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Corrective Surgeries for Brachycephalic Airway Syndrome

Brachycephalic breeds, commonly referred to as snub-nosed or short-headed breeds, can be prone to breathing difficulties. Brachycephalic airway syndrome (BAS) refers to a combination of abnormalities resulting in upper airway obstruction. These abnormalities may include, but are not limited to, stenotic nares, elongated soft palate, and everted laryngeal saccules.

How is BAS diagnosed?

There are a number of typical clinical signs indicating BAS, such as:

  • Difficulty breathing
  • Noisy breathing
  • Snorting, snoring
  • Retching, gagging, wheezing
  • Exercise intolerance
  • Salivation Collapse, in extreme cases


In the case of an animal displaying these clinical signs, a physical exam as well as an oral cavity examination is in order. Stenotic nares can easily be diagnosed via physical exam, but sedation or anesthesia will be needed to properly examine the oral cavity for elongated soft palate or everted laryngeal saccules. Elongated soft palates will extend 2-3 mm or more past the epiglottis. Everted laryngeal saccules will be white and glistening, and obstruct airflow.

Which breeds are most at risk?

Some of the dog and cat breeds that are most at risk include:

English Bulldogs
French Bulldogs
Shih Tzus
Pugs
Boxers
Pekingese
Shar-Pei
Lhasa Apso
Boston Terriers
Bull Mastiffs
Persians
Himalayans
Ragdolls

What are some corrective surgical techniques?

Stenotic Nares
Stenotic nares are malformed nostrils that can make it difficult for a patient to breathe through their nose. Oftentimes, the nares are narrow or collapse during inhalation. There are two methods to correct stenotic nares: Wedge resection, and laser ablation. Wedge resection involves using a blade to remove a wedge from the lateral aspect of the alar fold in order to widen the diameter of the nares. Laser ablation involves the removal of nasal cartilage to widen the nares. Laser ablation is typically used in smaller breeds, as wedge resection may not be possible with nares of a smaller size. The widening of the nares helps to greatly improve breathing and is a relatively simple procedure. When discussing this procedure with a client, be sure to emphasize that a difference in the nares will be visibly obvious; their pet may look different, but their ability to breathe will be greatly improved.

Elongated Soft Palate
Resection of the soft palate, or staphylectomy, should be performed in the case of an elongated soft palate obstructing the airway. This procedure can be performed with a variety of different tools: A blade, scissors, a CO2 laser, a bipolar sealing device, or a fi ne-tip electrocautery unit. During this procedure, the palate is stretched and the excess tissue is removed. The junction where the soft palate and epiglottis touch is typically used as a landmark to determine the excision point. Excising the extra tissue greatly minimizes patient respiratory distress.

Everted Laryngeal Saccules
Everted laryngeal saccules can be surgically excised using scissors, a blade, or a CO2 laser in another simple procedure.

Are there any complications to these surgeries?

Like any medical procedure, these surgeries may have complications. Some complications include:

  • Inflammation that can obstruct the larynx and trachea, leading to respiratory distress
  • Hemorrhage from the lateral aspect of the soft palate or caudal aspect of the tonsillar crypt
  • Nasal discharge
  • Coughing/gagging
  • Regurgitation and/or vomiting
  • Aspiration pneumonia
  • Infection
  • Sloughing of the pigmented layer of the skin after laser rhinoplasty


Monitoring these patients following surgery is critical to recovery. Respiratory rate and effort should be monitored postoperatively for at least 24 hours. Respiratory distress should be addressed immediately with oxygen and sedation, and, in some cases, may require a tracheostomy. There have also been reports of the recurrence of less extreme upper airway signs.

Is it worth it?

When contemplating whether or not a surgery is worth the risk, it is important to consider an animal’s quality of life: If an animal is having obvious respiratory distress and is otherwise fit and well, it may be worth considering surgical correction.

Surgical prognosis is generally good but is dependent on condition severity. Addressing the issue when an animal is young, before the condition has time to progress, is recommended. Dogs under two years of age have a better postoperative prognosis.

Early detection and correction of BAS is crucial to prevent the development of secondary changes. Brachycephalic breeds are incredibly prone to respiratory issues, and it is our responsibility as veterinary staff to keep an eye on these predisposed breeds and recommend the best course of action for ailing animals.

References

Azra, Ray. “Elongated Soft Palate Resection with a CO2 Surgical Laser.” Aesculight, Oct 2015, www. aesculight.com/case-studies/elongatedsoft- palate-resection-co2-surgicallaser/.

Lodato, Dena, and John Mauterer. “Surgical Skills: Corrective Surgery: Brachycephalic Airway Syndrome.”

Today's Veterinary Practice, 22 Oct. 2019, todaysveterinarypractice.com surgical-skills-corrective-surgery-dogswith- brachycephalic-airway-syndrome/

“Small Animal Topics.” ACVS, https:// www.acvs.org/small-animal/ brachycephalic-syndrome.

Trappler, Michelle and Kenneth W. Moore. “Canine Brachycephalic Airway Syndrome: Surgical Management.” Vetlearn.com, May 2011, vetfoliovetstreet. s3.amazonaws.com/59/5cda70 a41911e087120050568d3693/fi le/PV0511_ Trappler2_CE.pdf Williams, Krista and Cheryl Yuill.

“Brachycephalic Airway Syndrome in Dogs.” VCA Hospitals, 2018, https:// vcahospitals.com/know-your-pet/ brachycephalic-airway-syndrome-indogs

About the Author

Mara DePena has been working as a veterinary assistant in a number of hospitals and vaccine clinics since 2016. She obtained her B.S. in Animal and Poultry Sciences from Virginia Tech in 2018 with a companion and laboratory animal emphasis. She currently works at Morris Animal Foundation as a Veterinary Research Associate.