Respiratory obstruction due to tonsillar lymphoglandular polyp in a brachycephalic dog: a case report

BACKGROUND: Respiratory distress is one of the most common afflictions of brachycephalic dogs. Dogs in respiratory distress usually present to the emergency service with a constellation of clinical signs including but not limited to: stertorous breathing, dyspnea, gagging, cyanotic mucus membranes, hyperthermia, and commonly a history of gastrointestinal signs. While Brachycephalic Obstructive Airway Syndrome is the most common cause of respiratory distress in dogs with brachycephalic conformation, any condition eliciting an inflammatory response in the oropharynx, can result in obstruction. There is no previous report of respiratory obstruction leading to emergency tonsillectomy caused by tonsillar polyps. CASE PRESENTATION: A 9-month-old male intact English bulldog presented to the emergency service in severe respiratory distress. Due to continued severe dyspnea and cyanosis the patient was induced with propofol (Propofol, Hospira) 4 mg/kg intravenously titrated to effect and tracheal intubation performed. Intubation was noted to be difficult due the presence of two, large, inflamed masses in the oropharynx region. The remainder of his physical exam was unremarkable. Minimum database blood work and chest radiographs revealed only minor abnormalities. The patient was placed under anesthesia and the masses were transected sharply using a carbon dioxide (CO2) laser (Aesculight, Bothell, WA, USA). Anesthesia and recovery were uneventful, and the patient was discharged the following day. Histopathology results of the masses revealed them to be benign lymphoglandular polyps. CONCLUSIONS: This is the first report of bilateral tonsillar polyps causing life-threatening respiratory obstruction in a dog. Both masses were excised safely and completely with the CO2 laser. Difficulties inherent to oropharyngeal surgery include the hemorrhage, small working space, tissue swelling and difficult visualization. Surgical excision of these polyps alleviated all emergent and chronic clinical signs, and the patient’s remains healthy 12-months post-treatment.