonia.
Outcome
Dogs under a year of age show excellent and moderate outcomes 1 year post-operatively in 98% of cases. Based on owner evaluation, the success rate ranges from 64 to 89%.
Shadi Ireifej DVM DACVS
