Elongated Soft Palate in Bulldogs and French Bulldogs
Elongated Soft Palate in Bulldogs and French Bulldogs
Elongated Soft Palate in Bulldogs and French Bulldogsis one of the most common upper airway conditions diagnosed in the “smooched flat face” (Brachycephalic) breeds such as English bulldogs, French bulldogs, Boston terrier, and Pugs.
Elongated Soft Palate is only one of a few bully upper airway anatomical abnormalities named “Brachycephalic Obstructive Airway Syndrome (BOAS), the other ones are stenotic nares, hypoplastic trachea, thicken bully tongue, thicken nasal passages (turbinates), and everted laryngeal saccules.
Your bulldog or French bulldog puppy may be affected by a combination of one or more of these abnormalities.
The “pushed in” compressed flat head appearance has an undesirable effect on the entire anatomy of your bulldog neck and head and its relation to the respective soft tissue and structures.
Bulldog Elongated Palate BEFORE & AFTER Surgery (note the dramatic breathing sound improvement)
“Bubba” is a rambunctious 2y old puppy who was referred to Dr. Kraemer by his regular veterinarian after collapsing multiple times. “We had to give him mouth2mouth to bring him back” said his frantic and terribly worried owner
“Bubba” 1 week AFTER Dr. Kraemer had repaired his elongated Soft Palate (note the normal breathing / panting)
This video was taken during Dr. Kraemer post-op recheck exam. “In the first few days after his surgery I kept waking up in the middle of the night it was too quiet, i had to get up and check that he is still alive. His breathing was so quiet and relaxed, the terrible noise was gone, he now able to run around and take a walk with us, we are so happy for him, this surgery saved his life”
Elongated Soft Palate in Bulldogs and French Bulldogs PRESENTATION:
Elongated Soft Palate and the other brachycephalic obstructive airway syndrome (BOAS) skeletal face shortening and airway compression abnormalities adversely affect your bulldog airways by increasing airway resistance, as well as an increase of negative intra-airway pressure.
If this negative intra-airway pressure exceeds the resistance of the surrounding tissue, inflammation, swelling, and laryngeal edema will occur, which will further narrow the airways and further increase your bulldog effort required to inhale.
Overtime the laryngeal tissue and cartilages will fatigue, atrophy and eventually irreversible collapse (i.e. “Bulldog Laryngeal Collapse”)
In addition, due to the chronic restrictive brachycephalic airway disease, your bulldog is likely to suffer from other serious medical problems such as:
- Chronic Vomiting, Retching, Reflux, and Regurgitation
- Exciersie Intolerance
- Overweight due to inactivity
- Aspiration Pneumonia
- Acute Hyperthermia
- Heat Intolerance
- Stress and Excitement Intolerance
- Prolapse Urethra due to Intrabodminal pressure
- Pulmonary Edema
- Heart Failure
- Sleep Apnea
- Digestive Problems
- Bully Gastric Emptying Disorder
- Faint due to high vasovagal tone
- Collapse and Sudden Death
Elongated Soft Palate in Bulldogs and French Bulldogs ANATOMY:
Your bulldog and French bulldog palate is located in the roof of the mouth and has two parts:
- HARD PALATE: The front (anterior) part is the “hard palate” named after the bone it is made from, it can easily be felt by opening your bulldog puppy (or yours) jaw and pressing with your finger just behind the upper incisors.
- SOFT PALATE: The back (posterior) part is the “soft palate” and it is located right behind the hard palate along with the roof of the mouth where bone meets soft tissue.
Sadly, for the brachiocephalic breeds like your bulldog and French bulldog, and as a direct aftermath of selective “cute smooched face” inbreeding practices, the normal anatomical boundaries of the soft palate are altered and airflow obstruction.
Dr. Kraemer demonstrating a bulldog elongated palate in action (note the palate plugging the airway when released)
Dr. Kraemer performing surgery on a bulldog with an elongated palate (the halfway resected elongated part is on the rt side of the screen held by an instrument)
Dr. Kraemer view of a bulldog soft palate after placing the last stitch (note the wide laryngeal opening)
Elongated Soft Palate in Bulldogs and French Bulldogs DIAGNOSIS:
STRIDOR: Stridor is a harsh “mechanical” high-pitched respiratory sound that is the hallmark of a bulldog and French bulldog elongated soft palate. The laryngeal restrictive passage noise is a result of the turbulent airflow that is worsened by the increase of airflow volume such as during exercise or excitement. Stridor in bulldogs will also exasperated by warm weather.
