Laryngeal paralysis is a relatively common disorder causing difficulty with breathing. It typically occurs in middle age and older, larger breed dogs, but it can be seen in small breed dogs and occasionally in cats. It can occasionally be seen as a congenital disease in young Bouvier dogs, Dalmatians, and Siberian huskies.

Laryngeal paralysis refers to paralysis of the muscles that open up the upper airway (specifically, these muscles pull the two vocal folds in the larynx apart from each other, thereby increasing the size of the opening into the trachea and lungs). Most of the time, the specific cause of the muscle paralysis is not known. Occasionally, laryngeal paralysis is only one sign of a systemic neurological disorder, but most of the time it is a problem that occurs by itself.

Clinical signs of laryngeal paralysis are related to failure of normal movement of the vocal folds. Since the vocal folds cannot be pulled apart from each other when breathing, the opening of the airway is smaller than usual. This means that the dog is not able to get as much air into his or her lungs as is needed. Common clinical signs include progressively noisier breathing, intolerance to exercise, and sometimes a voice change. More severe signs include coughing/gagging, vomiting, and sometimes a near inability to breathe. Laryngeal paralysis can be an emergency situation if the dog is unable to breathe.

Definitive treatment for laryngeal paralysis involves surgery. If a dog is in a crisis situation - where it cannot breathe and is essentially choking - emergency intervention is essential. A dog in this situation is typically sedated to decrease anxiety, and an endotracheal tube might be placed so that oxygen can be administered. Often, sedation is sufficient to calm the dog down enough to allow improved breathing.

There are several types of surgery available for laryngeal paralysis. All of them are designed to increase the size of the opening of the airway to allow easier passage of air. The most successful surgery, and the one most frequently performed, is called ARYTENOID LATERALIZATION, or laryngeal tieback. This surgery involves opening the larynx from the side of the neck to expose the piece of cartilage to which the vocal fold attaches. Typically, this is done on the left side of the neck. The cartilage is freed from its attachment and pulled back and to the side and sutured in this position. Doing this will pull the left vocal fold off to the side which increases the size of the opening to the airway. Only one vocal fold usually needs to be tied back. Most dogs respond very nicely to this surgery. The surgery does not necessarily make the dog perfectly normal and act like a puppy again, but it is very good at improving their ability to breathe and is excellent at preventing the breathing crises which can occur with laryngeal paralysis.

After the surgery, most dogs are sent home for a couple of weeks of rest. Mild coughing is common after the surgery, but should resolve within a week or two. Improved breathing is usually seen almost immediately after surgery and usually lasts for the life of the dog.

The preceding information was written by Dr. George Siemering and Dr. Dan Brehm. Drs. Siemering and Brehm are the surgeons at SouthPaws and perform a full range of soft tissue, orthopaedic, and neurological surgical procedures. They can be reached at (703) 451-0909.

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