Brachycephalic resources

Nose and soft palate: In various studies, about 60% of dogs with BOAS had stenotic nares and 90% had an elongated palate. Using advanced imaging, the palate is not only long but also thickened (hyperplastic) which may be a secondary change to other areas of airway obstruction. The lesions sites are also breed specific, with nasal stenosis being more of an issue in French bulldogs and pugs than bulldogs where the hyperplastic palate is the most noticeable lesion. In an objective study of airway function the nostril status was the most significant conformational factor associated with BOAS (though we still see unaffected dogs with severely stenotic nostrils). As lesion sites vary between breeds and also between individuals of the same breed it is important to assess individuals carefully prior to surgery with a functional assessment (https://www.thekennelclub.org.uk/health-and-dog-care/health/getting-started-with-health-testing-and-screening/respiratory-function-grading-scheme/). We use a nasal grading scheme which is breed specific to assess the nostrils. Open and mildly affected nostrils are desirable (https://www.vet.cam.ac.uk/boas/about-boas/recognition-diagnosis#stenoticnares). There are a myriad of techniques described for soft palate resection and nasoplasty. This presentation covers the current surgical options for nasoplasty and soft palate resection, including alar fold resection and folding flap staphylectomy techniques along with the evidence behind them. Potential complications and outcomes (where known) are also discussed.

Laryngeal collapse and tracheostomy: Laryngeal collapse is a form of upper-airway obstruction caused by loss of cartilage rigidity that allows medial deviation of the rostral laryngeal cartilages. Although laryngeal collapse has usually been considered to be associated with progression of the BOAS, when it comes to the more advanced stages of the condition, the breed of dog is often indicative of the severity in laryngeal changes seen. Conventionally, the condition is sub-divided into three stages in the dog: in stage I laryngeal collapse there is eversion of the laryngeal saccules, in stage II there is loss of rigidity and medial displacement of the cuneiform processes of the arytenoid cartilage, and in stage III there is collapse of the corniculate processes of the arytenoid cartilages with loss of the dorsal arch of the rima glottidis. In its advanced forms, the condition is life-threatening and often very difficult to treat effectively. This presentation covers the condition and its potential management options (e.g. husbandry changes, surgical correction of primary abnormalities, sacculectomy, arytenoidectomy, cricoarytenoid and thyroarytenoid caudo-lateralisation, and permanent tracheostomy), highlighting the controversies and difficulties in its treatment.

The Kennel Club and the University of Cambridge have devised the respiratory function grading scheme designed to advise owners if their dog is affected by BOAS and give guidance to breeders on how to lower the risk of producing affected puppies. Jane Ladlow, Senior Lecturer in Small Animal Surgery at Cambridge, explains what the scheme entails.

   Iago Asorey Blazquez and Enzo Vettorato of Dick White Referrals, help work through how to anaesthetize these tricky patients.