BRACHYCEPHALIC SYNDROME

Brachy means “ shortened “ and cephalic means “ head “. In dogs and cats, being brachycephalic means that the skull and in particular the face and nose are shortened.

People may describe it as the face appearing "pushed in." As the face and nose bones are shortened, the anatomy of other tissues change as the amount of space is restricted.

Some dog breeds that are brachycephalic include the English Bulldog, Boxer, Pekingese, Chinese Pug, Shar Pei, Lhasa Apso, Shih Tzu, King Charles Spaniel, and Boston Terrier. In cats, the Himalayan and Persian breeds are brachycephalic. While the brachycephalic head shape in these dog and cat breeds is desirable, associated anatomical changes can be problematic. 

Animals that are brachycephalic have a compressed face, with nostrils that are, often times narrowed. Additionally these breeds will have an abnormally shaped nasopharynx ( the area where the nasal cavity meets the throat ).

Brachycephalic syndrome, also known as brachycephalic respiratory syndrome or congenital obstructive upper-airway disease, is a collection of physical abnormalities that are common in the breeds mentioned above.

One or more of these abnormalities may be present in an individual animal, and include : 

• Stenotic nares : A severe narrowing of the nostrils.
• Elongated soft palate : The soft palate extends into the back of the throat and may partially block the airway.
• Eversion of the laryngeal saccules : The laryngeal saccules are small out-pouchings located in the larynx ( voice box ). With the increase in respiratory effort, due to stenotic nares and an elongated soft palate, these out-pouchings get sucked into the airway, further restricting air-flow.
• Narrowing of the trachea : The trachea ( wind pipe ) is narrower in diameter.
• One or more of these abnormalities makes breathing difficult because of increased airway resistance and the increased effort it requires to inhale.

Animals with brachycephalic syndrome, over time, may develop other abnormalities in the airway including : 

• Inflammation and swelling of the voice box ( laryngitis ) and throat ( pharyngitis )
• Tonsil eversion ( the tonsils protrude into the throat )
• Collapse of the epiglottis ( part of the larynx ), larynx and/or trachea.

Symptoms of brachycephalic syndrome include : 

• Labored breathing
• Noisy breathing
• Exercise intolerance ( inability to exercise without becoming “ out of breath “ )
• Gagging
• Coughing
• Snorting
• Cyanosis ( turning blue )
• Collapse
• Restlessness

These animals may also exhibit : 

• An increased susceptibility to heat stroke
• Difficulty swallowing
• Abnormal body posture as they try to more efficiently move air into their respiratory systems
• Increased incidence of dental and periodontal disease
• Increased incidence of eye problems
• Infections in the folds of the skin of the face

In diagnosing brachycephalic syndrome, a veterinarian will use information obtained through : 

• A complete history
• A physical exam
• Analysis of the animal's blood, especially the pH and CO2 levels
• Radiographs ( x-rays ) of the neck and chest to look for evidence of airway problems
• Endoscopic exam of the upper airway and trachea
• Bacterial culture and/or a biopsy of the airway

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