Mochi is an eight-year-old French Bulldog who has been seen at Hawthorne Hills Veterinary Hospital since he was a puppy. Just like a lot of his flat-faced friends, his family has noticed him suffering from difficulty breathing and exercise intolerance since he was young. He got his nares surgery and soft palate surgery done at a young age. Still, he snores loudly when sleeping and needs a long time to catch his breath after playing. Mochi was diagnosed with meningoencephalitis of unknown origin several years ago. Luckily it is well-controlled by an immunosuppressant and he is still a happy boy who loves to explore the neighborhood.
Mochi presented for a pre-dental procedure exam. During the physical examination, loud upper respiratory sounds could be heard at all times. Mochi also has increased breathing efforts. All these are part of his severe brachycephalic obstructive airway syndrome (BOAS).
What is Brachycephalic Obstructive Airway Syndrome (BOAS)? 
The major findings include:
- Stenotic nares: congenitally small nostrils that may also collapse as the dog inhales
- Elongated soft palate
- Everted laryngeal saccules: tissue near the vocal cords that are pulled inward during inhalation and can block airflow
- Hypoplastic trachea: narrow trachea
Other possible findings include:
- Laryngeal collapse
- Large tongue
- Enlarged or everted tonsils
- Nasopharyngeal turbinates (elongated nasal turbinates)
A lot of brachycephalic dogs also suffer from vomiting and/or regurgitation. A majority of them also experience eye problems and skin fold issues due to the shape of their head. Mochi vomits frequently after eating and is taking smaller meals (4 or more small meals per day) and medication for that. Mochi’s skin folds on his face get itchy easily if not cleaned regularly.
How is Brachycephalic Obstructive Airway Syndrome (BOAS) treated?
- After a thorough examination, the doctor would determine if surgery is needed to correct stenotic nares, elongated soft palate, and everted saccules. Brachycephalic Obstructive Airway Syndrome can progress and become more severe if not corrected in an early stage.
- A temporary tracheostomy may be needed in some cases or during emergencies.
- Maintaining a healthy weight can help with their breathing. Ideally, dogs with Brachycephalic Obstructive Airway Syndrome should maintain a lean body condition score of 4 out of 9.
- Minimize panting by avoiding excessive heat or exercise.
Although Mochi’s stenotic nares and elongated soft palate were corrected by surgery in the past, we did not know if he had other issues that could make anesthesia challenging. Often, it is not possible to fully evaluate the severity of Brachycephalic Obstructive Airway Syndrome without a sedated oral exam, endoscopy, and radiographs to evaluate the overall structure of the upper airway. Mochi’s family decided to proceed with an anesthetic dental procedure due to his poor dental health.
After the pre-anesthetic injections were given, we started intubation. However, Mochi’s airway was way smaller than we expected. In the end, a size 4 endotracheal tube was tried, but it was still too big to be placed into Mochi’s airway. The challenge too with smaller tubes, is they often are not long enough to reach fully into the trachea, as the smallest tubes are usually only used in cats. You can compare the photos below showing a size 7 endotracheal tube that we use in dogs of the same weight but without Brachycephalic Obstructive Airway Syndrome and the size 4 endotracheal tube that we were unable to intubate into Mochi’s trachea.
[The #4 tube is on the top, the #7 tube is below]
The dental procedure was aborted, and Mochi recovered smoothly with flow-by oxygen. Mochi’s family has scheduled him for a dental specialist consultation. Mochi is also on a diet since maintaining a healthy weight is an important part of managing Brachycephalic Obstructive Airway Syndrome. Knowing how severe Mochi’s airway disease is, Mochi’s owner will make sure to avoid excessive heat or exercise and will bring him to the emergency hospital if he has any respiratory crisis in the future.
If you are concerned about your flat-faced dog’s breathing or suspect they may have Brachycephalic Obstructive Airway Syndrome, please schedule an appointment with one of our doctors.
For more information:
VeterinaryPartner.com – Brachycephalic Airway Obstruction Syndrome in Flat-Faced Dogs
