Surgical Options
Can laryngeal paralysis be treated?
The most common treatment is the laryngeal “tie-back” surgery (technically called unilateral arytenoid lateralization). The surgeon makes a small incision on the side of the dog’s neck and places a permanent suture in one of the laryngeal folds to hold the fold open and allow air to more freely flow through. It’s a little like using a curtain tieback to permanently hold a curtain open so air can flow through the window. The suture must be tied with just the right amount of tension to avoid pulling the fold back too far and leaving the windpipe overly exposed. When done by a veterinary surgical specialist, the surgery itself takes about 30 minutes, and dogs can often go home the same day of the surgery.
Veterinarians have also explored surgically placing a stent to hold the larynx open, but this technique is not widely available. (Ricart 2020, Cabano 2011)
Swallowing function: depending on the degree of esophageal dysfunction and risk of aspiration pneumonia, medications (cisapride, metoclopramide, omeprazole) to aid with swallowing and reflux issues may be prescribed. Feeding habits may also be changed to decrease risk of aspiration pneumonia.
Is my dog a good candidate for surgery?
Dogs who are otherwise healthy or have chronic diseases that are well-managed should be eligible for laryngeal tieback surgery. If a dog with GOLPP already has moderately reduced esophageal function, their chance of developing aspiration pneumonia after tie-back surgery increases. In that case, the surgeon may use a slightly different, more complex laryngeal surgery technique. But if a dog has severely reduced esophageal function or has megaesophagus, laryngeal surgery may not be an option at all. (With megaesophagus, the esophagus is so overly enlarged and distended that food doesn’t move to the stomach.) In addition, dogs who already have severe mobility problems or can’t get up on their own are not candidates for this surgery.
To check esophageal function before surgery, your dog will have x-rays taken of his esophagus while he swallows (called an esophagram). These radiographs show how fast food and liquid move through the esophagus and whether any of it moves backward, which helps us decide whether laryngeal surgery is a good option.
Veterinary surgeons also recommend that dogs have a computed tomography (CT) scan to check for thyroid, lung, or heart tumors before laryngeal surgery. Tumors of the neck and chest can also cause signs of laryngeal dysfunction and change a dog’s treatment options and prognosis. If a tumor is found elsewhere (nose, spleen, adrenal glands, liver), it also affects a dog’s prognosis and may need to be treated first if possible. For dogs with megaesophagus who aren’t candidates for laryngeal tieback surgery, a tracheostomy (surgically creating a permanent opening in the windpipe) may be an option.