Secondary changes are eversion of the laryngeal saccules (Figure 4) and laryngeal collapse. These two components occur from
lifelong excessive inspiratory pressures that place undue stress on the airway structures. In most cases, eversion of the
laryngeal saccules usually occurs earlier than laryngeal collapse.
Figure 4: After the soft palate has been mobilized (same patient as in Figure 1), the arrow points to the white, shiny, everted
laryngeal saccules. Also note the amount of glottic area obstructed by the eversion of this tissue.
The saccules can be removed by excision and allowed to heal by second intention. Swelling of the saccule sites can cause airway
obstruction postoperatively. Once laryngeal collapse occurs, the prognosis becomes guarded, and treatment can be fraught with
complications. There are no widely accepted techniques to treat laryngeal collapse. When clinical signs progress, permanent
tracheostomy or euthanasia is usually required.
Perioperative and postoperative care
Antibiotics are not necessary perioperatively. Preoperative administration of anti-inflammatory medication is recommended
after soft palate resection and sacculectomy. Antiemetics can limit gagging and vomiting; these should be administered to
the patient preoperatively.
Any patient undergoing upper airway surgery must have tracheal intubation and may require temporary tracheostomy postoperatively
for relief of airway obstruction caused by swelling, hemorrhage or a combination of the two. Oxygen therapy is administered
in the postextubation period. Animals with preoperative respiratory crises or that have moderate to severe clinical signs
need close monitoring after intubation. Reintubation and temporary tracheostomy should be anticipated if obstructive signs
The need for tracheostomy seems greater in dogs requiring multiple airway procedures and intraluminal manipulations (sacculectomy).
In most cases the tracheostomy is needed for about 48 hours or as long as needed to allow swelling to decrease. Ensuring that
patients are both comfortable and calm means avoiding situations that induce heavy panting, barking and exertion, which can
create inflammation. Fans can be used for cooling as needed.
Prognosis and precautions
Many patients that undergo an operation at a young age should have little progression of airway signs and can be relatively
active. Caution should always be used with exertion and exposure to high temperatures since a brachycephalic animal can get
into a heatstroke crisis. Avoiding obesity is difficult in several of these breeds, but many animals seem to retain a lot
of perilaryngeal fat that complicates their airway patency. Owners should be instructed to avoid using neck leads and use
a harness instead.
Dr. Keats currently practices at VCA Veterinary Referral Associates in Gaithersburg, Md. He graduated from the Virginia-Maryland
Regional College of Veterinary Medicine in 1999. He completed his surgical residency in 2005 with Chesapeake Veterinary Surgical
Services and then became board-certified in 2006. He practices both orthopedic and soft tissue surgery.