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Brachycephalic Airway Syndrome

By Dr. Meghan Sullivan, DVM, DACVS | Nov 01, 2019

Brachycephalic airway syndrome is a common syndrome which is found in breeds who have been purposely bred to have shortened skulls. French Bulldogs, English Bulldogs, Boston Terriers, Pugs, and Cavalier King Charles Spaniels are some of the most common breeds with this condition. The shape of their head results in redundant soft tissues in the airway which causes impaired breathing and sometimes obstructive breathing.

Brachycephalic airway syndrome consists of stenotic (narrowed) nostrils, elongated soft palate, and a severely narrowed trachea. Clinical signs of brachycephalic airway syndrome includes exercise intolerance, stertorous (noisy) breathing, and snoring. Some pets will gag or retch especially while swallowing. Pets with stenotic nares have secondary increase in airflow resistance and therefore increased negative inspiratory pressure. This pressure results in the redundant upper airway tissues getting sucked in and causing progressive collapse of the airway including everted laryngeal saccules, laryngeal and pharyngeal, and lower airway collapse. If you can imagine sucking air from a deflated balloon, you can understand how the airway collapses.

Diagnosis of brachycephalic airway syndrome is two-fold. Examination of the pet awake will reveal a narrowed (stenotic) nares. A sedated oral examination is required for further evaluation of elongated soft palate and collapse of the larynx.

Surgical correction with a certified specialty surgeon is recommended for any brachycephalic breed with clinical signs of airway issues. These patients have an increased risk of anesthetic complications and the surgery and aftercare must be precisely planned. The nostrils are widened surgically so that they can pass air more readily. The soft palate is trimmed to the correct length so that it does not get sucked into the airway. If the laryngeal saccules are everted those are removed at the same time. Surgery is very quick and routine and carries an excellent prognosis.

Brachycephalic airway syndrome is a progressive condition with age and also worsens with obesity. The ideal time to have the airway evaluated and surgically corrected is at the same time as spay or neuter. Patients who undergo surgery at a young age have a fantastic prognosis and tend to recover very well from anesthesia and surgery. As patients age and the negative pressure causes worsening of the airway, the surgical recovery and anesthesia recovery can become more challenging and risky. A very small percentage of patients require a temporary tracheostomy if they have significant swelling post-op for a day or two to help with their recovery. If laryngeal collapse is too far advanced as the pet has aged, then the prognosis is poor, and only rarely a permanent tracheostomy tube may be recommended.

It is recommended for one overnight stay postoperatively and then patients have a short rest period for about a week at home to recover from surgery. Performing the brachycephalic airway surgery on young pets when they are neutered/spayed is helpful to prevent them from requiring separate anesthesia episodes. Most owners notice marked improvement in their pet’s quality of life including better ability to exercise, less noisy breathing, less gagging/choking on food or water, and less progression of breathing difficulty.

Dr. Meghan Sullivan, DVM, DACVS

Portland Veterinary Emergency and Specialty Care