Radiographic Diagnosis and Surgical Planning in Brachycephalic Obstructive Airway Syndrome: Comparative Case Reports in Pekingese, French Bulldog, and Pug
Keywords:
Brachycephalic obstructive airway syndrome, Pekingese, French Bulldog, PugAbstract
Brachycephalic obstructive airway syndrome (BOAS) is a multifactorial disorder characterized by congenital upper-airway abnormalities, with clinical severity influenced by secondary changes such as laryngeal collapse. Although Bulldogs and Pugs dominate clinical reports, toy breeds such as the Pekingese are equally predisposed. Early surgical correction of primary lesions is critical to preventing progression and optimizing long-term outcomes. Three canine BOAS cases are described. Case 1 involved a 3.5-year-old Pekingese with progressive stertor and exercise intolerance, unresponsive to conservative therapy. Radiography confirmed soft-palate elongation and Grade I laryngeal collapse. Case 2, a 2-year-old French Bulldog, exhibited lifelong noisy breathing and exercise intolerance; imaging demonstrated congenital hypoplastic trachea with concurrent soft-palate elongation and stenotic nares. Case 3, a 5-year-old Pug, presented with severe inspiratory stertor, recurrent syncope, and gastrointestinal signs. Endoscopy confirmed elongated soft palate, stenotic nares, everted saccules, and Grade II laryngeal collapse. Survey radiography provided critical initial information in all cases. A tracheal-to-thoracic inlet ratio of 0.10 confirmed hypoplastic trachea in Case 2, while endoscopy established Grade II collapse in Case 3. Arterial blood gas analysis revealed hypercapnia and hypoxemia in Cases 2 and 3, guiding anesthetic planning. All cases underwent alar wedge rhinoplasty and staphylectomy (CO₂ laser in Cases 1 and 3, cold steel in Case 2). Case 3 also required bilateral sacculectomy. Perioperative management emphasized preoxygenation, cautious sedation, rapid airway control, and corticosteroids. Case 1 achieved full clinical resolution by 30 days. Case 2 improved substantially, though persistent stridor reflected fixed tracheal hypoplasia. Case 3 demonstrated reduced syncopal episodes but residual stridor due to Grade II collapse. All owners reported improved quality of life. These cases illustrate the diagnostic and prognostic value of imaging, the importance of early intervention, and the influence of concurrent anomalies on surgical outcome in BOAS.
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References
1. Krainer, D. and G. Dupré, Brachycephalic obstructive airway syndrome. Veterinary Clinics: Small Animal Practice, 2022. 52(3): p. 749-780.
2. Wallace, M.L., Surgical management of brachycephalic obstructive airway syndrome: An update on options and outcomes. Veterinary Surgery, 2024. 53(7): p. 1173-1184.
3. Bottero, E., et al., Clinical Evaluation and Systematic Classification of Endoscopic Gastrointestinal Findings in 176 French Bulldogs with Brachycephalic Airway Obstructive Syndrome. Animals, 2025. 15(14): p. 2137.
4. Cook, L., T. Hallowell, and J. Sun, Retrospective evaluation of the outcomes of advanced airway management in intubated patients with brachycephalic obstructive airway syndrome: 52 cases (2010‐2020). Journal of Small Animal Practice, 2025.
5. Åsbjer, E., Å. Hedhammar, and K. Engdahl, Awareness, experiences, and opinions by owners, breeders, show judges, and veterinarians on canine Brachycephalic Obstructive Airway Syndrome (BOAS). Canine Medicine and Genetics, 2024. 11(1): p. 3.
6. Fitzmaurice, M., et al., Static respiratory compliance in anaesthetised and intubated brachycephalic dogs with and without brachycephalic obstructive airway syndrome. The Veterinary Journal, 2025: p. 106372.
7. Rein, A., et al., Laryngeal and pleural ultrasound and acoustic radiation force impulse elastography in dogs with brachycephalic obstructive airway syndrome. Scientific Reports, 2025. 15(1): p. 19884.
8. Dimopoulou, M., et al., Use of respiratory signal analysis to assess severity of Brachycephalic Obstructive Airway Syndrome (BOAS) in dogs. The Veterinary Journal, 2024. 308: p. 106261.
9. Yoshida, S., et al., Vocal fold granuloma associated with brachycephalic obstructive airway syndrome in 13 dogs. Journal of the American Veterinary Medical Association, 2025. 263(6): p. 786-790.
10. Williams, P.J., C. De Gennaro, and J.L. Demetriou, Evaluation of the addition of adrenaline in a bilateral maxillary nerve block to reduce hemorrhage in dogs undergoing sharp staphylectomy for brachycephalic obstructive airway syndrome. A prospective, randomized study. Veterinary Surgery, 2024. 53(1): p. 67-74.
11. Tamburro, R., et al., Histomorphological evaluation of thermal injury following palatoplasty performed with CO2 laser or LigaSure device in dogs with brachycephalic obstructive airway syndrome. The Veterinary Journal, 2024. 307: p. 106195.
12. Cardoso, D.R., et al., Oral focal mucinosis in a dog with brachycephalic obstructive airway syndrome. Veterinary Record Case Reports, 2025. 13(2): p. e70030.
13. Zibetti, F.L., et al., Arrhythmogenic Right Ventricular Cardiomyopathy in English Bulldog with Brachycephalic Obstructive Airway Syndrome (BOAS). Acta Scientiae Veterinariae, 2025. 53.
14. Siddiqui, M., et al., Canine Brachycephalic Obstructive Airway Syndrome (CBOAS)-Diagnosis and Non-Surgical Management. 2024.
15. Vrijsen, E., et al. Topical application of epinephrine on everted laryngeal saccules as an alternative to surgical resection in dogs with brachycephalic obstructive airway syndrome. in BSAVA. 2024.
16. Cooper, L.M., J.A. Grimes, and A.M. Davros, The brachycephalic risk (BRisk) score’s predictability for major postoperative complications varies between breeds undergoing brachycephalic obstructive airway surgery. Journal of the American Veterinary Medical Association, 2025. 1(aop): p. 1-6.
17. Kravchenko, S., et al., A case of brachiocephalic syndrome in a French bulldog. Ukrainian Journal of Veterinary and Agricultural Sciences, 2024. 7(3): p. 37-41.
18. Anyamaneecharoen, T., et al., Quantitative assessment of preoperative and postoperative brachycephalic airway obstruction syndrome surgery using clinical grading questionnaires and 6-minute walk test in French bulldogs. The Thai Journal of Veterinary Medicine, 2024. 53(4): p. 495-503.
19. Vicenti, C., et al., Respiratory Effects of Continuous Positive Airway Pressure Administered during Recovery from General Anesthesia in Brachycephalic Dogs. Veterinary Sciences, 2024. 11(2): p. 75.
20. Mostafa, A.A., K. McCutcheon, and C.R. Berry, Comparison of tracheal diameter in non-brachycephalic versus brachycephalic dogs using manubrium and thoracic inlet tracheal indexes. Frontiers in Veterinary Science, 2024. 11: p. 1454930.
21. McDonald, A., et al., Neural network analysis of pharyngeal sounds can detect obstructive upper respiratory disease in brachycephalic dogs. Plos one, 2024. 19(8): p. e0305633.
22. Araos, J., et al., Effect of continuous positive airway pressure helmet on respiratory function following surgical procedures in brachycephalic dogs: A randomized controlled trial. Veterinary Surgery, 2024. 53(5): p. 872-880.
