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Brachycephalic Syndrome – A Pug’s Nightmare

Pugs, like other dog breeds with short noses, are prone to suffering from Brachycephalic Syndrome. This is a condition characterized by a defect in the flow of air through the dog’s upper respiratory tract. This syndrome is predisposed by abnormalities in the anatomy of the dog’s facial bones as manifested by their shortened bones and compressed faces. However, there is no proportionate shortening of the soft tissues of the soft tissues associated with these bones thus leading to obstruction of the airways. The abnormality in the anatomical structure is often associated with everted laryngeal saccules, pinched nostrils (stenotic nares), and overlong soft palate.

Pugs with Stenotic Nares (Collapsed Nostrils) possess small nasal openings with soft and floppy nasal cartilage. These anatomical aberrations often cause the nostrils to collapse as the puppy takes in air during inspiration. The collapsed nostrils lead to obstruction of the dog’s airways which is manifested by noisy breathing, mouth breathing, and sometimes nasal discharge. Dogs suffering from a severe case of Stenotic Nares often have flattened chests.

In severe cases, surgery may be required to enlarge the nasal openings in order to improve the dog’s respiration. The surgical procedure involves the removal of a part of the cartilage and skin of the nose. In some cases, the nasal cartilage may harden satisfactorily before the puppy reaches 6 months old.

The soft palate functions to close off the nasopharynx during the act of swallowing. Normally, the soft palate only slightly overlaps the epiglottis however when a soft palate is abnormally elongated, it interferes in the dog’s respiration leading to snoring, snorting, gurgling, and gagging. These signs are most obvious when the dog engages in play or exercise. As time passes, the ligaments in the larynx can lead to breathing difficulties and collapse of the larynx.

Surgery can shorten an abnormally long soft palate to ensure that its edges just slightly overlap the epiglottis. Prognosis is often favorable when surgery is done before damage has occurred in the larynx.

The eversion of the laryngeal saccules usually accompanies the occurrence of an elongated soft palate. Laryngeal saccules are pouches of small mucosa that protrude into the larynx. When these saccules enlarge and turn out, they can obstruct the airways. Everted saccules are often removed during surgical removal of an elongated soft palate.

Aside from the Pug, other brachycephalic breeds include the Boston Terrier, Pekingese, and English Bulldog. Symptoms may not be quite obvious while the puppy is still very young however symptoms of respiratory difficulties may be manifested starting at middle age.

Over time, the progressive development of air resistance can lead to respiratory difficulties leading to the weakening and eventual collapse of the larynx and trachea. When this happens, there is the obstruction of the airways causing cyanosis (bluish-gray coloration of the mucus membranes of the mouth as a result of poor oxygenation within the body). Severe cases can possibly lead to death.

Diagnosis is made based on the dog’s breed and the clinical signs which are manifested. The most common signs associated with brachycephalic syndrome include poor exercise tolerance, bluish discoloration of the gums, noisy breathing which is obvious during inspiration, and possibly fainting.
Aside from a thorough physical examination that includes listening to chest sounds using a stethoscope, x-rays of the thorax may also be recommended to rule out heart or lung diseases. The dog’s nose will also be examined to ascertain if the dog has pinched nostrils. Your vet may put your dog under sedation in order to freely examine the mouth and larynx to determine if it has an elongated soft palate and the presence of everted laryngeal saccules.
Mild cases of respiratory distress can be effectively managed with medications and supportive therapy including administration of oxygen, tranquilization, and use of anti-inflammatory steroids. However, you should always bear in mind that there is always the possibility that the condition can progress to a more severe one. When you see that your dog is showing initial signs of the condition, be sure to closely monitor your dog for worsening symptoms.
For better prognosis, your vet may recommend surgery before clinical signs become too severe.

In order to delay and/or prevent the onset of respiratory difficulties, help your dog maintain his ideal weight for obesity can further aggravate the situation. It is also advisable to avoid subjecting your dog to excessive stress such as from exercising during hot weather. Using a harness instead of a dog collar can also prevent breathing difficulties.