Brachycephalic airway syndrome, Part 1: Correcting stenotic nares - DVM
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Brachycephalic airway syndrome, Part 1: Correcting stenotic nares


DVM360 MAGAZINE


Correcting stenotic nares


Figure 1: Note the stenosis of the nares by the medial pinching of wings. (Photo courtesy Joseph Hauptman, DVM, Dipl. ACVS, Michigan State University College of Veterinary Medicine.)
Most airway resistance comes from the nasal passages, so correction of stenotic nares can greatly reduce airway pressures (Figure 1). Stenotic nares are corrected with one of several resection techniques—alar wing amputation, punch resection, vertical wedge, horizontal wedge, alapexy and laser ablation. The goal of all techniques is to remove all or a portion of the alar wing to provide an unobstructed pathway for air to flow. These techniques have various levels of difficulty. Techniques described here are the more easily performed. Placing the patient in straight ventral recumbency and maintaining this position help create a symmetrical, cosmetic repair.

Alar wing amputation


Figure 2: An intraoperative photo showing the Trader’s technique before achieving hemostasis. (Photo courtesy Joseph Hauptman, DVM, Dipl. ACVS, Michigan State University College of Veterinary Medicine.)
The alar wing amputation (Trader's technique) was the original technique reported. The technique is simple and is performed as follows:

1. Place a No. 11 blade into the dorsal aspect of the nasal opening with the blade pointing ventrolaterally.

2. Incise to amputate the ventral alar wing.

3. Apply pressure for five to 10 minutes to provide hemostasis (Figures 2 & 3).

4. Allow the wound to heal by second intention; no suturing is needed.


Figure 3: An intraoperative photo showing the Trader’s technique after achieving hemostasis. (Photo courtesy Joseph Hauptman, DVM, Dipl. ACVS, Michigan State University College of Veterinary Medicine.)
5. Repeat the process on the other side.

6. Trim additional tissue as needed to attain symmetry.

Cosmesis is satisfactory after the site heals (10 to 14 days) (Figure 4). Complications of this techniques are rare. For some surgeons, this may be preferred in the smallest patients where the geometric excisions and closures can be demanding.

Punch resection

The punch technique allows for an identically sized piece of nasal wing to be resected from each side. A 2- to 6-mm punch is inserted into the meat of the rostral aspect of the nasal wing. The plug is grasped with thumb forceps and the base is excised with Metzenbaum scissors. The size is selected to leave a 2- to 3-mm rim of tissue for suturing with simple interrupted fine suture. Bleeding is controlled with gentle pressure with cotton-tipped applicators and suturing.

Vertical wedge

The vertical wedge procedure is a relatively easy technique that involves using a No. 11 blade to create upside-down V-shaped incisions in the rostral aspect of the wing and then removing this wedge. Similar to the punch technique, several interrupted sutures are placed.


Figure 4: A healed nose one year after surgery using the Trader’s technique. (Photo courtesy Joseph Hauptman, DVM, Dipl. ACVS, Michigan State University College of Veterinary Medicine.)
For all techniques, postoperative Elizabethan collars are needed for 10 to 14 days to prevent self-trauma to the surgery site. In Part 2, I will discuss the landmarks and technique for surgery on the soft palate and larynx.

Dr. Keats currently practices at VCA Veterinary Referral Associates in Gaithersburg, Md. He graduated from the Virginia-Maryland Regional College of Veterinary Medicine in 1999. He completed his surgical residency in 2005 with Chesapeake Veterinary Surgical Services and then became board-certified in 2006. He practices both orthopedic and soft tissue surgery.


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