SA URT Surgery Flashcards
BOAS Signalment and Hx.
Breeds.
Respiratory noise.
GI signs.
Management.
Exacerbating factors.
GI abnormalities.
Depends on site.
- e.g. oesophagitis, megaoesophagus.
- e.g. gastritis, displacement/mobile stomach.
- e.g. intestinal issues secondary to upper GI issues.
Signs:
- reflux.
- regurgitation.
- vomiting.
- others e.g. eyes and skin.
Respiratory signs.
Effort.
Stertor.
Reverse sneezing.
Stridor (laryngeal).
Examination of respiratory anatomical abnormalities under GA.
Tonsils - enlarged, everted.
Soft palate - over-elongated, thickened.
Laryngeal saccules - everted if higher grade BOAS.
Aberrant turbinates - w/ advanced imaging.
Trachea - imaging – hypoplastic.
Examining brachycephalics.
Visual exam conscious or under GA.
- nose (stenosis - can be dynamic).
Functional grading.
Whole Body Barometric Plethysmography (objective measure of BOAS).
GI.
Check eyes.
Check skin all over body.
Other non-surgical components of BOAS.
Nasopharyngeal hyperplasia.
Macroglossia - enlarged tongue.
Bronchial collapse.
- First line surgical options for BOAS.
- Salvage procedures for BOAS.
- Nares resection / rhinoplasty / alar fold excision.
Tonsillectomy.
Soft palate resection (Staphylectomy).
Sacculectomy. - Laryngoplasty.
Tracheostomy.
Hiatal hernia and GORD.
Gastro-oesophageal reflux disease.
High force inspiratory action.
- abdominal force used too, leading to laxity of the diaphragm and intermittent entry of the stomach through the diaphragm into the thorax (hiatal hernia).
Inflammatory.
Basic pre-op preparation considerations.
Drugs - short-acting, appropriate use of steroids.
Equipment ready for if things go wrong.
Induction method.
Experienced team.
24 hour nursing care:
- experience w/ tracheostomies.
Post-op BOAS.
Close monitoring on recovery.
Leave in ET tube a little longer?
Hospitalise to monitor.
Try to discharge same day if poss.
- reduce stress.
Feeding:
- balls of wet food to hand feed.
- not liquids – nature of surgery causes risk of aspiration.
Consider and prep for post-op complications.
Prognosis good?
- Laryngeal collapse signalment.
- Clinical signs of laryngeal collapse.
- Dx laryngeal collapse.
- ‘End-stage’ BOAS.
Primary condition in English Bull Terriers. - Severe dyspnoea.
Syncope.
Severe respiratory noise. - Laryngoscopy.
Staging laryngeal collapse.
1 = saccule eversion.
2 = partial cuneiform collapse.
3 = complete collapse.
Laryngeal collapse Tx options.
BOAS surgery.
Laryngoplasty.
Permanent tracheostomy.
Partial arytenoidectomy (laser ablation).
Cuneiformectomy.
*prevention better than treatment.
- When considering Staphylectomy, what is the recommended anatomical landmark for resection?
- Caudal tonsillar crypt.
Common reasons for laryngeal paralysis.
Degenerative.
Idiopathic.
Immune-mediated.
- Laryngeal paralysis signalment.
- Hx.
- Congenital / young dogs <1yo (less common).
Geriatric dogs. - Slow onset.
Gradual progression.
Presentations of laryngeal paralysis.
Normal at rest.
Increased respiratory effort.
Increased respiratory noises.
Exercise intolerance.
Coughing, gagging.
Dysphonia.
Dysphagia.
Heat stroke.
Aspiration pneumonia.
Cyanosis and collapse.
Laryngeal paralysis Dx.
Radiography:
- cervical.
- thoracic.
- allows assessment of patient’s overall fitness of surgery – megaoesophagus, aspiration pneumonia etc.
- findings can determine Px and influence choice to perform surgery or not.
Laryngoscopy:
- light GA.
- well-positioned laryngoscope.
- assistant to inform when breathing in and out from chest movements.
- give Doxapram by injection to encourage larynx to move.
Tx of laryngeal paralysis.
Mild cases:
- drugs – symptomatic (anti-inflammatories etc.)
- home management e.g. harnesses, not collars, no swimming, no going out into the heat, feeding.
Severe and collapsed cases:
- Stabilise.
- Sx.
– Unilateral arytenoid lateralisation (exam) / laryngoplasty / ‘Tie Back’.
- Complications of unilateral arytenoid lateralisation.
- Short-term Px.
- Long-term Px.
- Snap suture by barking.
Haemorrhage.
Swelling (tracheostomy may be indicated).
Always life-long risk of aspiration. - V good - 90-95% improvement QoL.
- Depends on polyneuropathy but if standard degenerative idiopathic paralysis, good.
- Tracheal collapse signalment.
- Hx.
- Types of causes of tracheal collapse.
- Any age.
Small breed dogs.
+/- overweight. - Chronic, dry cogh.
- ‘goose-honk’.
Stertor.
Triggered by excitement.
Can be progressive. - Degenerative/developmental.
Infectious/inflammatory.
- a vicious cycle.
- primary aspect = cartilage degeneration.
Dx for tracheal collapse.
Fluoroscopy.
Radiography.
Endoscopy.
- Dx method for tracheal collapse grading.
- Tracheoscopy.
- I = 25% loss of lumen.
II = 50% loss of lumen.
III = 75% loss of lumen.
IV = total loss of lumen.
Tx for mild cases of tracheal collapse.
Drugs - symptomatically e.g. anti-inflammatories.
Home management - harness, not collar, avoid over-excitement etc.
Majority of cases respond well enough to Tx that don’t need to progress any further.
