Brachycephalic Airway Disease: Surgery and Prognosis

Primary problems include stenotic nares, elongated soft palate, redundant pharyngeal folds and tracheal hypoplasia.
Exacerbated negative airway pressures lead to secondary events such as eversion of the laryngeal saccules and laryngeal collapse. Hiatal hernia, tracheal collapse and epiglottic entrapment may also occur.
Clinical signs are chronic and progressive and include snoring, coughing, respiratory stertor/stridor, dyspnoea, regurgitation, vomiting, exercise intolerance, cyanosis and syncope. Corticosteroids, oxygen, cage rest, weight loss and keeping the patient cool may be palliative. Surgical treatment includes correction of stenotic nares and resection of elongated soft palate, laryngeal saccules and excessive palatopharyngeal folds. Laryngeal collapse is a serious secondary complication of BAOS and results from softening of the laryngeal cartilage subsequent to chronically exaggerated intraluminal airway pressures. There is no specific treatment for laryngeal collapse. Partial laryngectomy can be associated with serious complications. Laryngeal lateralization does not address the major problem; the loss of cartilaginous support of the laryngeal structures. Temporary tracheostomy is helpful in dogs with mucosal edema following surgery, but only permanent tracheostomy is likely to provide long-term relief.
Stenotic nares should be treated at the earliest possible opportunity. The nasal plane and alar cartilages are prepped with dilute chlorhexidine. Application of ice may reduce the amount of bleeding. The incision sites should be determined prior to the first incision, as bleeding will make visualisation difficult. The ventral alar cartilage is grasped with a toothed thumb forcep and a fine scalpel blade used to incise down either side of the forceps to remove a wedge. The incision is closed with 2 or 3 simple interrupted absorbable sutures, drawing the alar fold laterally and enlarging the nares. A relatively small increase in diameter results in a large increase in area of the nares, with marked improvement in air flow. Owners usually comment on an immediate improvement in the character of their dog’s breathing. [...]