Elongated Soft Palate in Bulldogs and
French Bulldogs

Elongated Soft Palate in Bulldogs and French Bulldogs is one of the most common manifestations airway and breathing problems in the English Bulldog Puppy, French Bulldog Puppies , American Bulldog   and Old English Bulldog as well as other breeds with a “smooched flat face”    “Brachycephalic Airway Syndrome ”  such as Boston terrier and pugs .  The brachycephalic syndrome refers to a set of primary upper airway anatomical abnormalities that in addition to the elongated palate also include stenotic nares,  and everted laryngeal saccules.

A secondary set include hypoplastic trachea, overly enlarged protruding tonsils and Laryngeal Collapse. Your bulldog puppy may be affected with a combination of one or more of these abnormalities. This french bulldog and English bulldog  “pushed in” appearance has a undesirable effect on the entire anatomy of the neck and head and its relation to the respective soft tissue and structures.

See in this video an Elongated Palate Bulldog Puppy case BEFORE the surgical Trimming Procedure (note the harsh stertorous  breathing sound)

“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 (this video was taken at Dr. Kraemer’s Hospital Vet4HealthyPet Advanced Medical Care )

“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”

Soft palate in a bulldogs. Note the breathing tube and the elongated soft palate completely covering it (taken by Dr. Kraemer)

Soft palate in a bulldogs. Note the breathing tube and the elongated soft palate completely covering it (taken by Dr. Kraemer)

Elongated Soft Palate in Bulldogs and French Bulldogs as well as any of these upper airway narrowing of your bulldogs airways are abnormalities that can cause increased 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, collapse, inflammation and edema will occur, which will further narrow the airways and further increase the effort required to inhale. Overtime this airway restrictive vicious cycle can lead to acute Hypertherima (as high as 106f) , hypoxia (Oxygen deficiency), cyanosis (blue- purple tongue due to oxygen deprivation), collapse, fainting (syncope), and possible asphyxiation, pulmonary edema, heart failure and death.

Your bulldogs palate is located in the roof of the mouth and has two parts: one hard and the other soft. The front (anterior) part is  the “hard palate” named after the bone it is made from and can easily be felt by opening your bulldog puppy (or yours) jaw just behind the upper incisors. The back (posterior) part is the “soft palate” and it is located right past the hard palate along the roof of the mouth where bone meets soft tissue. Sadly, in the brachiocephalic breeds like your bulldog the natural anatomical boundaries of the soft palate were altered as a direct aftermath of   selective “cute smooched face” inbreeding practices. Decades of selective inbreed leading to compression of the bulldog’s head, forced the soft tissue into the laryngeal area normally designed for airflow and by doing so, obstructing space critical for respiration.

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)

Mildly elongated soft palate affected bulldog puppy will exhibit noisy breathing, especially with excitement, exercise, and stressful conditions, all of which will increase your bulldog puppy demand for oxygen. Most will snort when excited and snore when relaxed or asleep. Severely affected bulldogs and french bulldogs have more pronounced airway noise, appear to tire easily with exercise, and may collapse or faint after exercise. Other symptoms may include coughing, gagging, retching and vomiting. On many occasions I will hear a bulldog puppy with elongated palate before I see him/her all while the client is still in our reception area. The sound has the elongated palate signature noise written all over it.

Due to the seriousness of the brachycephalic syndrome in bulldog puppies, and in particular elongated soft palate, early intervention is imperative. I always discuss the syndrome during your very first visit, hopefully when your bulldog puppy is only a few weeks or months old .  I will offer a vocal demonstration of the stridor/Stertor (breathing noise associated with the condition) and provide handouts with text and photos. For a definitive diagnosis of an elongated palate, everted saccules and other laryngeal abnormalities direct visualization of those structures would be necessary. 

The bulldog elongated soft palate posterior tip has been flipped over demonstration it entire length and size (as this photo attached to suture ( taken by Dr. Kraemer vet4bulldog.com)

The bulldog elongated soft palate posterior tip has been flipped over demonstration it entire length and size (as this photo attached to suture ( taken by Dr. Kraemer vet4bulldog.com)

Dr. Kraemer’s V4B Elongated Soft Palate in Bulldogs and French Bulldogs Maintenance:

When it comes to brachycephalic airway syndrome , weight control is instrumental in proper bulldog care. Bulldogs with mild symptoms will often show improvement with controlled exercise practiced in combination with avoidance of hot or humid conditions and stress. . It’s important to note, that medical management of those conditions does not correct the underlying anatomical abnormalities, but merely lessens the symptoms. Surgery is the treatment of choice whenever the anatomic abnormalities interfere with the patient’s breathing.

Since obesity, stress and hot warm weather worsens the symptoms of elongated obstructing soft palate, I recommend weight control and avoidance of hot condition and stress as the first step.  Medical management with a tranquilizer, Anti-inflammatory and oxygen therapy may all be useful for short term relief of airway inflammation or respiratory distress. However, It’s important to note, that medical management of those conditions does not correct the underlying anatomical abnormalities, but merely lessens the symptoms. Surgery is the treatment of choice whenever the anatomic abnormalities interfere with the patient’s breathing.

