Laser Treatment for Brachycephalic Airway Syndrome

Brachycephalic airway syndrome is a well-described condition involving abnormal anatomic development of the upper airway of specific short-nosed dog and cat breeds. Classic features include stenotic nares, elongated soft palate, everted laryngeal saccules, laryngeal collapse, and tracheal hypoplasia. The nasal cavity and its potential role in airway obstruction has received little focus.

This 2-part study investigated breed-specific anatomic considerations of the nasal cavity and a novel laser-assisted turbinectomy (LATE) for obstructive intranasal tissue. In part 1, computed tomography (CT) and rhinoscopy were performed on 132 brachycephalic dogs (66 pugs, 55 French bulldogs, and 11 English bulldogs) with severe respiratory distress. Rostral and caudal aberrant turbinates were found in 72.0% and 66.7% of cases, respectively. Septum deviation was noted in 55.3% of dogs. Rhinoscopy confirmed aberrant turbinates and points of mucosal contact in 91.7% of dogs. In part 2, LATE was performed in 158 dogs with a diode laser to remove obstructive nasal conchae. Other traditional surgical treatments for brachycephalic syndrome were performed concurrently, depending on the case. Transient hemorrhage occurred in 32.3% of dogs, and the perioperative mortality rate was 1.6%. Dogs were hospitalized for 1 week postoperatively, at which time CT and endoscopy were repeated to confirm nasal patency. Turbinate regrowth required resection of potentially reobstructive tissue in 15.8% of dogs. The authors conclude that LATE is a feasible, effective method for removing obstructing turbinate tissue in dogs.

Commentary

This is the first study to document substantial intranasal obstructive pathology and laser treatment in dogs with brachycephalic airway syndrome. The visual differences noted on CT and rhinoscopy between the clinically affected patients in this study and a German shepherd dog included for comparison were striking. A laser was used to remove obstructive nasal turbinates, similar to commonly performed procedures in humans and horses. This procedure appeared to be safe and effective for treating obstructive intranasal pathology, an underappreciated component of brachycephalic airway syndrome in dogs. Further investigation is warranted to understand the breed-specific components identified in this study and the long-term outcomes associated with this treatment.—Jason Bleedorn, DVM, DACVS