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Surgeries

Tracheotomy and soft palate resection in a pug

Marley, an 8 year old desexed female pug, was presented to SEAH with considerable respiratory distress. She had been taken to an emergency centre the night before, had been given valium and oxygen and had settled over some hours, but was worse than ever this morning. She had had a similar attack a couple of weeks ago but this had cleared over a day.

Marley had marked increase in both inspiration and expiration, meaning she had trouble both breathing in and out. Marley was admitted for an anaesthetic so that her larynx and pharygeal region could be inspected, as this appeared to the area where the problem was.

Marley was placed on iv fluids and anaesthetised with propofol slow IV to effect. Inspection of the pharynx (back of the throat) revealed marked swelling at the base of the tongue, which was severely obstructing the passage of air to the larynx. The soft palate also appeared to be obstructing the epiglottis and larynx as well.

Tracheotomy was elected as the only way to safely recover Marley. A cut down endo-tracheal tube was inserted between the second and third tracheal rings after incising the ventral neck skin and parting the tissues over the trachea. The endo-tracheal tube was sutured to the skin. Marley recovered uneventfully and was immediately able to breath easier.

The owners where instructed in care of the tracheotomy and how to clear it if respiratory effort increased suddenly. “Marley” was sent home on antibiotics and and prednisolone twice daily to allow time for the swelling at the base of the tongue to clear.

Marley was anaesthetised again 11 days later and inspection of the back of the throat revealed that the swelling at the base of the tongue had completely cleared.

The epiglottis and larynx could still not be seen, so it was elected to resect some of the soft palate. Approximately 1.5cm of soft palate tissue was cut away and the cut edges was sutured together. The tracheotomy was then reversed.

Marley was then watched in recovery for the next hour by one of our nurses and then for another two hours by the owner but showed no respiratory issues, and Marley was allowed to go home. The owners then texted the next day to say "that it was like Marley was never unwell”, that Marley no longer snored, and Marley was more active than she had been in many months and no longer appeared to breathing issues.

The cost of these two anaesthetic’s and surgical procedures… $1,700 in total! Managed at the referral level, then this case would have cost the owners between $10,000 - $20,000, depending on the time spent in hospital between surgeries. Pugs and other short nosed (brachycephalic) breeds can have respiratory issues due to interference of the soft palate with the epiglottis, making it hard for air to pass in and out of the larynx.

The continuous effort led to swelling of surrounding tissues which just compounded the problem in Marley’s case. Tracheotomies are dangerous and never undertaken lightly and can end in disaster but are sometimes necessary and life saving. This case highlights that owners can manage these at home if they wish too, making the procedures far more affordable. High costs can otherwise lead to euthansia in many of these cases. Soft palate resection to alleviate breathing issues in brachycephalic dog’s is as little as $700 - $1,000 at SEAH.

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