Brachycephalic Upper Airway Syndrome

Brachycephalic Upper Airway Syndrome

By Dr. Ed Mapes
Stonebridge Animal Hospital
McKinney, Tx

Animals with shortened noses and mouths are called the brachycephalic breeds. We all know how breeds like Bulldogs, Boston Terriers, Boxers, Shih Tzus, Lhasa Apsos, Pekingese, and Pugs look like they ran head first into a wall. Persians are examples of brachycephalic cats.

These animals are well known for the snorting, gurgling, and drooling they do, and it can all be associated with being a brachycephalic. Some of these animals, though, can have severe airway restrictions that make breathing even more difficult; a situation that can become life threatening under certain conditions – these unfortunates suffer from the Brachycephalic Upper Airway Syndrome.

Symptoms of trouble are worse at exercise, and include louder breathing sounds, slobbering, and decreased ability to exercise. You’ll see elevated respiratory effort, very rapid breathing rates, possibly cyanotic (blue) oral membranes, and even collapse if they attempt vigorous activity or become overheated. These pets usually adopt more sedentary lifestyles rather than being more active.

The upper airway consists of the nose, sinuses, pharynx, and larynx. There are a variety of problems that can affect the upper airway and compromise normal air flow, and brachycephalics are especially prone to these abnormalities. Problems include stenotic nares, elongated soft palates, and everted laryngeal saccules. These patients can have any or all of these conditions. Breathing and quality of life will always be compromised in those with more serious forms of this syndrome, and they should be considered candidates for surgical correction of their abnormalities.

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The Bulldog in this picture has severely under-developed nasal openings; the classic stenotic nares. Note the prominent facial fold that, left untreated, will always be prone to yeast infections and dermatitis. This facial fold can also be corrected during the same procedure to relieve the Upper Airway Syndrome.

Stenotic nares are abnormally narrow nostrils. Some patients I’ve operated on have had almost no openings at all, and surgical restoration of the nares makes a significant improvement in their breathing. Air can actually get through at last!
The surgery has traditionally been a bloody one when scalpel and scissors were used, but the new laser surgical techniques make this procedure much easier and faster, with very little bleeding and post-op swelling.

Overlong Soft Palate Some dogs are born with a soft palate that is too long. It extends back into the throat, and produces severe rattling during breathing. Dogs with this condition have to exhale with more force than normal, leading to swellings of the larynx and damage the trachea as well; this makes breathing even more difficult. These are the cases that can become the most serious.
Correction of the overlong soft palate is a procedure that the laser has also made much safer; again due to the control of bleeding.

Tonsillitis Many dogs undergoing these procedures are also found to have swollen tonsils because of chronic inflammation. The enlarged tonsils are usually removed during the same procedure.

Everted Laryngeal Saccules and Collapsing Trachea can occur as primary problems, but are more commonly secondary conditions that result from the increased effort to breathe. Everted laryngeal saccules represent swelling of normal tissue in the larynx that protrudes into the airway and restricts breathing. These can also be resected at surgery.
The collapsing trachea can occur secondary to the respiratory syndrome. My usual recommendation is to correct the stenotic nares, overlong soft palate, and swollen tonsils as the first step in treatment. Many patients’ breathing is so much better with these procedures that the other conditions improve to the point that surgery is not needed.
Left untreated, animals with Brachycephalic Upper Respiratory Syndrome must live their lives with constant breathing difficulty. They are forced to sacrifice their normal energetic natures and love of physical activity – in fear that a breathing crisis will occur. The procedures we use to alleviate these difficulties have now been made so much safer for the patient that none of these animals should have to live in fear of passing out. We really can help these guys, now even better than before.

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