Tracheal Collapse
Article Written by Dr. Daniel A. Degner, Board-certified Veterinary Surgeon (DACVS)
Key Points 

Tracheal collapse is commonly seen in small breed dogs such as Yorkshire terriers, Poodles, and Pomeranians to name a few
Tracheal collapse is caused by a progressive weakening of the the tracheal rings
When medical treatment is not effective surgery is a good option
Prognosis is good following surgery
Anatomy

The trachea, commonly known as the windpipe, is a tube that allows passage of air from the back of the throat to the lungs
There are two regions of the trachea: cervical which is located in the neck and the thoracic trachea which is located in the chest
The trachea is made of many "C"-shaped cartilage rings and a dorsal tracheal ligament which connects the "C" to form a complete tube
Each of the cartilages is connected together by fibrous tissue
The voice box or larynx is the gateway of the trachea and prevents food and water from getting into the trachea
Two delicate nerves located on each side of the trachea, called the recurrent laryngeal nerves, control the muscles that open the doors of the voice box; damage to these nerves causes laryngeal paralysis
Below is a section of a normal trachea illustrating the dorsal tracheal ligament that is on the top side of the trachea and the cartilage rings that maintain the structure of the trachea


Cause of tracheal collapse

Tracheal collapse is commonly seen in small breed dogs such as Yorkshire terriers, Poodles, and Pomeranians to name a few
Tracheal collapse is caused by a progressive weakening of the the tracheal rings
One study showed that dogs with tracheal collapse have less chondroitin sulfate in their tracheal rings
Cushing's disease (adrenal gland produces too much steroid) can weaken the cartilages
Below is an illustration showing about 50% collapse of the trachea, as the cartilage rings become progressively weaker, the trachea continues to collapse


Clinical signs

Goose honking cough is the classic sign of this disease
Coughing frequently is worsened by hot weather, exercise and excitement
Fainting spells due to lack of oxygen
Exercise intolerance


Diagnostic testing

Complete blood cell count
Chemistry profile
Testing for Cushing's disease if clinical signs are present
Urinalysis
Fluoroscopy - movie type of x-ray (real time) that allows evaluation of the airway during inspiration and expiration
Scoping the airways
Chest radiographs below demonstrates a severely collapsed trachea (dark grey thin stripe labeled as trachea) in a dog; both the trachea in the neck and in the chest are collapsed


Treatment

Medical therapy
Cough suppressants
Antibiotics if indicated
Short course of steroids
Bronchodilators
Weight loss
Use harness instead of neck collar
Limit excitement
Keep out of hot environment
Surgery
Indicated if collapse is advanced
Indicated if collapse is not responsive to medical therapy
Surgery involves suturing the collapsed trachea to plastic rings which are placed around the trachea (see illustration); in the photo below, two clear plastic rings have been sutured to the trachea; an instrument has been passed beneath the trachea in order to pass the third plastic ring


Aftercare

Cough suppressants are needed while the trachea is healing - excessive cough can break the repair down
Pain medication
Antibiotics
Exercise restriction for 4 month
Use harness instead of neck collars
Weight reduction


Potential complications

Laryngeal paralysis
Swelling of the airway
Necrosis of the trachea
Recurrence
Anesthetic death
Pneumonia
Infection of surgical site