Arytenoid Lateralization

The opening of the trachea (windpipe) is normally pulled open during inhalation and relaxes during exhalation. In laryngeal paralysis, the muscles that should open the airway do not work properly. When the pet breathes in, the airway walls fail to widen and may instead be drawn inward—sometimes collapsing enough to obstruct airflow. Early on, this causes louder breathing sounds; as the condition progresses, it can lead to critical obstruction and suffocation.

Early signs may be mild and easy to miss, such as:

• harsher or noisier panting
• panting more than expected, even when calm or in cool conditions
• a hoarse, raspy, or weak-sounding bark

With progression, owners may notice increasing breathing effort: anxious facial expression, prominent eyes, strong chest movements, and a “smiling” appearance while panting (lips pulled back, tongue extended). Dogs often fatigue sooner during normal activity.

Because panting is a key cooling mechanism, affected animals are more vulnerable to overheating even with modest exercise or mild heat exposure.

In advanced cases, pets may be in obvious respiratory distress: harsh inspiratory noise, reluctance to be handled, and dark red to purple tongue or gums. This is an emergency requiring immediate veterinary care.

Your veterinarian may recommend some or all of the following:

• bloodwork
• chest radiographs (x-rays)
• sedated examination of the throat/larynx
• neurologic examination

During an acute breathing crisis, immediate stabilization may include:

• oxygen supplementation
• external cooling
• sedation
• in some cases, intubation and short-term assisted ventilation

These measures often return the pet to baseline, but animals that have reached crisis commonly experience recurrent episodes because the airway remains functionally inadequate.

Several surgical approaches exist, but the technique most consistently associated with good results and relatively fewer complications is Unilateral Arytenoid Lateralization (“tieback”).

In a tieback procedure, a suture is placed to permanently hold one side of the larynx in a more open position. Opening only one side helps improve airflow while limiting the risk of food or liquid entering the airway.

When performed by an experienced ACVS board-certified veterinary surgeon, the operation is typically considered straightforward and relatively minimally invasive, involving a neck incision of roughly 3–4 inches and structured pain control to reduce postoperative discomfort.

Other surgical options may be considered if tieback is not appropriate, and this should be discussed with the primary care veterinarian and surgeon.

Typical postoperative recommendations include:

• use a harness instead of a neck collar
• limit barking for about 6 weeks
• feed as formed “meatballs” (to reduce aspiration risk)
• consider an elevated feeding station
• use caution with swimming
• implement weight-loss strategies if needed

Minor complications can include:

• incision infection
• seroma (fluid accumulation under the incision)
• loss of voice (often present even before surgery)
• coughing during/after eating or drinking (often improves over time)

Major complications can include:

• failure of the suture/cartilage attachment causing return of preoperative breathing difficulty and possible revision surgery
• aspiration of regurgitated material leading to aspiration pneumonia (mild to severe)

Many owners interpret the early decline as “just aging,” but improved airflow after surgery often results in marked increases in energy and activity. Overall, most families report good quality of life after surgical correction, although each case should be assessed individually and risks discussed in advance.