Lecture 18 11/4/24 Flashcards
What are the components of BOAS?
-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
What are the clinical signs of BOAS?
-snoring
-nasal discharge
-nostril collapse on inspiration
-gagging/coughing
-regurg.
-exercise/heat intolerance
-resp. distress
-cyanosis
How is BOAS diagnosed?
-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
What can CT be used to assess in english and french bulldogs?
-nasal turbinates
-nasopharynx
-palate thickness
-middle ears
-other areas of disease in the head
What are the characteristics of BOAS and surgery?
-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
What are the pre-op considerations for animals with BOAS?
-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
What are the characteristics of elongated soft palate?
-palate blocks airway
-major cause is brachycephalia
-increased resp. effort can cause tissue edema, laryngeal collapse, and further airway obstruction
What steps should be taken when anesthetizing an elongated soft palate correction case?
-pre-oxygenate before induction
-have a stylet available for intubation
-look for other abnormalities and repair as needed
What are the methods for staphylectomy/resection of posterior soft palate?
-laser/cautery/radiosurgical unit
-ligasure
-cut-and-sew technique
-folded flap technique
How can one prepare for postoperative swelling following elongated soft palate correction?
-supplemental oxygen
-sedation
-ET tube
-possible nasotracheal tube
What are the steps to a cut-and-sew staphylectomy?
-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
What are the characteristics of ligasure?
-seals vessels up to 7mm in diameter
-transects tissue after sealing vessels
-no need for suturing
What are the characteristics of a folded flap palatoplasty?
-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
What are the post-op complications of staphylectomy?
-aspiration pneumonia
-swelling and subsequent airway obstruction
-palate now too short
What are the characteristics of palatopexy?
-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
What are the characteristics of stenotic nares?
-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
What are the characteristics of alar fold resection?
-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
What are the characteristics of the punch technique for alar fold resection?
-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
What are the characteristics of a stenotic nares wedge resection?
-bleeding should be expected
-bleeding resolves with pressure
-closed with absorbable suture that does not need to be removed
What are the steps of a wedge resection?
-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
What are the options for stenotic nares correction in cats?
-single pedicle advancement flap
-alar lift up and sulcus pull down
What are the complications of stenotic nares correction?
-dehiscence
-excess scarring
-unequal nares
-inadequate resection
-anesthetic complications
What are the characteristics of everted laryngeal saccules?
-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
What are the potential causes of continued upper resp. signs after a surgical procedure?
-laryngeal collapse or paralysis
-insufficient resection of palate or alar folds
-nasopharyngeal inflammation
-nasopharyngeal turbinates
-hypoplastic or collapsed trachea
What are the treatments for laryngeal collapse?
-correct predisposing causes
-remove everted laryngeal saccules
-epiglottectomy + partial arytenoidectomy
-laryngeal tieback
-permanent tracheostomy
