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What you should know about brachycephalic airway disease

April 16, 2023 at 4:00 a.m.
The proper terminology for flat face shape is “Brachycephalic,” which means “short head.” - Submitted photo

Who does not love the squishy little faces of our Pugs, Shih Tzus, Pekingnese, and Bulldogs? What do these kids all have in common? That's right, flat lil' button noses that are so fun to boop! Am I right? Well, unfortunately, these endearing flat face shapes come with their own set of troubles. I want to tell you all about that so, if you are mom or dad to one of these guys, you will have a better understanding of their special needs.

The proper terminology for flat face shape is "Brachycephalic," which means "short head." The skull of dogs in these breed categories is shaped in such a way that the nose is very short and flat against the face instead of having a longer muzzle. Humor me for a moment. Use your fingers to pinch your nostrils and press your nose as flat as you are able. Now, breathe. Is that comfortable? Just so you know, as I type this, I am also practicing this breathing strategy in my office. I have to say, it is difficult to breathe with narrow nostrils and a flat nose!

Do you feel increased pressure in your throat when you pinch your nose this way? How about the feeling of your chest rising to force air into your lungs? While this may not be an apples-to-apples comparison between dogs and humans, it is a close representation of what our flat-faced friends experience when breathing. Can you imagine trying to exercise with this breathing pattern? As it turns out, brachycephalic dogs also have additional components to their airway structure that further complicates breathing. It is a complex set of problems.

Narrow nostrils: This is termed, "stenotic nares." The opening of the nostrils is so small in some dogs that they experience low oxygen levels and reduced energy and activity because it is so hard to breathe. Veterinarians often recommend early intervention by surgical correction of the nares. This is most commonly performed at the time of spay or neuter surgery, but can be done at any time and still be beneficial for the dog.

Large tongues: Also called, "Macroglossa." Small mouths plus huge, thick tongues is not a preferred combination for breathing, panting, or swallowing. Bulldog breeds, such as the English bulldog and the French bulldog, are especially affected by this issue.

Long palates: Better known as, "elongated soft palates." If you run your tongue along the roof of your mouth starting near your top front teeth, you will feel where your hard palate transitions into your soft palate. The soft palate helps to separate the mouth from the nasal passage in the throat area. When this tissue is too long in dogs, as is common with the short skull shape of brachycephalics, the palate can actually cover the opening of the airway (trachea) in the throat. The palate will flap up and down as the dog breathes, which accounts for the heavy snoring sounds we hear even when the dog is awake.

Narrow windpipe: In medical terms, "tracheal stenosis." This is a severe narrowing of the trachea, which makes breathing fragile and can complicate safety with anesthesia. Not every brachycephalic dog experiences this complication, but it is most commonly seen in English Bulldogs. The condition can usually be screened for on an X-ray, but may require more advanced testing to diagnose.

Everted laryngeal saccules: I cannot think of a common name for this! Laryngeal saccules are little pockets in the larynx. When a dog has upper airway breathing difficulty over time, these pockets can turn inside out, or "evert." When this happens, the saccules block the flow of air and further complicate breathing. The Pug breed is most prone to this condition.

We see other issues in brachycephalic dogs, including gastrointestinal problems and eye issues. In this article, I have chosen to focus on airway disease. Of the components of airway disease I have listed, most are correctable with surgical intervention. If corrected early in life, we can better protect all components of the airway. For instance, correcting the nostrils at the time of spay or neuter (assuming this is performed at around 6 months of age), we allow for better oxygen intake, and reduce the pressure on the throat in chest. In turn, we can possibly prevent thickening of the soft palate and/or eversion of the laryngeal saccules.

Brachycephalic describes the head shape of many of our favorite breeds. These guys are so fun to own, but do require some extra education and responsibility. I know that pinched nose is cute, but it might be possible to keep your dog healthy if we correct the shape of it. Please listen to your veterinarians recommendations and strongly consider your top priorities for your dog. Sometimes, we do have to choose function over fashion!

Information for portions of this article was taken from

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