TEMPORARY PALATOPEXY FOR THE PREVENTION OF SHORT TERM COMPLICATIONS AFTER SURGICAL TREATMENT OF THE BRACHYCEPHALIC AIRWAY OBSTRUCTIVE SYNDROME (BAOS)

The aim of the study is to assess a temporary palatopexy associated with the resection of the elongated soft palate and the correction of stenotic nares, to decrease the rate of short‐term complications of the surgical treatment of the Brachycephalic airway obstruction syndrome(BAOS) Eight English Bulldogs affected by BAOS,that underwent correction of stenotic nares and resection of the elongated soft palate,were included in this study. After premedication with Diazepam(0.2mg/kg iv) and Butorphanol(0.2mg/kg im), the anaesthesia was induced by Propofol(4mg/kg iv)and maintained with Isoflurane in 100% Oxygen. A temporary palatopexy was performed applying a horizontal "U" traction suture in PDS II® USP 2‐0 between the middle point of the soft palate and the cranial third of the hard palate. The suture was tight enough to pull forward the soft palate and was removed 24h after surgery. Respiratory grading scores(1‐3)as reported by Torrez(1),pulse‐oximetry and spirometry were used to record the severity of the disease, before and after surgery. A follow‐up time of 180 days was required for inclusion in the study. Differences between pre and post‐surgical parameters were compared using the Kruskall Wallis test. Statistical significance was set at p≤0.05 The dogs weighed 23±5.7kg(mean±st.dev) and were 18.1±9.5 months old. Mean operating time was 33 minutes (range 30‐45). No intraoperative complications occurred. Tracheostomy was not necessary in any case. Two dogs showed blood regurgitation, soon after extubation. Post‐surgical oxymetry, heart rate, respiratory rate and respiratory scores differed significantly from preoperative values. Significant differences of the spirometric values were not recorded. All dogs showed improvement of respiratory signs at all times of the clinical follow‐up. Routine surgical treatment of BAOS includes correction of the stenotic nares and resection of the elongated soft palate, laryngeal saccules and excessive palatopharyngeal folds(1). Dyspnea is still the most common postoperative complication of these procedures. A combination of mucosal oedema, collapse of laryngeal structures and reduced pharyngeal muscle tone consequent to recovery from anesthesia are responsible for post‐surgical respiratory distress(1). Postoperative dyspnea rate has been reported to reach 20.3%(1); this complication requires emergency tracheostomy in a percentage of cases varying from 5%(2) to 10.9%(3). Temporary palatopexy may reduce the incidence of short‐term post‐surgical complications through traction on the soft palate, which inhibits the laryngeal obstruction due to the collapse of oedematous laryngeal structures and reduces pharyngeal muscle tone. Thus temporary palatopexy combined with upper respiratory surgery seems to prevent the complication of postoperative dyspnea and improve the prognosis of dogs presented for BAOS