LARYNGEAL PARALYSIS

For treatment of breathing difficulties in older dogs
The most common cause of breathing difficulties in older dogs is a condition called laryngeal paralysis. This condition typically affects older dogs (>8 years of age) and seems to be more common in Labrador Retrievers and their cross breeds.

LARYNGEAL FUNCTION

The larynx functions like a gateway to the trachea (windpipe) and lungs. The larynx is made up of a number of rigid cartilages to keep the airway open but avoid food and saliva from entering the lungs (Figure 1).
The three cartilages in the front of the larynx, the epiglottis (that acts like a drawbridge) and two arytenoid cartilages (that act like large gates) close up when the dog is swallowing food, water or saliva. These cartilages open when the dog is breathing.
In some dogs mostly due to long-term degeneration of the nerves, the function of the arytenoid cartilages can be lost meaning that they stay closed or only partially open during breathing. This leads to narrowing of the airway and difficulty breathing (Figures 2& 3). 

SYMPTOMS

Symptoms typically develop slowly with increased panting and more noise during breathing. Dogs may become reluctant to perform their normal exercise. Some dogs will gag and bring up foamy liquid.
These symptoms can be worse during warm weather. In advanced cases, breathing can be severely compromised and the lips and gums can become blue due to lack of oxygen.

PROGNOSIS

In general, the prognosis for recovery following surgical treatment is good with dogs being able to return to a satisfactory level of exercise for their age. There is a risk of pneumonia developing after surgery.
Occasionally, the condition can be caused by other diseases such as cancer and infection which can affect the prognosis.

DIAGNOSIS

Knowledge of the dog’s history is essential in helping make a diagnosis. A thorough physical and neurologic examination is performed evaluating the head, all four limbs, and the spine. Blood tests, urine tests and chest X-rays are frequently performed. Ultrasound examination can also be used. Confirmation of laryngeal paralysis is made under anaesthesia with visualisation of the opening and closing of the larynx during breathing.

MEDICAL TREATMENT

Some dogs with only mild symptoms will respond to medical treatment. Generally this involves avoiding warm, humid environments, restricting exercise, and sometimes prescribing cough suppressants and anti-vomiting drugs. Occasionally, dogs will present as an emergency and these dogs require urgent treatment with oxygen therapy and anti-anxiety drugs.

SURGERY

Most dogs with laryngeal paralysis are surgical candidates. The surgery is designed to permanently open the larynx to allow more air into the lungs. Typically, the procedure involves placing two nylon sutures in the side of the larynx to permanently “tieback” one of the arytenoid cartilages. Only one side is tied back to reduce the risk of food or fluids entering the lungs.

COMPLICATIONS

Typical post-surgical complications such as infection, wound breakdown and bleeding can occur after laryngeal surgery but the main complication is the development of pneumonia. This risk can be reduced by careful surgical technique and by changing the way dogs are fed after surgery.

RESULTS

Most dogs have a rapid improvement in breathing immediately after surgery and can enjoy a significantly increased quality of life.

DISK FUNCTION

The intervertebral disk of the dog acts as a cushion between the spinal bones (vertebrae) to absorb the shocks and movements of normal activity. The normal disk is like a “jelly doughnut” with a gelatinous centre and an outer ring of stronger fibrous tissue. In certain breeds of dog (Dachshund, Poodle, Beagle, Spaniel, Corgi), the disk degenerates at a very early age. As the dog ages, the jelly like component of the disk becomes more gritty and less resistant to pressure. The disk is then no longer able to cushion the spine and the contents of the centre may forcibly squirt out and bruise the spinal cord. Alternatively, the outer part of the disk may bulge up putting pressure on the spinal cord.

DIAGNOSIS

A thorough neurologic examination is performed evaluating the head, all four limbs, and the spine. Pain can frequently be felt at the site of the affected disk. Anaesthesia and X-rays can help to show signs of narrowed disk spaces and degenerative disks. To confirm the diagnosis, a CT scan is recommended as this provides us with the best information on the spine. A special X-ray test called a myelogram can be helpful, in addition to a CT scan. Some dogs have an associated instability of the vertebrae that has contributed to the disk degenerating.

SURGERY

Dogs that have severe neck pain.or significant spinal cord damage are also candidates for surgery. The most common procedure is a ventral slot, which involves drilling a slot in the base of the vertebrae to relieve the spinal cord pressure and allow the delicate extraction of the disk material. Sometimes, the central portion of adjacent degenerative disks is removed to reduce the chance of further disk

SYMPTOMS

Syleptoms typically develop, in order of severity, from neck pain to weakness and wobbliness then finally to unwillingness to stand depending on the speed or the amount of the disk rupture. In the most severe cases, dogs lose the ability to walk and become quadriplegic.

MEDICAL TREATMENT

Some dogs with only mild symptoms will respond to medical treatment. Generally this involves three or four weeks of strict confinement to a cage with the dog only allowed out to go to the toilet. Pain relief (cortisone or aspirin-like medication) is given at the same time but this does not mean the dog can be more active. Dogs that do not improve or get worse with medical treatment are candidates for surgery.

RESULTS

Dogs that have retained the ability to walk prior to surgery have a 95% chance of complete recovery following surgery. Complete healing of the spinal cord can take up to six months to occur. Regular progress in spinal cord recovery is seen during this time. Dogs with unstable vertebrae have an increased risk of further instability developing later in life.

Rupture

For dogs with instability of the vertebrae, additional surgical stabilisation may be performed. This is done using metal plates and screws or bone cement.

PROGNOSIS

The prognosis for recovery is mostly dependent on the severity of the damage to the spinal cord. The ability to walk before treatment is the key indicator for prognosis in dogs with a slipped disk in the neck.

POSTOPERATIVE CARE

EXERCISE CONTROL

To allow the larynx to heal following the surgery, complete restriction of exercise is necessary for the first 2-3 weeks. Your dog can be walked on a lead for toileting. Light (5-15 minutes) lead walks can begin after 2 weeks.

BANDAGE AND SUTURE REMOVAL

A bandage is generally placed over the operated site for protection. This bandage should be removed 4-5 days after surgery. The skin stitches need to be removed 10-14 days following surgery. These tasks can be done by your regular veterinarian. Please call our hospital if there is any swelling, discharge or redness around the stitches.

FEEDING MANAGEMENT

As the larynx area will be swollen after surgery making swallowing difficult, it is very important that your dog is not allowed to eat watery or crumbly food after surgery. It is best to make up small meat-balls and feed your dog by hand each meatball for the first 2-4 weeks after surgery. Water intake also needs to be carefully monitored so that your dog is not gulping in large amounts of water at one time.

MEDICATION

Most dogs are sent home with medication for additional pain relief. Sometimes, antibiotics are also dispensed. Give the medications as prescribed. Further pain relief can be prescribed if necessary. Please let us know two days before suture removal if you think more medication is required or you may be charged an urgent fee.

BREATHING MANAGEMENT

Some dogs will cough and gag a small amount after surgery which is normal. Warm, humid environments should be avoided. Sometimes, excessive barking can occur putting a strain on the internal stitches, behavioral control can help this but anti-anxiety medication may be prescribed. You may notice a change in your dog’s voice after surgery, this is normal and occurs even when surgery is not performed.
Monitor your dog for signs of lethargy, decreased appetite and a moist cough, this could indicate pneumonia. If this occurs then an appointment with our hospital or your regular veterinarian is strongly recommended.

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