BOAS Surgery

---

• Stenotic nares are easily observed on physical examination with small slits instead of open nostrils. 
• Definitive diagnosis of elongated soft palate, tonsil enlargement and laryngeal collapse can only be made under very carefully monitored anaesthesia, using a laryngoscope. Chest x-rays can be taken to evaluate the trachea, lower airways and lungs for evidence of concurrent problems, especially aspiration pneumonia, which may result from inhaling regurgitated stomach contents. 
• It is common to also note multiple spinal abnormalities on x-rays of brachycephalic breeds (although these do not cause a clinical problem in the majority of dogs). 
• Body condition score (BCS) will be assessed on a scale of 1-9, (5 = normal, 1 = very underweight, 9 = obese). Mild or moderately affected dogs may undergo a 3-minute exercise test at a moderate trot to assess changes in their breathing. 
• Additionally, dogs presenting primarily with regurgitation may undergo endoscopy of the stomach and small intestine and have biopsies taken to help exclude other causes of intestinal disease, which may be contributing to the problem. 

  BOAS Surgery is tailored to the needs of each individual animal. The 5/5 BOAS surgery refers to:

• Nares: Nostrils widened and deepened (Ala-vestibuloplasty)
• Palate: Shortening and thining of the elongated soft palatete with a H pharyngoplasty (Palatoplasty)
• Saccules: Removal of everted laryngeal saccules (Sacculectomy) 
• Tonsils: Remove of enlarged, everted tonsils  (Tonsillectomy)

• Pets are monitored very closely in intensive care immediately following surgery and then using owner assisted recovery to reduce post operative complications.
• Surgical recovery time and surgical outcomes increased by use of a surgical C02 laser.
• Occasionally (around 0.5% of cases) a temporary tube must be placed and maintained through an incision in the neck into the trachea (tracheostomy) until the swelling in the throat subsides enough that the pet can breathe normally

The genetics leading to a squishy face also leads to abnormalities in the tail. 'Cute' little nubbin tails are often painfful screw tails digging into the dogs skin and causing pain and skin fold dermatitis. Unfortunately these uncomfortable tails are overlooked by owners and sometimes even vets as they do not recognise the issue. 

Diagnising a painful tail: 

• Spinning on the floor
• Not liking the tail to be touched
• Really liking the tail to be 'itched'
• Often needing to clean the skin around the tail

In mild cases these tails can be medically managed but often the tail needs to be removed, a procedure called a Caudectomy. The relief felt after a caudectomy cannot be overstated. Images in section below. 

'Nose rope' is a large component of why people chose Brachycephalic dogs. It gives them their 'cute' look. Skin folds however can lead to dermatitis, that becomes infected and is a source of irritation. Dr Ema surgically reduces the skin folds, leaving the cute look, but significantly improving the dogs' quality of life. 

Look at a Brachycephalic's face - often their eyes show too much white and they have 'bug eyes' because the eyeball doesn't sit properly in the socket. Many brachycephalics end up with significant ocular disease because too much of the eye is exposed and tears cannot properly spread across the eye. It is also not uncommon to lose an eye with relatively little trauma. A Medial canthoplasty, along with other procedures, is a surgical technique performed in brachycephalic dogs to correct some of the anatomical abnormalities of the eye. Effectively these procedures reduce the exposed eyeball, reducing the likelihood of chronic disease, or even  a lost eyeball.

Not necessarily specific to Brachycephalics but 'hooded vulva' occurs where there is an overhang of skin/fat over the top of the vulva of female dogs. When the vulva is cocooned under a fat pad dermatitis is a common sequelae. Dermatitis and itch are concern enough, but the constant trauma can cause urinary tract infections (UTIs). The risk of a vulva becoming 'hooded' is reduced by allowing the female dog to have at least one season so her vulva become larger and is less likely to be trapped. Signs a dog is bothered by their hooded vulva are - brown staining observed, licking observed or frequent UTI's observed. 

A vulvoplasty is a surgical procedure to remove some of the skin hanging over the vulva and elevate the skin to give the vulva a face lift.