Brachycepahlic Airway Syndrome

Question 1

What is brachycephalic?

Answer 1

Caused by premature ankylosis of the cartilage at the base of the skull

Question 2

The shorter, wider skull of brachycephalic breeds causes a __ nasal passage which alters __ anatomy

Answer 2

The shorter, wider skull of brachycephalic breeds causes a compressed nasal passage which alters pharyngeal anatomy

Question 3

what are the primary components of BAS? The increase in negative pressure from these components causes what secondary components?

Answer 3

Primary: stenotic nares, elongated soft palate, hypoplastic trachea, abnormal nasopharyngeal turbinates

Secondary: mucosal edema, everted laryngeal saccules, laryngeal collapse, tonsillar eversion

Question 4

Commonly effected breeds of BAS

Answer 4

Bulldogs, Pugs, Boston Terriers

Question 5

List a few of the clinical signs of BAS

Answer 5

Hyperthermia
Inspiratory stridor
Panting
Anxiety
Coughing, Gagging
Collapse, exercise intolerance
Cyanosis

Question 6

__ diseases has been noted as a clinical sign of BAS patients due to lower negative thoracic pressure

Answer 6

Gastrointestinal disease has been noted as a clinical sign of BAS patients due to lower negative thoracic pressure

*frenchies are the poster child for this

Question 7

Medical treatment with __ and __ may improve case outcomes with GI disease

Answer 7

Medical treatment with antacids (H2 blockers and PPI’s) and prokinetics (metoclopramide and cisapride) may improve case outcomes with GI disease

Question 8

Dyspnea

Answer 8

Difficulty breathing

Question 9

Stertor

Answer 9

Low pitched noise

Question 10

What is the typical age for BAS diagnosis?

Answer 10

2-3

Question 11

What stance may animals in respiratory distress have?

Answer 11

Abducts elbows +/- abdominal breathing

Question 12

Endoscopic evaluation of the upper airway can diagnose what 5 things?

Answer 12

1. Everted laryngeal saccules
2. Elongated soft palate
3. Laryngeal collapse
4. Everted tonsils
5. Aberrant nasopharyngeal turbinates

Question 13

Upper airway ER stabilization

Answer 13

1. O2 stabilization
2. Sedate with Ace
3. Cool them
4. IV fluids
5. Tx inflammation with steroids
6. BW + rads will help create a plan

Question 14

List surgical treatments of BAS and when should you perform these?

Answer 14

1. Stenotic nares
2. Hyperplastic / elongated soft palate
3. Turbinectomy
4. Laryngeal conditions
5. +/- GI

Perform them after 6 months of age, treating proximal obstructions first

Question 15

Stenotic nares are due to the __ cartilages collapsing inwards. They can be treated by __, __ or __ . An interrupted absorbable suture will be used and hemostasis reached via __

Answer 15

Stenotic nares are due to the dorsolateral cartilages collapsing inwards. They can be treated by wedge excision with primary closure, #11 blade or biopsy punch or pyramidal. An interrupted absorbable suture will be used and hemostasis reached via direct pressure.

Question 16

Elongated soft palate __ the epiglottis so we partially remove the __ which corrects the length and thickness

Answer 16

Elongated soft palate entraps the epiglottis so we partially remove the palatine musculature which corrects the length and thickness

Question 17

Everted laryngeal saccules treatment

Answer 17

They sit between the vocal and vestibular fold and can be resected by cutting with long metzenbaums and then heal by second intention

Question 18

Aberrant nasal turbinates treatment

Answer 18

Turbinectomy: resection of malformed obstruction conchae in the ventral and medial turbinates

Question 19

What is a hypoplastic trachea and how do we dx?

Answer 19

When the tracheal cartilages overlap and the trachealis muscle is non functional which cause a narrowing of the lumen. This can be diagnosed radiographically by comparing the Tracheal diameter to the thoracic inlet. If the ratio is < 0.16 then its considered hypoplastic.

Question 20

What should you especially do for post op recovery of brachycephalics?

Answer 20

• ensure adequate airflow
• slow anesthetic recovery with o2 supplementation
• corticosteroids
• prolonged maintenance of the ET tube
• reintubate if needed
• +/- tracheostomy
• +/- ventilator

Question 21

__ of BAS dogs improve with surgery with perioperative mortality is <__ and long term recurrence of clinical signs is __

Answer 21

90% of BAS dogs improve with surgery with perioperative mortality is <5% and long term recurrence of clinical signs is 100%

Question 22

__ is the end result of untreated BAS

Answer 22

Laryngeal collapse is the end result of untreated BAS

Question 23

What are the stages and options for treatment of laryngeal collapse?

Answer 23

Stage 1: laryngeal saccule eversion
Stage 2: medial displacement of the cuneiform process
Stage 3: collapse of the corniculate process

Options for treatment are the fix the stenotic nares, elongated soft palate, and everted laryngeal saccules or if no improvement occur pursue surgery which would be unilateral arytenoid lateralization or a permanent tracheostomy

Question 24

Cats with BAS?

Answer 24

They may get stenotic nares in breeds such as Persians, himalayans, Burmese, exotic shorthairs or Scottish folds

Question 25

Basics of upper airway stabilization

Answer 25

Cool, quiet and calm environment

Question 26

__ should be used to induce a light plan of anesthesia for an upper airway examination and you should avoid medication that cause __ muscle tone

Answer 26

Propofol should be used to induce a light plan of anesthesia for an upper airway examination and you should avoid medication that cause increased muscle tone

Question 27

A temporary tracheostomy tube should be __ the size of the trachea and should have __ to avoid displacement.

Answer 27

A temporary tracheostomy tube should be 75-80% of the size of the trachea and should have stay sutures to avoid displacement.

Question 28

Temporary tracheostomy care and removal

Answer 28

Consider how to remove and clean the tube, suction accumulated secretions in the tracheal lumen, cleaning the stoma, maintaining appropriate humidity in the trachea and lower airways. Only remove when the patient is ready and can heal by second intention healing.