Soft and Cleft Palate Problems

Cleft palate or oronasal fistula

Question: Hello Dr. Richards, Our newest family member is a six week old Boston, in the family since November 13. She has a problem, since day 3 with us, of "fits" of sneezing, with a significant mucus discharge out of her nose and mouth every 3-4 hours. There appears to be little or no coughing during the "fits" but she becomes quite distressed, running in circles, shaking her head, running under furniture, etc. The discharge has a foul odor. She seems to rest comfortably in the interim, especially after eating, and sometimes feels like playing a bit, although play time usually leads into another "fit". We had her examined by our family Vet last Monday, and he treated her for round worms . A call to him on Wednesday regarding the "fits", which had seemed to worsen, resulted in a diagnosis of a possible upper respiratory problem and a prescription of a "mild" antibotic (amoxi), which we give orally twice daily in .5 ml dosage and a statement by him of allowing her immune system to mature in a month or so plus the usual reminder regarding short nose dogs . He also said it could possibly be a problem with the soft palate. Her actions do not really resemble a reverse sneeze . On Wednesday, we changed her diet from baby rice cereal and milk to canned Nutro Puppy food.Her stool is firm, dark green in color. Occassionally, perhaps once a day, she may regurgigate a small amount of material within an hour or so of one her four daily feedings. We spoke with the breeder, an elderly lady, on Thursday and she bassured us that the puppy had been indoors for the entire time, prior to our purchase, and that there is no possibility of distemper exposure. She indicates that the remaing three puppies from her litter were healthy and without problems. We read that the "puppy" version of kennel cough was different from that of an adult dog. Do you agree with the upper respiratory diagnosis? Do you have any other suggestions, ideas, recomendations? Should we be highly worried, which we currently are? Thank you, C. and P. S.

Answer: C. and P.-

Two conditions come to mind quickly with the signs you describe. The first and foremost is the possibility of a cleft palate or oronasal fistula (opening between the mouth and nasal passages) for some other reason. I think it would be really worthwhile to rule out this possibility, even if anesthesia is necessary in order to do a good exam. The second thing that I see sometimes in Bostons (more often in Pugs, though) is stenotic nares. In this disorder, the openings to the nostrils are too small and the puppy has a really hard time breathing through the nose. This leads to inflammation in the airways and is sometimes accompanied by nasal exudates. I view this as a distant secondary possibility to a cleft palate problem, though, with the overall description you give. In addition, there is a small potential for a nasal foreign body. These sometimes occur when a puppy eats something like grass or string and then vomits it up but the vomitus goes out the nasal passages instead of the mouth -- except for the foreign body which gets lodged there. A few puppies have other problems, like fungal or bacterial nasal passage infections but these really aren't that common in young dogs and might suggest an immune system deficiency in a dog. Lastly, viral upper respiratory problems, with distemper being the one that comes to mind first, is a possibility as well. This usually causes more severe signs of illness but some puppies seem to get nasal exudates and coughing for some time before showing other signs.

I'd start with a really good oral exam, looking for a cleft palate or oro-nasal fistula. A pretty decent examination of the nasal passages is possible if anesthesia is used but it isn't possible to see all of the nasal passages without an endoscope. Plus, palate abnormalities other than cleft palates and oronasal fistulas are often visible with anesthesia, too. Examination of the exudate from the nose under the microscope might reveal a cause if fungal elements are visible in the exudate. If none of this produces a diagnosis, then endoscopic exam might be necessary.

I think your worry is justified. Please as your vet to take a really good look in your puppy's oral cavity for a cause for the signs you are seeing.

Mike Richards, DVM 11/21/99

Soft palate surgery for Pug

Q: Dr Mike, could you tell me is the operation for a large soft palate in a 1yr old pug simple or are there dangers?She was spayed recently and while under the anaseithic was found to have a very large soft palate.She is very nervy and tense for a pug and at times quite growly towards our other pug.She showed signs of this behavior before being spayed and has started doing this again, also I don't know if it is normal or not but her nails are changing from black to white, still good and strong just changing colour.Where we are in New Zealand there is not much information available about conditions like soft palate's etc;as pugs aren't all that common.I would appreciate any advice you can give me. Sharon

A: Sharon- Soft palate surgery seems to be pretty safe when done by someone who is experienced in the procedure. I have only operated on soft palates when trauma or other situations made it necessary. Surgery does not seem to be technically difficult in this region. However, determining whether or not surgery is necessary does seem to be difficult to me, as well as deciding which surgery is best in many situations which obstructive airway disease is present. So I tend to refer these cases to surgical specialists. If this was not possible and a patient had obvious signs of respiratory distress, did not have have obstruction of the nostrils (pretty common in pugs) and seemed like a good candidate for surgery I think I'd be willing to try it. Since I have access to surgical specialists close by I think my patients are better served by referral, though.

We have done a number of the procedures for opening up nostrils and a couple of these dogs did seem to have positive behavioral changes associated with the increased ability to breathe.

I don't think I'd worry over the nails changing color unless there is inflammation around the nailbeds or other signs of problems.

Mike Richards, DVM

Cleft Palate- Toxins that cause

Q: Dr. Mike: Could you tell me which toxins might be the cause of cleft palate in puppies and what other environmental conditions might also contribute to this problem. Thank you. Kim

A: Kim- There are genetically identifiable strains of laboratory animals that produce high incidences of cleft palate, so it is likely that genetics plays a role in cleft palate formation in some dogs as well. In a litter with a small number of affected puppies it is probably most likely that a genetic cause may be present.

There are definitely toxins that can lead to cleft palate formation, too. I think that if the whole litter or a large percentage of the litter is affected then it would be more likely that a toxic condition may have caused the problems. While there may be a much larger number of causes of cleft palates than I am aware of, these are the toxins that may cause cleft palates (or other birth defects, if administered during pregnancy) that I know of:

steroids (cortisones), Vitamin A in overdosages, tiopronin, sulfa based antibiotics, meclizine and griseofulvin. Some plants can cause cleft palates if ingested during pregnancy but this is more common in livestock.

Mike Richards, DVM

Cleft Palate

Q: Can you please help me find information about a cleft palette on a dog. Much appreciated

A: Cleft palates do occur in dogs. They are more common in the short nosed breeds of dogs than in other breeds. Cleft palates are considered to be an inherited trait. If both parents of a dog have cleft palates, the odds of it having a cleft palate are about 40%. This is thought to be a recessive trait or an irregular dominant trait according to A. Nelson, writing in the "Textbook of Small Animal Surgery", Slatter, ed.

Exposure to toxins or infectious diseases during the 25th to 28th day of pregnancy may also induce cleft palates.

Primary cleft palates are obvious as they cause the typical "harelip" appearance that people think of with cleft palate. These are less common in dogs than clefts of the secondary (hard) palate. These are usually noticed when a puppy starts to nurse and milk exudes from their nose or they gag when nursing. Clefts of the secondary palate also can affect the soft palate. These may cause less clinical signs but dogs with this problem may have stunted growth or chronic respiratory conditions.

These can almost always be fixed surgically but the techniques are often complicated if the cleft is even moderately severe and it may be best to seek a surgical specialist if repair is contemplated. If your vet feels competent to do the surgery, he or she probably is. Just ask and see whether or not your vet feels better about referring these or fixing them.

Mike Richards, DVM