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Laryngeal Collapse in Dogs

By: Dr. Nicholas Trout

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Laryngeal collapse develops when there is loss of the rigidity and support provided by the laryngeal cartilage (voicebox), causing the larynx to fold and collapse. When this occurs there is an obstruction that prevents normal movement of air into the trachea.

Laryngeal collapse usually occurs secondary to other long standing upper airway disorders, such as those seen in short-faced dogs like pugs, Boston terriers and English bulldogs. The chronic effect of difficulty "pushing and pulling" air through their deformed upper airways weakens, fatigues, and eventually deforms the cartilage. In rare instances the cartilage may fracture and collapse following trauma to the neck.

Most dogs with advanced upper airway disease are over two years of age, but occasionally this condition may be found in younger dogs. Both males and females are affected.

Laryngeal collapse can result in severe respiratory distress, potentially leading to death.

What to Watch For

  • Difficulty breathing following direct trauma to the upper neck region

  • Increased effort or difficulty breathing, particularly in a dog with a history of upper respiratory problems

    Diagnosis

  • Initially, a diagnosis of upper airway obstruction is based upon a history of respiratory difficulty and a physical examination of your pet.

  • A thorough laryngeal evaluation is difficult and perhaps dangerous to perform when your pet is awake; general anesthesia is required for a thorough examination. Prior to anesthetizing your pet, blood may be obtained to determine his overall health. Additionally, chest radiographs (X-rays) may be performed to evaluate the heart and lungs. Radiographs of the neck may be helpful in traumatic cases of laryngeal collapse, since the cartilage may be mineralized and visible on an X-ray.

  • Assessment of the larynx is performed under light anesthesia. The diagnosis is made by direct visualization of the fleshy folds around the vocal cords being everted into the airway (everted laryngeal saccules), and/or a deviation and collapse of the cartilage of the larynx toward the midline.

    Treatment

  • Your dog may benefit from a weight loss program. Limiting the amount of exercise your pet gets will also be helpful. Keep your dog in a cool or air conditioned environment, particularly during the warm months of the year.

  • Some dogs get much worse when they become excited, so sedatives might be beneficial.

  • Since laryngeal collapse is an anatomic abnormality of the upper airway, medical options are purely palliative. If the laryngeal collapse is associated with other upper airway problems, surgical correction of these conditions is recommended. Once laryngeal collapse occurs the prognosis becomes more guarded.

  • Surgical resection of everted laryngeal saccules and abnormal folds of tissue around the epiglottis, the cartilage flap that flips up to protect the airway when swallowing food or water, can be performed when the degree of collapse is mild to moderate. In more severe cases, a permanent opening must be created in the trachea to allow air to by-pass the obstructed upper airway (permanent tracheostomy).

    Home Care and Prevention

    Since the surgical correction of various defects is performed through the mouth, there is no incision to monitor or sutures to be removed. Feed soft food and water for a week or so after the procedure. Avoid excitement or situations in which your dog will pant.

    Following a permanent tracheostomy, the surgical site will need to be kept clean and free of debris. Stitches at a permanent tracheostomy site should be removed within 10 to 14 days after surgery.

    The opening will need to be checked daily to ensure that it is not closing over and occluding the new airway. Your pet must NEVER swim since water would instantly be drawn into the lungs.

    Laryngeal collapse, when it occurs secondary to chronic upper airway obstruction, should be a preventable disease. If the primary airway disorders are addressed in a timely fashion, that is before the dog is two years of age, it is normally possible to prevent the secondary changes in the laryngeal cartilages.

    Sometimes, airway problems get overlooked in the brachycephalic breeds of dog because the owner thinks this is just how a pug or bulldog should sound. Have your pet checked regularly by your veterinarian particularly if airway noise becomes increased with moderate exercise or excitement or if your pet seems unable to exercise a reasonable amount. Excessive snoring and snorting is not normal and should be evaluated.

    Once the later stages of laryngeal collapse have developed, correction of the primary problems will have very little benefit.

    Although there is a surgical option for the treatment of severe laryngeal collapse, the long-term management of the tracheal opening and the increased risk for aspiration pneumonia should not be forgotten. Your pet will be far happier preventing laryngeal collapse by fixing the underlying causes than dealing with a permanent tracheostomy after the fact.

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