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.