Airway surgery

Question 1

What do you need to prepare when intubating a BOAS dog?

Answer 1

Laryngoscope, head lamp
Camera and endoscope
2 blades available for the laryngoscope
cotton buds

Question 2

What are the components of BOAS?

Answer 2

Naso-pahryngeal hyperplasia
macroglossial
Stenotic nares
Aberrant tubrinates
Overlong-thick soft palate
Everted laryngeal saccules
Tonsillar enlargement 
Hypoplatisc trachea 
Broncial collapse

Question 3

What are the components of BOAS that can be surgically corrected?

Answer 3

Overlong- thick soft plate
Stenotic nares
Everted largyngeal saccules
larynx collapse

Question 4

What other clinical problems can arise from BOAS and how are they treated?

Answer 4

GI signs will resolve after surgery
Cardia can remain open gastric reflux
CRI Metoclopramide pre-op, post-op omeprazole, zantac, sucralfate

Question 5

What surgical treatment can be started early in the BOAS dog?

Answer 5

Alar fold resection (Nose)

Question 6

What additional procedures can also assist with BOAS?

Answer 6

Laryngeal collapse correction

tonsillectomy

Question 7

What are the three stages of laryngeal collapse?

Answer 7

1 aversion of layrngeal sacculse
2-3 larynx is collapsing
3 completes collapse (can’t medically manage)

Question 8

What airway condition is common in cats?

Answer 8

naso-pharyngeal and aural polyps

Question 9

What are the symptoms of Naso-pharyngeal and aural polyp?

Answer 9

URT obstruction
stretor
sneezing

Question 10

How are Naso-pharyngeal and aural polyps treated?

Answer 10

VBO and steriods

Question 11

How is Naso-pharyngeal atresia/stenosis treated?

Answer 11

Open surgery and resection of the stenotic area
endoscopic guided resection
endoscopic guided stent placement

Question 12

What is the etiology of laryngeal paralysis?

Answer 12

Congenital- severe polyneuropathy rapid onset of symptoms less than 12 months of age
Aquired, degenerative disease of the recurrent laryngeal nerve resulting in crico-arythnoidues dorsalis muscle incompetency

Question 13

How is laryngeal paralysis diagnosed?

Answer 13

Slow onset (excpet congenital)
Inspiratory stridor
Voice change 
cough 
exercise intolerance 
syncope 
neurological signs

Question 14

What is the emergency treatment of laryngeal paralysis?

Answer 14

o2 therapy
anti-inflammatory medication
sedation
tracehal intubation (worst case)

Question 15

What is the surgical treatment of laryngeal paralysis?

Answer 15

Arytenoid lateralization (tie back) 
no intra-oral sutures 
partial laryngectomy not recommended

Question 16

Why is it important to exam the larynx under a light plane of sedation?

Answer 16

Anaesthetic drugs impact on laryngeal function

Question 17

What are the post-operative considerations with laryngeal paralysis surgery?

Answer 17

Careful with analgesia protocol 
Mild sedation 
20-30% complication rate 
life long risk of aspiration
megaeophagus 
neurological condition

Question 18

What is tracheal colapse?

Answer 18

Dynamic obstruction of the upper airway
tracheomalacia
common cause of cough in dogs
more prevalent in small breeds 
affects cervical, intrathoracic or both regions

Question 19

What is the medical treatment for tracheal collapse?

Answer 19

Weight loss management 
Anti-tussive (butorphanol) 
Anti-secretory (codeine, hydrocodone, atropine) 
Bronchodilators (tetrabutaline) 
Antibiotics

Question 20

How is the surgical treatment for tracheal collapse preformed?

Answer 20

Stent intra-tracheal
Extra-luminal prosthesis
intra-luminal prosthesis
Self expandable nitinol stents

Question 21

What are the indications for a permanent Tracheostomy?

Answer 21

Creation of a permanent stoma in the ventral tracheal wall by suturing tracheal mucosa to the skin
Permanent upper airway obstruction

Question 22

What is the aftercare required for a permanent tracheostomy?

Answer 22

No collar
suction
humidification

Question 23

What are the complications of a permanent tracheostomy tube?

Answer 23

Mucus and secretions plug 
stenosis
obstruction 
dehiscence 
respiratory complication
Granulation tissue formation 
Skin fold obstruction 
impact on quality of life