STERTOR: Stertor is not the same as Stridor. Stertor is not a laryngeal airflow restriction but rather nasal or nasopharynx obstruction. It’s a snore or snort and gasp heard during inspiration.
Elongated Palate in Bulldogs and French Bulldog initial diagnosis is usually done in the exam room, either by demonstrating the stridor noise to the owners and have them confirm, have them show me a video of their bulldog during excitement or strenuous exercise or often the stridor can be heard at the exam room. The definitive diagnosis must be done under mild sedation via a visual inspection using proper illumination.
For a definitive diagnosis of an elongated palate, everted saccules and other laryngeal abnormalities mild sedation will be necessary in order to able direct visualization of those structures.
Dr. Kraemer’s V4B Elongated Soft Palate in Bulldogs and French Bulldogs MAINTENANCE
WEIGHT CONTROL: weight control is instrumental in proper bulldog care.
EXERCISE: limited and controlled exercise is essential
CONTROLLED TEMP: temp control and avoidance of hot or humid conditions is critical
STRESS & ANXIETY CONTROL: stress-free, calm and relaxing environment is important, you can offer your bulldog natural anxiety relief supplements like Dr. Kraemer’s V4B Bully Calm & StressLess Chews
IMPORTANT: It’s important to note, that medical, climate control, reduced activity, and weight management control do not and will not correct the underlying anatomical abnormalities, but merely lessens the symptoms.
Dr. Kraemer’s V4B Elongated Soft Palate in Bulldogs and French Bulldogs REPAIR:
Due to the seriousness and dire outcome of bulldog untreated elongated soft palate and the other brachycephalic compressive airways syndrome problems, early intervention is imperative.
SURGERY: corrective surgery is the treatment of choice whenever the anatomic abnormalities interfere with the patient’s breathing.
Dr. Kraemer’s V4B Elongated Soft Palate in Bulldogs and French Bulldogs RULE OF THUMB:
Since elongated soft palate always gets worse with the passage of time it’s critical that you take care of it in a timely manner, the sooner the better. Early correction of stenotic nares and elongated soft palate will significantly improve airway function and should prevent the development of everted laryngeal saccules and other secondary airflow restrictive problems.
The overall prognosis for bulldog patients depends upon HOW MANY anatomic abnormalities are present, and HOW SOON they were corrected. Surgical correction for stenotic nares and/or an elongated soft palate have a better prognosis than dogs with more defects.
Dr. Kraemer’s V4B Elongated Soft Palate in Bulldogs and French Bulldogs TIPS & WARNINGS:
Elongated Soft Palate in Bulldogs and French Bulldogs TIP #1 GAG & VOMIT: Bulldogs suffering from elongated soft palate often gag and vomit. To prevent aspiration (i.e. aspiration pneumonia) you can implement the following:
- SLOW FEEDING: Don’t let your bully eat or drink too fast. To slow them down, you can use a cupcake baking pan with its small wells (i.e. slow feeder).
- BLEND DIET: You can use a blended diet and mix it with water to form a thick soup-like meal.
- SMALLER & FREQUENT: Feed smaller portions at a time but more often.
- LATE NIGHTER: Try a late-night meal, at times that help morning retching
- HEADS UP: Feed your bulldog on a step or a stool to elevate his upper body, the more vertical the better.
- ANTI REFLUX: to decrease stomach acidity and gastric reflex, discuss with your vet home medication like antacids and antiemetic (anti-vomit).
Elongated Soft Palate in Bulldogs and French Bulldogs TIP #2 HARNESS: I recommend a harness rather than a neck collar to prevent airflow restriction (for all bulldogs)
Elongated Soft Palate in Bulldogs and French Bulldogs TIP #3 HYPERTHERMIA: In the event of a respiratory crisis you should check the rectal temperature: normal is between 100-1.02.5 F. If it is over 105 F, and you can’t get to a veterinary hospital, rinse your dog with cool water and place a fan over him/her till the temperature drops to 103. Don’t let it go below 100F.
Elongated Soft Palate in Bulldogs and French Bulldogs TIP #4 TONGUE: The thick, large bulldog tongue often retracts inward to further compound the respiratory crisis. If your bully is in respiratory distress or collapse, make sure that he/she is sternal (i.e. laying on sternum/chin, rather than on the side). Pull your bully’s tongue so it is stretched out and keep an eye on the color of the tongue, pink is good, purple-blue is bad.
Elongated Soft Palate in Bulldogs and French Bulldogs TIP #5 TIMING: I recommend surgical repair of the elongated palate and/or stenotic nares as soon as your bully reached maturity at about 8 months of age.
