With the recent increased popularity of brachycephalic dog breeds, and their all too common respiratory problems, it’s not surprising that VetPrac’s upcoming “Fix the Face” workshop filled up quickly. If you’re one of the lucky vets that managed to snare a spot for this year’s workshop, we thought we’d whet your appetite with a few case studies demonstrating the importance of thorough clinical and radiographic investigation prior to surgery, as well as always warning owners about the risk of recurrence of elongation of the soft palate post-resection surgery. Thanks to Dr. Charles Kuntz and Dr. Abbie Tipler for providing these case studies. Both Charles and Abbie are educators at the workshop this year; VetPrac looks forward to welcoming Charles and Abbie back to the education team; they always give 110 % at the workshop and we love having them both in our team.
If you missed out on this years’ workshop, register your interest in future Fix the Face workshops via this Waitlist Link.
Case report by Dr. Charles Kuntz: Brachycephalic Airway Syndrome
Signalment: Derby is a 4-year-old male neutered Boston Terrier
History: He presented one year ago for increased respiratory noise since he was a puppy. He had exacerbation of clinical signs with exercise and heat.
Physical examination: He had stertorous breathing during examination. There was stenosis of the nares bilaterally. Normal on thoracic auscultation and abdominal palpation.
Diagnosis: Brachycephalic airway syndrome with stenotic nares, redundant soft palate and low-grade laryngeal collapse (eversion of laryngeal saccules). No further diagnostics were performed.
Treatment: The nasal fold was resected using a wedge technique and reconstructed using 4-0 PDS. The soft palate was resected using a 3 stay sure technique and was closed using 3-0 PDS in a simple continuous pattern. Laryngeal saccules were resected using Metzenbaum scissors. The soft palate was iced before and after surgery and methylprednisolone (15 mg/kg) was administered IV.
Discharge medications: Codeine liquid for pain relief and omeprazole for 2 weeks.
One week recheck: He was doing really well. No concerns were stated, and his breathing was much better. He had stopped snoring.
10 months after surgery, he presented for recurrence of clinical signs over the preceding 6-10 weeks. His snoring had deteriorated and was as bad as ever. He sometimes sounded like he is really struggling to breathe.
Physical examination: Mild increase in respiratory noise. Some serious discharge from both nares. Review of owner videos confirmed severe snoring.
Diagnosis: Recurrence of redundant soft palate.
Treatment: Resection of redundant soft palate using 3 stay suture technique, assessment of laryngeal collapse.
Discharge medications: Codeine liquid for pain relief and omeprazole for 2 weeks. Owners counseled to monitor for progression of laryngeal collapse with possible modified laryngeal tie-back if this occurs.
Outcome: Resolution of excessive snoring in the short term (the last recheck was 26th August 2019).
Recurrence of elongation of the soft palate is an uncommon outcome following brachycephalic airway surgery. This illustrates that it is important to let owners know that recurrence is possible, usually due to progression of the laryngeal collapse.