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Brachycephalic Syndrome: Innovative Surgical Techniques

Laurent Findji, DMV, MS, MRCVS, DECVS VRCC Veterinary Referrals Essex, United Kingdom

Gilles Dupré, DMV, DECVS University of Veterinary Medicine, Vienna Vienna, Austria

Surgery, Soft Tissue

|June 2013|Peer Reviewed

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Brachycephalic Syndrome: Innovative Surgical Techniques

This article is part of the WSAVA Global Edition of Clinician's Brief.

Canine brachycephalic syndrome (BS) consists of anatomic abnormalities (eg, stenotic nares, tortuous nasal cavities, aberrant conchae, elongated soft palate [ESP], everted laryngeal saccules, laryngeal collapse, tracheal hypoplasia) of brachycephalic dogs, which can lead to obstructive dyspnea and digestive disorders. In one study, 97% of brachycephalic dogs presented for BS had concurrent GI diseases.1 Upper obstructions (eg, nares, conchae, soft palate) may aggravate and sometimes cause deeper obstructions (eg, laryngeal, tracheal, bronchial collapses) and digestive disorders.

Early surgical correction of these abnormalities is often recommended and commonly includes treatment for stenotic nares and ESP. Other abnormalities (eg, laryngeal collapse2) occasionally require surgical attention but rarely in first intention. ESP, the most consistent anatomic abnormality encountered in dogs with BS, has been reported in up to 100% of cases.3,4 Initially, ESP was primarily described as excessive soft palate length, which can cause obstruction of the rima glottidis on inspiration (laryngeal obstruction). However, in many brachycephalic dogs, it has long been observed5-11 and recently demonstrated12,13 that the soft palate is also excessively thick, adding nasopharyngeal and oropharyngeal components to airway obstruction.

Related Article: Surgeon’s Corner: Soft Palate & Stenotic Nares Resection for Brachycephalic Dogs

Folded flap palatoplasty (FFP) was developed to address the three components of obstruction caused by the soft palate by making it both thinner and shorter.8,9-11 Stenotic nares, when present, should be corrected following FFP. Various techniques have been described, but the authors prefer vertical wedge alaplasty, which consists of excising a vertical wedge from the ala nasi.

Comparing Traditional & Innovative
Conventional surgical techniques for ESP correction often consist of a simple resection of the redundant portion of the soft palate using different devices and various resection landmarks; although these techniques address the laryngeal component of obstruction, they may fail to fully address nasopharyngeal and oropharyngeal obstructions.14-26 FFP can address all components of the obstruction by reducing the soft palate’s length and thickness. The use of bipolar cautery in FFP increases intraoperative comfort. Compared with conventional staphylectomies, the suture material is more rostral and therefore farther from the pharynx, which should result in less postoperative pharyngeal inflammation and edema. Also, the rostroventral traction exerted on the remainder of the soft palate tends to further widen the nasopharyngeal opening. FFP tends to be longer and more technically demanding than conventional staphylectomy.

Before surgery, the patient should be premedicated (see Premedications to Consider) and stress avoided. Before anesthesia induction, oxygen can be supplied by mask or flow-by. Induction must be swift to allow prompt control of the airway via tracheal intubation. The pharynx should be examined and the larynx assessed for signs of laryngeal collapse.

Premedications to Consider

  • Acepromazine (0.01–0.05 mg/kg IM, SC)
  • Dexamethasone (0.1–0.2 mg/kg IM, SC)
  • Opioid analgesic (eg, morphine or methadone, 0.2–0.5 mg/kg IM)
  • Glycopyrrolate (2–10 µg/kg IM)
  • Antiemetics & antacids (SC or IM, depending on drugs)

What You Will Need:

  • Basic surgical kit
    • Long instruments to facilitate the procedure in small dogs with narrow pharynges (eg, pugs)
  • Electrocautery
    • Precise monopolar cautery used in cutting mode for the initial palatoplasty incision
    • Bipolar electrocautery to facilitate hemostasis during the dissection of the soft palate
  • Absorbable monofilament sutures on swaged round or tapercut needles, size 3-0–5-0

BS = brachycephalic syndrome, ESP = elongated soft palate, FFP = folded flap palatoplasty


LAURENT FINDJI, DMV, MS, MRCVS, DECVS, is soft-tissue surgeon and director at VRCC Veterinary Referrals near London. His primary interests include oncologic, reconstructive, and general soft tissue surgeries. Before spending 3 years in private practice and 4 years as a consultant surgeon, Dr. Findji was a teaching assistant and completed a 2-year surgical internship at the Alfort Veterinary School in Paris, where he also earned his doctorate in veterinary medicine; he earned a master’s of science in biology and physiology of circulation and respiration at La Pitié-Salpˆeterière Hospital in Paris and a degree in experimental surgery and microsurgery at the Lariboisère/St. Louis Hospital in Paris.

GILLES DUPRÉ, DMV, DECVS, is professor of small animal surgery and clinic head for small animal surgery, ophthalmology, dentistry, and rehabilitation at University of Veterinary Medicine Vienna in Austria. After practicing as a surgical assistant and resident in both France and the United States, he earned a degree in human surgical pneumology and thoracoscopic surgery; Dr. Dupré then spent 17 years in referral practice. His primary interests include oncologic, upper airway, and mini-invasive surgeries. Dr. Dupré has published more than 120 articles in peer-reviewed journals and book chapters and lectured at the NAVC Conference. He earned his doctorate in veterinary medicine from the Alfort Veterinary School.

References

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