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Management & Treatment

Management & Treatment of BOAS

Management 

Surgical intervention

Procedures

Risks and prognosis

 


Management

Fitness

Comparing body weight to the breed average weight is not a reliable way to assess a dog’s ideal weight. Body condition score (BCS) is a more useful scoring system to assess whether an animal is underweight or overweight.

Our research findings show that obesity (i.e. BCS≥7) is significantly associated with BOAS. Fat tissue within the airway tract can further narrow the lumen. For obese dogs with mild to moderate BOAS signs, weight loss is suggested prior to surgical intervention.

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Avoid overheating

While it is important that you exercise your dog regularly and keep him/her fit, it is also important to remember that brachycephalic breeds, particularly BOAS-affected dogs, may have difficulty regulating their body temperature. Therefore, it is recommended that you avoid exercising your dog excessively or during hot summer days. In general, it is best to keep your dog away from hot environments or situations that may cause too much excitement or stress in him/her. Signs of overheating include: heavy panting, elevated body temperature, glazed eyes, increased pulse, vomiting/diarrhoea, excessive thirst, dark red tongue, excessive drooling, staggering. In severe cases, they may seizure, collapse, become unconsciousness, or even die. If you notice signs of overheating in your dog, you should move him/her to a cool place with good air conditioning. You should keep providing him/her with a small amount of water to drink to avoid dehydration, and cool him/her down by soaking with cool water. Contact your vet for further treatment and evaluation. 

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Surgical interventions

 

Surgical procedures

Pharynx

The main BOAS lesions at the pharynx are the oversized soft palate and the everted/hypertrophic tonsils. Several surgical techniques have been reported to shorten and thin the soft palate. The elongated soft palate should be trimmed to the tip of the epiglottis. If the soft palate is thickened, a folded flap palatoplasty may be used.

Everted/hypertrophic tonsils are commonly seen in BOAS-affected dogs, where the tonsils extrude from the crypt and narrow the pharynx. Partial removal of the extruding tonsils increases the pharyngeal space. 

 

Elongated soft palate & enlarged tonsils
Elongated soft palate & enlarged tonsils
Soft palate shortened and tonsils were partially resected
Soft palate shortened and tonsils were partially resected

 

 

 

 

 

 

 

 

 

 

 

Larynx

Some BOAS affected dogs present with laryngeal collapse. Everted laryngeal saccules may cause additional airway obstruction. Removal of everted laryngeal saccules is a simple and effective procedure to open the ventral part of the larynx.

Laryngoplasty (e.g. trimming of the deformed/collapsed cuneiform processes) may be performed in dogs with Grade II and III of laryngeal collapse. Further laryngeal lateralization (laryngeal “tie-back”) may be required  for dogs with Grade III laryngeal collapse.

Unilateral resection of the cuneiform process
Unilateral resection of the cuneiform process

 

Nostrils

Wedge resection of the nostrils and Trader’s technique for amputating the nostril wings are both effective surgical techniques to widen the external nostrils. Resection of the interior alar folds opens the inner part of the nares. 

stenotic nostrils before surgery
stenotic nostrils before surgery
4 weeks after rhinoplasty
4 weeks after rhinoplasty
Collapse of the alar folds (second stenosis)
Partial alar fold resection

 

 

 

 

 

 

 

 

 

 

 

 

Nasal cavity

Laser-assisted turbinectomy has been used to address the intranasal obstruction, particularly in pugs and French bulldogs. The aberrant and hypertrophic ventral conchae are removed. LATE surgery is indicated for dogs that tend to mouth breathe  when at rest, dogs that present with excessive panting during exercise, and dogs that had little or no improvement after conventional surgery (e.g. soft palate shortening and widening of the nostrils). Rhinitis and reverse sneezing may be present after the surgery, but the symptoms usually resolve spontaneously.  

CT image of a pug before LATE surgery
CT image of a pug after LATE surgery
 

Risks and prognosis

Post-operative recovery from

Temporary tracheostomy
 anaesthetic is the major risk related to the surgery. Inflammation and swelling of the airway may occur post-operatively. A temporary tracheostomy tube can be placed if necessary. Aspiration pneumonia caused by regurgitation is also a risk after surgery. Gastro-protectants are given to surgical patients.

The surgical results are variable and depend on the severity of the disease. Dogs with Grade II or III laryngeal collapse usually have a poorer prognosis. BOAS is not curable. Nevertheless, upper airway corrective surgery can provide a better quality of life. Regular post-operative rechecks are suggested. Revision surgery might be required in some severely affected dogs. 

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