Brachycephalic Airway Surgery

Lecture by

Dr Arthur House

Reviewed by

Melissa Kozaruk

This lecture is presented by Dr Arthur House, specialist surgeon. With the “brachy boom” that has occurred across the globe, it is essential that we can recognise the symptoms of brachycephalic obstructive airway syndrome and recommend management options for these patients. Dr House presents a comprehensive review of the pathophysiology of brachycephalic obstructive airway syndrome, what factors are involved, options for surgical management and outcomes.

The top 5 takeaways from this excellent and practical lecture are:

Surgical intervention at an early age for affected breeds is indicated. Don't wait for the dog to present with acute clinical signs of decompensation. If the dog is showing signs of BOAS, recommend surgery before the patient progresses to laryngeal collapse and presents in acute respiratory crisis.
Chronic regurgitation and chronic vomiting frequently seen in these patients is often due to their airway disease (hiatal hernia). Surgically addressing BOAS often reduces these issues and should be considered before surgery for hiatal hernia or extensive investigations into vomiting.
How much to cut? Cut the soft palate to the level of the caudal edge of the tonsillar crypt. Be more cautious about taking off too much soft palate length in non-extreme brachy breeds such as staffordshire bull terriers, as taking too much can cause issues with reflux into the nasopharynx, and associated rhinitis and pharyngitis. Be careful not to enter into the nasopharynx during suturing!
Dr House’s preferred order of procedures during BOAS surgery is to do the palatoplasty/staphylectomy first, then saccule removal and tonsillectomy, with rhinoplasty last.
Dr House prefers the vertical wedge technique over the punch biopsy technique for rhinoplasty. This is not a superficial wedge – it should extend 0.5-1 cm into the alar fold when using a number 11 blade.