Brachycephalic airway syndrome (Proceedings) - Veterinary Healthcare


Brachycephalic airway syndrome (Proceedings)


Surgical treatment

Stenotic nares

In brachycephalic breed the cartilage plates are short, thick and displaced medially. Stenotic nares are present in 48% of dogs presented for brachycephalic airway syndrome. Stenotic nares are frequently found in brachycephalic dogs and interference with inspiration by the obstructed nares leads to secondary airway changes (i.e., everted saccules, laryngeal collapse, tracheal collapse). Stenotic nares have also been reported in cats.

The wing of the nostril is examined to determine the amount of tissue to be removed for optimal airflow. The technique of removing a vertical wedge from the wing of a nostril and extending the incision caudally to include part of the alar cartilage has been useful in eliminating stenosis. The incision is made with a # 11 BardParker blade. The tip of the blade is introduced at the apex of the wedge and directed caudally, with the cutting edge directed medially to the free edge of the wing of the nostril. The apex of the wedge is the pivot point of the flap created to allow the edges of the incision to come together evenly and without tension. The blade is again introduced at the apex of the wedge, and the cutting edge directed ventrolaterally as the tip is pushed in caudally to end at the same point as the first incision. The width of the base of the wedge (free edge) determines the opening of the nostril. The wedge is removed, and the edges are sutured with two or three interrupted sutures performed with 30 or 40 absorbable material using a small halfcircle cutting needle.

The surgical site is kept clean and protected from rubbing (self-mutilation) with an Elizabethan collar. Additional medical care is usually not needed.

Elongated soft palate

In brachycephalic breed the soft palate extends beyond the epiglottis obstructing the airway passage. Vibration of the soft palate in the pharynx induces inflammation and swelling that will obstruct even more the airway. Approximately 80 per cent of cases of overlong soft palate are found in brachycephalic dogs, English and French bulldogs being the most frequently afflicted. Edematous pharyngeal mucosa and enlarged, protruding tonsils are common. The intention of palate resection is to shorten the soft palate so that its free border lies at the tip of the epiglottis or just covers it with the tongue in a normal position.

The mouth is held open with a mouth gag, and the tongue is extended to provide adequate exposure of the oral pharynx. A pair of malleable ribbon retractors is helpful in moving soft tissues while the resection level is being determined. The free border of the palate is grasped with forceps, and both sides of the palate as well as the oral cavity are swabbed with antiseptic.

The tongue is relaxed, and the point at which the tip of the epiglottis touches the soft palate is noted and marked with a scalpel cut or a sterile felt-tipped marking pen. The caudo-dorsal part of tonsils can also be used as a cranial landmark for the soft palate. A pair of Allis forceps or a traction suture is placed in the free edge of the palate and retracted rostrally. An absorbable suture (40 to 50) is placed in the mucosa at the lateral edge of the free soft palate. The visualization is not always good in the mouth of brachycephalic dogs. It will open the surgical field and improve the visualization if the procedure is performed with long and curved instruments. The palate is incised from the lateral traction suture to the reference mark at its midline with a scalpel or scissors while low tension is applied on the forceps and lateral traction suture. The soft palate is completely excised. The incised edge is sutured with a simple continuous pattern, with sutures placed through both the nasal and oral mucosa, 1 mm from the cut edge and 2 mm apart. The layer of muscle is avoided so that the mucosa is pulled over the exposed muscle when the sutures are tightened. The closely placed sutures provide a smooth hemostatic closure and do not shorten the width of the soft palate. Postoperative hemorrhage or edema is minimal.


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