Bulldog elongated soft removed by Dr. Kraemer

Bulldog elongated soft removed by Dr. Kraemer

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, in order to ensure your bulldog puppy’s longevity and good health. In addition, early correction of stenotic nares and elongated soft palate will significantly improve airway function and should prevent 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 correctedSurgical 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:

TIPS:

Dr. Kraemer’s Elongated Soft Palate in Bulldogs and French Bulldogs Tip #1(DrKraemers.com): Bulldogs suffering from elongated soft palate often gag and vomit. To prevent aspiration (i.e. aspiration pneumonia) of the gag content, gastric juices and food, don’t let your bully eat or drink too fast. To slow them down, use cupcake cups or place objects in their water/food dish. Second, use a blend diet and mix it with water to form a thick soapy meal. Third, Feed smaller portions at a time and fourth, feed your dog on a step to elevate his upper body, the more vertical the better. . Finally, to decrease stomach acidity and gastric reflex, discuss with your vet home medication like antacids  as well as and antiemetic (anti-vomit) .

elongated soft palate resection in bulldogs. Showing 2/3 removed and sutured with the elongated part tip held by a hemostat on the left bottom of this photo ( taken by Dr. Kraemer vet4bulldog.com)

elongated soft palate resection in bulldogs. Showing 2/3 removed and sutured with the elongated part tip held by a hemostat on the left bottom of this photo ( taken by Dr. Kraemer vet4bulldog.com)

Dr. Kraemer’s Elongated Soft Palate in Bulldogs and French Bulldogs Tip #2(Vet4HealthyPet.com):  I recommend a harness rather than neck collar to prevent airflow restriction (all bulldogs)

Dr. Kraemer’s Elongated Soft Palate in Bulldogs and French Bulldogs Tip #3(StemCell4Pet.com):   In the event of a respiratory crisis you should check 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.

Dr. Kraemer’s Elongated Soft Palate in Bulldogs and French BulldogsTip #4: 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.

Dr. Kraemer’s Elongated Soft Palate in Bulldogs and French BulldogsTip #5: I recommend surgical repair of the elongated palate and/or stenotic naers as soon as your bully reached maturity at about 8 month of age

Dr. Kraemer’s Elongated Soft Palate in Bulldogs and French Bulldogs Tip #6:  If you cannot afford, or have to delay surgical treatment, you should ask your vet for a “Tranquilizer & Anti-Inflammatory emergency kit” to be used in stressful situations before, or as soon as, your dog shows signs of respiratory distress.

Dr. Kraemer’s Elongated Soft Palate in Bulldogs and French Bulldogs Tip #7: Bulldog suffering from BCS often gag and vomit, to prevent aspiration (i.e. aspiration pneumonia)  don’t let your bulldog puppy eat or drink too fast.

Dr. Kraemer’s Elongated Soft Palate in Bulldogs and French Bulldogs Tip #8: I recommend a harness rather than neck collar to prevent airflow restriction (all bulldogs)

Dr. Kraemer’s Elongated Soft Palate in Bulldogs and French Bulldogs Tip #9: In contrast to common notion it is my experience that Trachea Hypoplasia appears to be tolerated well in bulldogs in absence of concurrent respiratory and heart disease.

Dr. Kraemer’s Elongated Soft Palate in Bulldogs and French Bulldogs Tip #10: Bulldogs with this syndrome have an increased risk of complications associated with general anesthesia, to evaluate general health I recommend routine pre-anesthetic blood work. Also, Chest x-rays could be taken to evaluate the esophagus (megaesophagus), trachea (Hypoplastic), lungs (aspiration pneumonia), heart (heart disease) and diaphragm (hital hernia). For selected cases we also recommend a ECG screening.

Dr. Kraemer’s Elongated Soft Palate in Bulldogs and French Bulldogs Tip #11: Read Dr. Kraemer’s  anesthesia warning and recommendations. We have special pre-anesthesia bulldog protocols specially designed to minimize the breed related anesthesia risks and maximize post anesthesia recovery safety. 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 as seen in this photo completely removed and sutured ( by Dr. Kraemer vet4bulldog.com)

elongated soft palate in bulldogs as seen in this photo completely removed and sutured ( by Dr. Kraemer vet4bulldog.com)

WARNINGS:

Dr. Kraemer’s Elongated Soft Palate in Bulldogs and French BulldogsWarning #1: Symptoms are often worse in hot or humid weather.

Dr. Kraemer’s Elongated Soft Palate in Bulldogs and French BulldogsWarning #2: Elongated Soft Palate problems are directly related to the conformation or breed standard for brachycephalic dogs. I don’t recommend breeding a bulldog that needs surgery to correct airway obstruction.

Dr. Kraemer’s Elongated Soft Palate in Bulldogs and French Bulldogs Warning #3: Over time, dogs with this syndrome will develop other secondary problems that further obstruct airflow, such as enlarged tonsils, and everted saccules, a direct outcome of years of negative intra-airway pressure (suction). Tragically this all can end with an irreversible, inoperable, atrophied, collapsed, larynx cartilage.

Dr. Kraemer’s Elongated Soft Palate in Bulldogs and French Bulldogs Warning #4: 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 brachycepalic syndrome is suspect to be one of the underlying cause of prolapse urethra.

Dr. Kraemer’s Elongated Soft Palate in Bulldogs and French Bulldogs Warning #5: Vomiting and gagging are common to the brachycephalic breeds (bulldogs) due to 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 elongated palate and other Brachiocephalic Syndrome problems (such as stenotic nares).

Dr. Kraemer’s Elongated Soft Palate in Bulldogs and French Bulldogs Warning #6: 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.

Dr. Kraemer’s Elongated Soft Palate in Bulldogs and French Bulldogs Warning#7: In the early post-operative 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.

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