Perioperative care of the brachycephalic patient and surgical management of brachycephalic obstructive airway syndrome

Brachycephalic breeds have arisen due to the human population breeding from animals that have local chondrodysplasia, and at present no specific genes have been identified (Bofan et al, 2015). Due to selective breeding these animals now present with common set of anatomical attributes including stenotic nares, hypoplastic trachea, an elongated soft palate and everted laryngeal saccules. This results in the airway being impaired and, alongside the high prevalence of regurgitation in these animals, this can result in aspiration pneumonia as a secondary disease. In extreme cases patients may also present with laryngeal collapse. The most commonly reported signs by owners include reduced exercise tolerance, stridor, coughing, respiratory distress, panting excessively and in extreme circumstances collapse (Furtado, 2014). Animals presenting with brachycephalic obstructive airway syndrome (BOAS) in practice will show other clinical signs including stertor accompanied with inspiratory dyspnoea, syncope, cyanosis, snoring, gagging and gastrointestinal signs including vomiting, regurgitation and dysphagia (Furtado, 2014). Airway obstruction may be the most commonly noticeable disease of these breeds, but there are other diseases that have been created by breeding animals in this way. They may be at an increased risk of corneal ulceration and globe prolapse, dental overcrowding and malocclusion, the excess of skin folds can cause pyoderma and a vertebral anomaly known as hemi vertebra, which is the lack of formation of one half of the vertebral body, which can result in spinal cord compression (Ladlow, 2018). The treatment for BOAS is surgical intervention, which may include shortening of the soft palate (staphylectomy), tonsil resection, removal of everted laryngeal saccules, nostril resection and laser assisted turbinectomy.