Repeat Staphylectomy and Concomitant Episioplasty in an Aged English Bulldog Crossbred Canine

Clinical signs of brachycephalic syndrome vary broadly in form, frequency, and severity. Respiratory insufficiency is often characterized by stertor or stridor, snoring, sleep apnea, open mouth breathing, apparent difficult breathing, abducted forelimb stance, exercise or stress/heat intolerance, hyperthermia, gagging or coughing, respiratory distress, cyanosis, and syncope. Digestive signs, such as vomiting, regurgitation, ptyalism, and dysphagia, may also be involved. Differential diagnoses may include foreign body obstruction of the upper respiratory tract, trauma, and neuromuscular dysfunction, specifically laryngeal paralysis. These changes in the upper airways may generate such severe negative pressure that the condition progresses to include laryngeal and pharyngeal inflammation, tonsillar eversion and epiglottic, laryngeal, or tracheal collapse. Other soft tissue structures may be affected by increased negative inspiratory pressure; macroglossia, amygdalitis and tonsillar hypertrophy, hiatal hernia, and digestive tract signs have frequent incidence in brachycephalic breeds and should be considered in clinical evaluations of these animals. Clinical signs may be exacerbated by obesity, heat, excitement, exercise, and stress.