Lecture 18 11/4/24

Question 1

What are the components of BOAS?

Answer 1

-stenotic nares*
-elongated +/- thick soft palate*
-everted laryngeal saccules and/or laryngeal edema*
-hypoplastic trachea
-aberrant nasal turbinates
-enlarged tongue
-arytenoid cartilage collapse-tracheal collapse
-GI issues

Question 2

What are the clinical signs of BOAS?

Answer 2

-snoring
-nasal discharge
-nostril collapse on inspiration
-gagging/coughing
-regurg.
-exercise/heat intolerance
-resp. distress
-cyanosis

Question 3

How is BOAS diagnosed?

Answer 3

-assess nares while awake
-assess trachea and lungs on thoracic rads
-assess soft palate and saccules under deeper anesthesia
-CT for nasopharyngeal and turbinate abnormalities
-abdominal radiographs
-endoscopy of esophagus and stomach

Question 4

What can CT be used to assess in english and french bulldogs?

Answer 4

-nasal turbinates
-nasopharynx
-palate thickness
-middle ears
-other areas of disease in the head

Question 5

What are the characteristics of BOAS and surgery?

Answer 5

-nostrils should be fixed early
-no consensus on youngest age to fix palate
-hypoplastic trachea is not associated with surgical outcome
-dogs are predisposed to GI diseases and aspiration pneumonia

Question 6

What are the pre-op considerations for animals with BOAS?

Answer 6

-avoid NSAIDs until steroid need is ruled out
-lubricate eyes before and after surgery
-limit post-op pure mu opioids due to risk of regurg. and vomiting
-use sedation before and after surgery to reduce post-op swelling
-metoclopramide can improve gastric emptying
-omeprazole can decrease gastric acidity

Question 7

What are the characteristics of elongated soft palate?

Answer 7

-palate blocks airway
-major cause is brachycephalia
-increased resp. effort can cause tissue edema, laryngeal collapse, and further airway obstruction

Question 8

What steps should be taken when anesthetizing an elongated soft palate correction case?

Answer 8

-pre-oxygenate before induction
-have a stylet available for intubation
-look for other abnormalities and repair as needed

Question 9

What are the methods for staphylectomy/resection of posterior soft palate?

Answer 9

-laser/cautery/radiosurgical unit
-ligasure
-cut-and-sew technique
-folded flap technique

Question 10

How can one prepare for postoperative swelling following elongated soft palate correction?

Answer 10

-supplemental oxygen
-sedation
-ET tube
-possible nasotracheal tube

Question 11

What are the steps to a cut-and-sew staphylectomy?

Answer 11

-mark palate and place stay sutures
-cut one third of palate
-appose oral and nasal mucosa with 3-0 or 4-0 absorbable monofilament
-continue to cut and sew
-tie suture and cut ends short

Question 12

What are the characteristics of ligasure?

Answer 12

-seals vessels up to 7mm in diameter
-transects tissue after sealing vessels
-no need for suturing

Question 13

What are the characteristics of a folded flap palatoplasty?

Answer 13

-used for very thick palates
-oral mucosa is incised and fibrous and glandular tissue within the palate are removed
-caudal edge of oral mucosa is pulled forward and sutured to cranial edge

Question 14

What are the post-op complications of staphylectomy?

Answer 14

-aspiration pneumonia
-swelling and subsequent airway obstruction
-palate now too short

Question 15

What are the characteristics of palatopexy?

Answer 15

-emergency, temporary procedure for airway obstruction by an elongated, swollen palate
-caudal free edge of soft palate is tacked rostrally with 1-3 vertical mattress sutures in 2-0 or 3-0 monocryl
-allows animal to breath better while palatal swelling and edema decrease

Question 16

What are the characteristics of stenotic nares?

Answer 16

-axial deviation of the dorsolateral nasal cartilage and overlying tissues
-can get secondarily elongated soft palate and everted saccules
-clinical signs include inspiratory dyspnea, nasal discharge, exercise intolerance, and difficulty eating
-treatment is to reduce alar fold size

Question 17

What are the characteristics of alar fold resection?

Answer 17

-alar fold is removed with blade or laser
-fold is cut off at an angle
-bleeding is staunched with pressure using cotton-tipped applicators dipped in neosynephrine or epinephrine
-white scar after surgery will darken over time

Question 18

What are the characteristics of the punch technique for alar fold resection?

Answer 18

-remove superficial and deep tissue with skin punch and metzenbaum scissors
-bury punch full depth into center of alar fold
-control hemorrhage with pressure
-place 2 or 3 simple interrupted sutures to close the site

Question 19

What are the characteristics of a stenotic nares wedge resection?

Answer 19

-bleeding should be expected
-bleeding resolves with pressure
-closed with absorbable suture that does not need to be removed

Question 20

What are the steps of a wedge resection?

Answer 20

-start at a point even with the top of the nares opening
-cut ventrally while including deep tissue, remaining medial to tissue forceps
-starting at the dorsal end of the first cut, incise lateral to the forceps to remove a pyramidal tissue wedge
-place suture across the corner of the flaps to appose the rostroventral edges of the site; tie suture and leave suture edges 3-4 cm long
-retract the long suture ends dorsally to appose the ventral intranasal portion of the resection site
-add additional sutures on the rostral surface

Question 21

What are the options for stenotic nares correction in cats?

Answer 21

-single pedicle advancement flap
-alar lift up and sulcus pull down

Question 22

What are the complications of stenotic nares correction?

Answer 22

-dehiscence
-excess scarring
-unequal nares
-inadequate resection
-anesthetic complications

Question 23

What are the characteristics of everted laryngeal saccules?

Answer 23

-resection recommended because everted saccules block airway on recovery and do not regress with correction of elongated soft palate and stenotic nares
-surgery involves cutting saccules off with scissors

Question 24

What are the potential causes of continued upper resp. signs after a surgical procedure?

Answer 24

-laryngeal collapse or paralysis
-insufficient resection of palate or alar folds
-nasopharyngeal inflammation
-nasopharyngeal turbinates
-hypoplastic or collapsed trachea

Question 25

What are the treatments for laryngeal collapse?

Answer 25

-correct predisposing causes
-remove everted laryngeal saccules
-epiglottectomy + partial arytenoidectomy
-laryngeal tieback
-permanent tracheostomy