Brachycephalic Syndrome in Short-Nosed Dogs
A treatable condition found in short-nosed dogs, Brachycephalic Syndrome can lead to severe respiratory distress due to three distinct anatomical abnormalities.
By Michael Huber, DVM, MS
Diplomate ACVS
Overview
The “squished“ faces of Bulldogs, Frenchies and Pugs are certainly cute but often lead to serious respiratory problems. The term brachycephalic means shortened head. These types of dogs, as well as cats such as Persians, have a much smaller space for all the normal soft tissue structures of the head. This can lead to a variety of respiratory problems. Brachycephalic syndrome includes 3 distinct abnormalities – stenotic nares, elongated soft palate, and everted laryngeal saccules. These abnormalities are commonly seen in the brachycephalic breeds.
Definitions
Stenotic nares: narrowed external nostrils
Elongated soft palate: palate that is too long and blocks or enters the larynx (voicebox)
Everted laryngeal saccules: soft tissue in front of the vocal folds which obstructs the airway
Dogs with chronic signs may also have damage to the laryngeal cartilages themselves causing them to become weak. This can lead to a condition known as laryngeal collapse.
Signs
Pets with brachycephalic syndrome typically are loud breathers with a tendency for snoring. These signs can get worse with over activity, excitement, and excessive heat. Gastrointestinal signs such as regurgitation and vomiting may also be noted.
Diagnositics
Stenotic nares are easily diagnosed on routine physical examination. Elongated soft palate is presumptively diagnosed but needs confirmation with a sedated oral examination as well as everted laryngeal saccules. Generally, routine bloodwork (CBC, chemistry, urinalysis) and thoracic radiographs are recommended for general anesthesia required for treatment.
Treatment
Medical management is usually not successful as a sole treatment but aids in the pre/postoperative period. Weight loss, exercise restriction and environmental modification are recommended.
Stenotic nares: surgical correction of this condition requires making the external nostril larger. This procedure is known as a rhinoplasty. Figure 1 shows a before and after image of a dog undergoing a punch alaplasty.
Elongated soft palate: surgical correction of this condition requires shortening the palate to the level of the tip of the epiglottis or caudal margin of the tonsil. Methods include resection with suture closure or CO2 laser surgery. Figure 2 is a video of a CO2 laser procedure to shorten the soft palate.
Figure 1: Before (right) and after (left) punch alaplasty in a dog with stenotic nares.
Figure 2: Video of CO2 laser procedure to shorten an elongated soft palate.
Aftercare
Pets are monitored in the ICU overnight since significant swelling can occur albeit rare. If rhinoplasty has been performed a collar with need to be worn for 10-14 days to prevent rubbing of the surgical site which can lead to scarring and stenosis.
Prognosis
Prognosis is generally very good if treated early. In advanced cases where laryngeal collapse has occurred, a permanent tracheostomy may be required.
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