Brachycephalic breeds seem to have a foreshortened skull with the full complement of soft tissues, and perhaps even some of the bony structure (turbinates) confined in a smaller area. The accepted conditions of the syndrome include stenotic nares, overlong soft palate, and hypoplastic trachea. Concurrent nasopharyngeal turbinates, macroglossia, and bronchial anomalies can confound the condition, making treatment more difficult. Secondary laryngeal collapse, the first stage of which is everted laryngeal saccules, occurs due to increased resistance to air flow. Stage I is eversion of the mucosa of the laryngeal ventricles, outpouchings between the vestibular and vocal folds, known as everted laryngeal saccules. The over long soft palate usually occludes the dorsal aspect of the glottis, and everted saccules will occlude the ventral glottis. Stage II laryngeal collapse is defined by cuneiform cartilage collapse, and Stage III is defined as collapse of the corniculate processes. Gastrointestinal diseases have also been described in brachycephalic breeds as has treatment options. The significant decreased intra-pleural pressure required to overcome the upper airway obstruction may contribute to vomiting and regurgitation and perhaps even hiatal herniation.

Surgical goals are to correct the anatomy that can be: stenotic nares revision, shortening of the soft palate, and excision of the everted laryngeal saccules. Improvement is seen in the majority of cases; however, tracheal and bronchial abnormalities remain, and nasopharyngeal turbinate resection does not necessarily result in permanent opening of the nasopharynx. Standard soft palate resection does not result in decreased thickness of the palate, which can be addressed by the procedure suggested by Dupre, et al. With this procedure, oropharyngeal mucosa is resected, and the remaining flap is sutured intra-orally to shorten and decrease the thickness of the palate.

Treatment depends on the diagnostic approach used and preference of the surgeon. CT scanning can delineate the presence of nasopharyngeal turbinates as can endoscopy with a rigid (120 degree) or flexible (retroflexed view) endoscope. The information is useful if the clinician chooses to address these turbinates or for owner education. Laser turbinectomy is specialized and requires exceptional patience and attention to detail if done in air. Reports on laser resection in a fluid medium have not been reported.

Stenotic nares may be done by vertical or horizontal wedge resection, laser resection, and by vestibuloplasty techniques. A wide opening and one that is symmetrical would be preferred. Eversion of the laryngeal saccules must be done with the anatomy in mind. The author uses Cushing Dura forceps and retracts the mucosa medially, then laterally so that the vocal folds are visualized and protected. Strongly curved Metzenbaum scissors are very helpful and ideally the mucosa is removed with a single incision to ensure all mucosa is resected. Hemorrhage is usually minimal and controlled with pressure. Soft palate resection can be done with the standard scissors and suture in a "cut and sew" fashion to avoid loss of the dorsal mucosa. Suturing is required for hemostasis. Avoidance of the lateral aspects will help to decrease significant hemorrhage that cannot be controlled with laser. The author makes a vertical incision paralleling the tonsil on one side, and then arches the excision to the middle of the tonsillar crypts and continues to the contralateral side, ending with another vertical incision paralleling the contralateral tonsil. The surgery is done in the "cut and sew" method.

Outcome Following

Sixty-two (62) dogs: excellent 47%, good 47%, 3.2% mortality. Good = some limits on physical activity. Riecks TW, et al. J Am Vet Med Assoc. 2007;230:1324–1328.

Ninety (90) dogs: 12% complication rate, 4% mortality, 10% noisy, dehiscence, regurgitation. Fasanella FJ, et al. J Am Vet Med Assoc. 2010;237:1048–1051.

Seventy-three (73) dogs: 56% much improved, 33% some improvement, 11% no improvement. Persistent signs = snoring (74%), stertor or stridor (50%), excessive panting (28%), dyspnea (10%). This study did not use the typical grading scheme for laryngeal collapse. Torrez CJ, Hunt GB. J Small Anim Pract. 2006;47:150–154.