Pug Dog Everted Laryngeal Saccules

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Overview

Laryngeal saccules (laryngeal ventricles) are soft tissue masses that are located inside the throat, right above the vocal cords. The exact function of these are not yet known.

Due to the compressed internal breathing passages of brachycephalic breeds like the Pug, there can be an abnormality in which this tissue becomes everted (they flip inside-out). When this happens, the tissue protrudes and blocks the entrance to the trachea (windpipe). Depending on the extent, this can cause breathing issues ranging from minor to severe.

Yet, there is more that can happen. This condition causes negative pressure and stress to be placed on the cartilage that supports the larynx. In these cases, this can lead to laryngeal collapse. Laryngeal collapse is a very severe and usually fatal condition which causes suffocation.

Occurrence Rate

In looking at all brachycephalic breeds with some level of brachycephalic obstructive airway syndrome, studies have shown a rate as high as 66% for the presence of everted laryngeal saccules. The bulldog is one of the breeds most at risk for this; however, it has been seen in all breeds with a brachycephalic profile.

Symptoms

Signs include one or more of the following:

Noisy breathing (grunting, gasping, rattling, or wheezing noises)
Nasal congestion
Gasping for breath
Symptoms may be more severe during or after exercise or when a dog is excited
Trouble eating (gagging on or regurgitating food)
Cyanosis (gums to turn blue)
Collapse, fainting

Note that symptoms can come on gradually, but in some instances, this is a sudden event that requires emergency surgery.

How this is Diagnosed

With a dog lightly anesthetized, laryngoscopy is performed which allows a veterinarian to look at the area and take photos for further study. The soft palate and all surrounding tissue structures will be evaluated as well. When it is possible to have this scheduled (not an emergency) it is usually recommended to not have a dog eat for 6 to 12 hours beforehand.

Additional tests may include x-rays, CT scans, a complete blood count and biochemistry, and arterial blood gas (ABG) to measure acidity (pH) and levels of oxygen and carbon dioxide in the blood.

Treatment

Overview:

Once this is confirmed, this is almost always treated via surgery. This is because everted laryngeal saccules cause pressure on the larynx and is considered to be the first stage of laryngeal collapse which is a fast, severe, and often fatal condition that causes a dog to suffocate.

A surgical laser is used to remove the saccules. Since Pugs that have everted saccules may also have elongated soft palate, surgery to correct both abnormalities may be done at the same time. A surgical laser is used to remove the saccules. Since Pugs that have everted saccules may also have elongated soft palate, surgery to correct both abnormalities may be done at the same time.

Prognosis:

Prognosis for Pugs that have surgery to fix everted laryngeal saccules varies depending on the dog's age, general health, the extent of the eversion, how quickly the abnormality was diagnosed, if there are other brachycephalic obstructive airway syndrome (BOAS) issues such as stenotic nares, elongated palate, or tracheal issues, and, importantly if laryngeal collapse has occurred.

With dogs that have everted laryngeal saccules that are treated before laryngeal collapse, success rate (ranging from noticeable improvement to significant improvement with normal breathing afterward) is 75+%.

However, with laryngeal collapse, the success rate is much lower. Some reports suggest marked improvement with just 40% of dogs and death within 36 hours for 14%. It should be noted, however, that death rate was highest with bulldogs over all other brachycephalic breeds.

Recovery:

Most dogs need to stay at the veterinary hospital for 1 to 2 days and recovery is typically 2 to 3 weeks. Pain and inflammation are controlled with long-acting anesthetics and NSAIDs, and sometimes opioids. Antibiotics are also given in most cases to help prevent post-surgical infections.

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