The diagnosis of a cleft soft palate is usually made from the history, signalment and physical examination. A defect may exist between the two sides of the palate leading to a split down the center of the soft palate. The cleft may be asymmetrical and off to one side. Anesthesia or sedation may be necessary to adequately visualize the tissues in a young squirming puppy
. Puppies with cleft soft palates tend to be thin, stunted and often have harsh lung sounds upon auscultation with a stethoscope.
The noise of an elongated soft palate tends to come during inspiration as the palate gets sucked into the opening of the larynx, restricting normal breathing. During excitement or panting in hot weather, the problem gets worse.
Some dogs with elongated soft palate may gag or retch. Some may turn blue and collapse.
Owners may also report snoring or restlessness when sleeping.
Traumatic injury to the soft palate is usually associated with a history of trauma, bleeding from the mouth, blood tinged water when drinking, reluctance to chew or swallow, and sometimes difficulty breathing.
Chest radiographs are useful in small puppies to assess for aspiration pneumonia. They are helpful in cases of elongated soft palate to assess for other thoracic abnormalities such as tracheal hypoplasia and heart disease.
Radiographs of the neck may be useful in cases of a stick injury, to look for a foreign body and/or air pockets where damage to the upper airway may have occurred. Endoscopic evaluation of the pharynx, trachea and esophagus can be useful where a stick has lacerated the palate and may have injured other nearby structures.
There are no specific laboratory abnormalities for soft palate disorders. Blood work may be useful prior to general anesthesia.
Congenital soft palate defects are best repaired surgically when the pet is at least 8 to 12 weeks of age. The older the animal at the time of repair, the better the chance that the surgery will be successful since the tissues in the mouth are stronger and hold stitches better. Owners should be aware that multiple surgeries may be necessary in some cases, to get the defect repaired.
To get to this age the animal will require either tube feeding or placement of a feeding tube, as oral intake of nutrition will be inefficient and dangerous with regard to aspiration pneumonia.
Traumatic injuries to the palate should be repaired as for any other soft tissue injury, by cleaning and debriding the affected tissue and closing the wound. Any pockets or punctures should be explored to ensure that any material, a stick remnant, for example, is not left behind.
Medical management of an elongated soft palate is limited to rest, restriction, avoiding exercise and hot weather, and using steroids and sedatives when necessary. It does not address the underlying problem; in fact, delay in surgical treatment usually exacerbates other airway disorders such as laryngeal collapse.
Surgical resection of the excessive palate is usually performed anywhere from 4 to 24 months of age. The elongated palate can be shortened using a scalpel blade and oversewing with absorbable sutures or using a laser, which does not require sutures. Concurrent airway problems such as stenotic nares or everted laryngeal saccules may be addressed at the same time.
All animals, regardless of their type of palatal surgery will be closely monitored in the postoperative period for difficulty breathing or swallowing.
Corticosteroids may be given around the time of surgery to reduce postoperative inflammation.
Your veterinarian may be sufficiently worried about the postoperative recovery and suggest the use of a temporary tracheostomy tube, a tube going directly into the trachea to by-pass the upper airway, to ensure control of the airway in the postoperative period. This tube can be pulled a few days after the procedure and the remaining hole left to heal on its own.
Dogs and cats should be carefully monitored when offered food and water to ensure there is no coughing and gagging before they go home. Water is offered first, usually the day following surgery, and if drinking goes well, small amounts of food can be offered on the second day of recovery.
Postoperative antibiotics may be required, particularly in young animals with a degree of aspiration pneumonia.