Tracheostomy in Dogs

A tracheostomy is a surgical procedure with the aim to allow breathing or the release of secretion by creating a hole in the trachea (windpipe). It will be performed by a surgeon and used as a permanent measure when there is a serious upper airway obstruction that cannot be resolved by any other means. It is used infrequently as a temporary, emergency measure, when a dog is unable to breathe via the mouth, nose, or larynx. 

Before the operation the dog will be thoroughly examined. Radiographs and physical examination of the respiratory tract will be undertaken. Cervical radiographs and possibly tracheoscopy may be needed to ensure the breathing tract down from the larynx is sufficiently functional. These initial steps may take a week to several weeks depending on the severity of the case. If tracheostomy is being used as a temporary measure, these initial stages will be bypassed. A step by step of the surgical procedure itself is as follows:

• The dog will be intravenously anesthetized
• The dog will then be placed in ventral recumbency with the neck hyperextended 
• An incision is made along the larynx and into the larynx
• For a temporary tracheostomy:
• A plastic tube is inserted to allow the dog to breathe 
• For a permanent tracheostomy:
• The sternohyoideus muscles are divided
• An adequate window is incised
• A rectangular suture is positioned to the adjoining skin
• The dog will then breathe through the new hole (no tube is needed)

Tracheostomies can be very successful in achieving their goal; to enable breathing again. As a temporary, emergency measure they can alleviate blockages and allow breathing almost instantly. As a permanent measure also, they can be extremely effective, often adding years on to the life of dogs.

When used as a temporary measure, the wound can be stitched back together after the tube is no longer needed, negating any long term effects. As a long term response, a tracheostomy will have a permanent impact, the effects of which will last the remainder of the dog’s life. 

There are limited alternatives to tracheostomy due to the fact they are mostly used as a last resort. There is the possibility of stents being inserted into the trachea, which keep the airway open. However, stents can move around or fracture. Tracheostomy as a last resort is often the more viable long term solution. 

The dog will usually be kept in the veterinary hospital for two to three days after a tracheostomy. With temporary tracheostomies, once the tube is removed the hole usually heals within two days. The wound itself should be healed within two weeks. The dog should be monitored for signs of swelling and infection at the incision site. The dog may need to return for checkups, but this is case dependant. 

For a permanent tracheostomy, the dog may seem lethargic for the next six months. It could be months to over a year before the dog is back in relatively good health. But care will be needed for the rest of the dog’s life. The stoma will need to be cleaned up to five times a day with a damp cotton pad. Water should be kept out of the stoma. The dog's fur will need to be regularly clipped to prevent it blocking the hole. Monitoring of the hole will need to be on-going to ensure it doesn’t reduce in size. If it does, further surgery may be needed to increase the size. Mucodine medication may also be required if the hole blocks up with excessive mucus. 

Due to the surgical nature of this procedure and the after care required it does come at a cost. Initial examinations may cost up to a $150. Radiographs and other tests may cost up to $500. Anesthetics can cost around $400. The cost of the surgery itself could climb as high as $6,500. However, this will depend on the experience of the surgeon, the hospital, and the individual case. Post-surgery medication to relieve pain or unblock mucus could cost around $50 a week. 

The alternative of having stents positioned in the trachea is also an expensive procedure. Each stent can cost up to a $1,000 and the procedure itself anywhere between $3,500 and $6,500. The alternative is not only equally as expensive, but it is not as effective in many cases and often not a viable option. 

Tracheostomy is a non curative procedure. It may enable breathing but it does not cure the primary condition causing the breathing difficulties. There is the short term risk of complications from the anesthesia and the risk of postoperative infection. The dog will also need a significant amount of aftercare and monitoring. Also to be considered in the long term is the risk the size of the stoma will reduce and further surgery will be required.

However, the benefits of this operation are plentiful. A tracheostomy may be the only viable way to enable the dog to breathe in the short term and the long term. Without the temporary, emergency operation, many dogs will die in theatre. The permanent tracheostomy enables breathing in dogs with severe tracheal difficulties, it can often add years onto the life of some very unwell dogs. 

Unfortunately, due to the often inherited characteristics particularly common amongst Brachycephalic dogs, short muzzles and thick necks, it is difficult to prevent conditions affecting the upper airways. The nature of the operation as a temporary, emergency response to a trachea blockage makes it difficult to prevent in the long run. Likewise, as a permanent measure, the conditions that lead to the requirement of a tracheostomy are usually inherited and thus difficult to prevent.

Having said that, keeping your dog fit and healthy with regular exercise is good for their breathing in general and builds muscles in their neck. This will also promote regular exercise amongst owners. Using a harness instead of a neck leash may also relieve pressure on the neck. Keeping your dog slim with a healthy, balanced diet will help to prevent the dog putting excessive weight on around the neck adding to the strain on the airways.