Challenges with Brachycephalic Conformation
Certain breeds of dogs and cats are prone to difficult, obstructive breathing because of the shape of their head, muzzle and throat. The most common dogs affected are the ‘brachycephalic’ breeds. Brachycephalic means ‘short-headed.’ Common examples of brachycephalic dog breeds include the English bulldog, French bulldog, Pug, Pekingese, and Boston terrier. These dogs have been bred to have relatively short muzzles and noses and, because of this, the throat and breathing passages in these dogs are frequently undersized or flattened. Persian cats also have a brachycephalic conformation.
The term Brachycephalic Syndrome refers to the combination of elongated soft palate, stenotic nares, and everted laryngeal saccules, all of which are commonly seen in these breeds.
- Elongated Soft Palate is a condition where the soft palate is too long so that the tip of it protrudes into the airway and interferes with movement of air into the lungs.
- Stenotic Nares are malformed nostrils that are narrow or collapse inward during inhalation, making it difficult for the dog to breathe through its nose.
- Everted Laryngeal Saccules is a condition in which tissue within the airway, just in front of the vocal cords, is pulled into the trachea (windpipe) and partially obstructs airflow.
Here is a helpful anatomy diagram to help you visualize some of these features.
Brachycephalic Syndrome Symptoms
Dogs with elongated soft palates generally have a history of noisy breathing, especially when they breathe in. Some dogs will retch or gag, particularly while swallowing. Exercise intolerance, cyanosis (blue tongue and gums from lack of oxygen), and occasional collapse are common, especially after too much activity, excitement, or excessive heat or humidity. Obesity will also aggravate the problems. Many dogs with elongated soft palates prefer to sleep on their backs. This is probably because this position allows the soft palate tissue to fall away from the larynx. The signs associated with stenotic nares and everted laryngeal saccules are similar.
Stenotic nares can be easily diagnosed on physical examination. Definitive diagnosis of both elongated soft palate and everted laryngeal saccules can only be made with the patient under anesthesia. Generally, brachycephalic breeds have a thick tongue that makes visualization of the larynx in an awake animal very difficult. Attempts to restrain the patient and pull back the tongue sufficiently to allow visualization of the larynx are generally unsuccessful.
Under anesthesia, elongated soft palates extend past the tip of the epiglottis (the entrance to the airway). In severe cases the soft palate will extend directly into the laryngeal opening. The tip of the soft palate and the edges of the larynx are often inflamed (swollen and red). In chronic cases, the cartilages of the larynx become inflexible and begin to collapse, further narrowing the airway.
Everted laryngeal saccules look like blue-gray soft tissue masses protruding into the airway just in front of the vocal folds. Your primary care veterinarian may also recommend chest x-rays to evaluate your pet’s lower airways and lungs.
Treatment and Repair
Soft palate abnormalities should be treated if they cause distress to your pet, become more severe with time, or cause life-threatening obstruction. If your pet shows gagging, coughing, exercise intolerance, or difficulty breathing, resection of the excess soft palate may be necessary.
Soft palate resection (staphylectomy) is performed using a scalpel blade, scissors, or CO2 laser. The palate is stretched and the excess tissue is removed with a blade or scissors. If the laryngeal saccules are everted, they may be removed at the same time as the soft palate resection, or they may be left in and allowed to return to a more normal position. Correction of stenotic nares, if present, helps improve breathing and is typically done at the same time.
Here is an example of a dog with stenotic nares, before and after corrective surgery (courtesy of Veterinary Practice News) – what a difference this can make to ease their breathing!
What to Expect
After your initial consultation with our surgeon, if you decide to go ahead with surgical repair for your companion’s condition, there are some details to consider in order to make the surgery and recovery process as smooth as possible for yourself and your companion. Below you will find a collection of key information to help you understand exactly what to expect. Once you have had a chance to review this information, we are happy to answer any questions or concerns you may have – please feel welcome to ask!
Typical Treatment Schedule
- Fluoroscopy – This diagnostic may be requested before surgery to confirm presence or absence of a hiatal hernia, as precautions need to be taken during surgery if this condition present.
- Surgery Day! – Generally a full day in hospital, with a morning drop-off and late afternoon discharge. Brachycephalic patients are monitored especially closely after surgery to ensure that there is no swelling or inflammation blocking their airways as they recover.
- Re-Checks – Sutures are dissolvable, and post-surgery rechecks are usually not required after these procedures unless there are any concerns noted. We’re always happy to answer any questions that come up during recovery.
