Brachycephalic Obstructing Airway Disease

Question 1

What are primary factors to the pathophysiology of BOAD?

Answer 1

• Relative overlength of the soft palate
• Relative oversize of the tongue
• Tracheal hypoplasia/stenosis
• Sliding hiatal hernia

Question 2

What are secondary factors to the pathophysiology of BOAD?

Answer 2

• Hypertrophy of the soft palate
• Tonsillar hypertrophy
• Everted laryngeal ventricles/saccules
• Laryngeal collapse
• Pharyngeal collapse
• Glosso-epiglottic mucosa displacement
• Scrolling of epiglottic cartilage
• Vomiting/regurgitation

Question 3

What are the 3 stages of laryngeal collapse? What surgery is possible to revert it?

Answer 3

• Stage 1 - laryngeal saccule eversion
• Stage 2 - medial deviation of the cuneiform cartilage and aryepiglottic fold or aryepiglottic collapse
• Stage 3 - medial deviation of the corniculate process of the arytenoid cartilages or corniculate collapse

Surgery
Excision of the everted laryngeal saccules

Question 4

What surgery is possible to aid the stenosis of the external nasal aperture?

Answer 4

Rhinoplasty
- wedge resection
- alar fold resection

Question 5

What surgery is possible to alleviate clinical signs associated with the overlong soft palate? What is often done at the same time?

Answer 5

• Partial staphylectomy
• folded flap palatoplasty

Tonsillectomy