Elongated Soft Palate in Bulldogs and French Bulldogs TIP #6 CALM: If you cannot afford, or have to delay surgical treatment, you can use a calm & cool environment, restricted activity, and supplements to help anxiety and inflammation like Dr. Kraemer’s
Elongated Soft Palate in Bulldogs and French Bulldogs Tip #7 HYPOPLASTIC TRACHEA: In contrast to the common notion it is my experience that Hypoplastic Trachea appears to be tolerated well by bulldogs and French bulldogs in absence of BAS or after they are repaired.
Elongated Soft Palate in Bulldogs and French Bulldogs TIP #10 ANESTHESIA: Bulldogs with this syndrome have an increased risk of complications associated with general anesthesia. I recommend routine pre-anesthetic screening tests:
- Blood Work
- Chest x-rays to evaluate the esophagus (megaesophagus), trachea (Hypoplastic), lungs (aspiration pneumonia), heart (heart disease), and diaphragm (hiatal hernia).
- ECG screening to r/o heart abnormalities
- Blood Pressure
Elongated Soft Palate in Bulldogs and French Bulldogs TIP #11 SEFOFLURANE: Read Dr. Kraemer’s anesthesia warning and recommendations. We have custom pre-anesthesia bulldog protocols especially designed to minimize the breed-related anesthesia risks. Finally, all of our bulldogs and brachycephalic breed patients are placed on sevoflurane anesthesia instead of isoflurane despite the higher cost. It is always best to ensure that your veterinarian has Sevoflurane.
Elongated Soft Palate in Bulldogs and French Bulldogs WARNING #1 TEMP: Symptoms are often worse in hot or humid weather.
Elongated Soft Palate in Bulldogs and French Bulldogs WARNING#2 ANATOMY: Elongated Soft Palate problems are directly related to the breed’s brachycephalic conformation and anatomy. I don’t recommend breeding a bulldog that needs surgery to correct airway obstruction.
Elongated Soft Palate in Bulldogs and French Bulldogs WARNING #3 TIME: Over time, as a direct outcome of years of negative intra-airway pressure (suction) bulldogs with elongated soft palate will develop other secondary problems that further obstruct airflow. Examples are enlarged tonsils, everted saccules, and hypoplastic trachea. Tragically this all can end with an irreversible, inoperable, atrophied, collapsed, larynx cartilage.
Elongated Soft Palate in Bulldogs and French Bulldogs WARNING#4 PROLAPSE: In the long term, the increased effort associated with breathing can put an increased strain on the heart with heart disease and failure as possible complications. the brachycephalic syndrome is suspect to be one of the underlying causes of prolapse urethra.
Elongated Soft Palate in Bulldogs and French Bulldogs WARNING#5 VEGAL TONE: Vomiting and gagging are common to the brachycephalic breeds (bulldogs) due to an increase in vagal tone, a direct outcome of the breed’s excessive upper airway pressure. This increase in vagal tone will further intensify in bulldogs with an elongated palate and other Brachiocephalic Syndrome problems (such as stenotic nares).
Elongated Soft Palate in Bulldogs and French Bulldogs WARNING #6 ASPIRATION: Gagging and vomiting could lead to aspiration of the vomit content with Aspiration Pneumonia the most likely outcome. Aspiration Pneumonia could be deadly, particularly to bulldog puppies due to their weak immune system and to any bulldogs going under anesthesia.
Elongated Soft Palate in Bulldogs and French Bulldogs WARNING#7 POST OP: In the early postoperative period, swelling of the surgical sites (laryngeal edema) may occur and interfere with breathing. Thus, we closely monitor our bulldogs after extubation. In my opinion, the post-extubation period is the most dangerous part of “bulldog anesthesia”. At my practice, we assign a trained technician to sit next to our pet, monitor vitals, and make sure he/she is sternal with tongue stretched and pink. We also have an oxygen cage in case of an emergency.
Elongated Soft Palate in Bulldogs and French Bulldogs WARNING#8 EXPERIENCE: It is critical that the surgeon performing the procedure is experienced with the breed and the surgery. Immediate Post-op complications are more common than severe chronic cases.
There are times that the edema (laryngeal swell) prevents extubation, those patients will need to remain induced (i.e. sedated) and intubated till the swelling subsides. Transportation to overnight care should be arranged if the hospital does not provide for that. Most times the swlling will subside with in 24-48h alowing extuabtion and awaking of the patient.
On rare occusion the swelling will linger and the endotrechea tube will be replaced with a temperory trachesomy.
“An Ounce of PREVENTION Is Worth a Pound of CURE”