Preparing for Surgery
Take the time before Surgery Day to prepare your home to welcome your companion back after their procedure. It’s much easier to make sure your space is prepared ahead of time, rather than struggling to sort things out with a groggy companion on your hands. Because you will need to restrict your companion’s movement after surgery so they can rest and heal, make sure you have an enclosed area of your home set up for them. You might want to move their crate or bed into the area, getting them used to where they will be spending most of their time.
One of the most important instructions to follow when preparing for Surgery Day is to stop offering your companion access to food about 12 hours before the procedure (but in most cases they should retain access to water). We generally flag 10 PM the night before as the cut-off time for food, although your vet will let you know if they recommend any changes to this. The reason it is so important to fast animals before surgery is to prevent them from accidentally inhaling any regurgitated food into their lungs while they are under anesthetic. Sometimes the anesthetic drugs can cause vomiting; because your companion’s muscles will be relaxed under sedation, their swallowing reflex is suppressed and it is easy to choke or inhale material into the lungs. For this reason, it is much safer to enter surgery with an empty stomach.
As the day of the procedure approaches, maintain your regular routine as much as possible so that your companion feels settled and secure. The day before, make sure to take them for a good walk or have a good play session so that they have a chance to burn off some extra energy, but avoid excessive roughhousing to make sure they’re not starting their day with sore muscles. Feed them their dinner at a regular time, and allow them to settle down for the evening as normal.
In the morning, plan ahead to make sure you’ve got a bit of extra time. Make sure that your wake-up time allows for morning medications to be given three hours before your appointment time. Take your companion for a short walk so they have a chance to go to the bathroom – if this isn’t successful, let the team know when you drop your companion off so we can make sure that they have another chance to go out before their procedure. Also allow plenty of travel time to get to the hospital, helping to minimize stress for everyone involved.
When you arrive, please feel welcome to ask us any final questions. We are happy to clarify anything, and will be looking forward to connecting with you after the surgery to let you know exactly how things went.
PVPs are medications chosen to address specific neurotransmitters associated with fear, stress, and anxiety. They can have a sedating and anxiety-reducing effect, helping to keep your companion calm and comfortable on surgery day. Giving these medications before anesthesia also often reduces the volume of sedation drugs used during the surgery. We also typically prescribe a medication that helps to reduce any nausea they may feel from the anesthetic drugs, and can help them with their appetite when they return home.
Ahead of your appointment, the surgical team will discuss any ongoing medications or supplements your companion is taking, to evaluate if they will have any impact on the surgical protocol. It may be the case that you will need to stop giving some medications (such as those that impact circulation, for example) ahead of the procedure day.
On your admission form, you’ll also be asked to confirm the medications and dosages you are giving your companion – this information is very important, as having a full picture of the pharmaceuticals your companion is taking can help the surgeon create the safest and most effective anesthesia protocol possible.
Brachycephalic patients are also typically prescribed medication prior to surgery to help reduce the acid content of their stomach and to prevent nausea. These breeds are at a higher risk for gastroesophageal regurgitation during surgery, and these medications help manage this risk.
Depending on the nature of your companion’s condition and the type of repair surgery required, the details of your post-surgical care may vary – during your discharge appointment, one of our veterinary technicians will go over exactly what you’ll need to do to support your companion. There will be a variety of medications to manage pain, prevent infection, and help keep them quiet during their initial recovery phase. Below you will find information on the key aspects of post-surgical care – please read through this information before Surgery Day, so that we can help answer any questions or concerns you may have.
A significant factor in ensuring a successful surgery is what happens after the main event – the recovery process. Fortunately there is plenty you can do to help your companion heal safely in the days following surgery. While this information may be most helpful for orthopedic surgeries, many of the tips and tricks will prove helpful in keeping your companion safe and comfortable during their recuperation.
Sometimes called a cone or lampshade, an Elizabethan collar is a plastic device that fits around your companion’s neck and is designed to keep them from licking, biting, or pawing at their surgical sites. Essentially, its purpose is to keep your companion from hurting themselves during their recovery – here’s how to help them stay safe and comfortable along the way.
Laser therapy assists in tissue repair by encouraging blood vessels to dilate – this increases the blood flow to the tissue, bringing in oxygen and the cells involved in the healing process. The main benefits of Laser therapy include decreased inflammation, decreased pain, and improved wound healing.