BOAS Surgery

Overview

Brachycephalic Obstructive Airway Syndrome (BOAS) is a condition we commonly see at Animal Trust. It predominantly affects dogs with short-nosed skulls (such as French Bulldogs, English Bulldogs, Pugs, Pekinese etc), although it can also be seen in some breeds of cats. The syndrome results from anatomical abnormalities obstructing the upper airway, leading to breathing difficulties and secondary health problems.

These are primarily: • Stenotic nares (small nostrils) • Elongated soft palate • Everted laryngeal saccules • Enlarged tonsils • Aberrant nasal turbinates

BOAS primarily affects the respiratory system but can have widespread implications for other body systems. The clinical signs of BOAS vary depending on the severity of the condition and individual anatomy. Symptoms may become more pronounced during periods of exercise, excitement, or heat stress. • Respiratory Signs: • Noisy breathing, including snoring and snorting • Inspiratory stridor (high-pitched wheezing during breathing in) • Difficulty breathing (dyspnoea), especially during exertion • Cyanosis (blue-tinged gums or tongue, indicating poor oxygenation) • Episodes of collapse (especially after physical exertion) • Gastrointestinal Signs: • Regurgitation • Vomiting • Excessive salivation • Behavioural Changes: • Exercise intolerance • Lethargy or decreased activity • Restlessness during sleep or difficulty sleeping due to airway obstruction • Other Signs: • Heat intolerance • Gagging or choking sounds, particularly after eating or drinking

Common Comorbidities

We often need to treat other conditions that are associated with BOAS: • Gastrointestinal Disorders: BOAS is commonly associated with conditions such as oesophagitis, hiatal hernia, and gastroesophageal reflux disease (GERD). Increased respiratory effort can exacerbate these issues. • Obesity: Many brachycephalic breeds tend to be overweight, which can worsen breathing difficulties and increase the risk of heat-related problems. • Laryngeal Paralysis: While BOAS primarily involves physical obstruction, some dogs may also develop laryngeal paralysis, a condition in which the laryngeal cartilages fail to open properly during inhalation.

Secondary Problems from Untreated BOAS

If left untreated, BOAS can lead to several secondary and life-threatening complications: • Laryngeal Collapse: Chronic increased effort to breathe can result in collapse of the laryngeal cartilages, which further obstructs airflow. • Aspiration Pneumonia: These patients offer suffer from gastrointestinal reflux and regurgitation. When stomach content enters the lungs, this can lead to pneumonia. • Heatstroke: Patients, particularly dogs with BOAS are at high risk of overheating, which can lead to potentially fatal heatstroke.

Surgical management

Surgical procedures are available to alleviate the symptoms of BOAS and improve the quality of life. The appropriate intervention depends on the severity abnormalities. We are able to offer BOAS surgery at Animal Trust for a fixed cost of £1019,* which includes the surgical interventions listed below and appropriate aftercare.

*Please note, in some cases it may be recommended that your pet has some imaging performed prior to surgery such as X-rays or CT scan. This will typically cost an additional £419 • Stenotic Nares Surgery (Rhinoplasty): • The nostrils are widened surgically to allow for better airflow through the nasal passage. • Soft Palate Resection (Staphylectomy): • The elongated portion of the soft palate is trimmed to a normal length, reducing airway obstruction. • Laryngeal Saccules Removal (Sacculectomy): • The saccules are surgically removed to open up the airway. • Tonsillectomy: • Excessively everted tonsils can further occlude the pharynx; these can be removed when appropriate

Post-Operative Care

Post-operative care is crucial for ensuring successful recovery after surgery for BOAS. The animal will require close monitoring and supportive care to manage pain, inflammation, and the risk of complications. • Hospitalisation: Immediately following surgery, most patients require 4-8 hours of hospitalisation for monitoring. This ensures any complications such as excessive swelling or bleeding can be addressed promptly. Occasionally patients may be required to be hospitalised overnight. • Pain Management: Post-operative pain control is critical for reducing discomfort and preventing excessive panting, which could exacerbate airway inflammation. • Anti-Inflammatory Medications: NSAIDs are often prescribed to manage post-surgical inflammation and swelling in the upper airway. • Restricted Activity: The patient’s activity should be limited for 7 to 10 days after surgery to prevent stress on the healing tissues. Lead walks should be brief, with harnesses used and the animal should avoid exertion, especially in hot or humid weather. • Monitoring for Complications: Owners are advised to watch for signs of airway obstruction, such as difficulty breathing, excessive panting, or cyanosis. Other signs to watch for include vomiting, coughing, or lethargy, which could indicate aspiration pneumonia. • Dietary Management: In cases where gastrointestinal symptoms were present, post-operative care may include a specialised diet or medications (e.g., proton pump inhibitors or prokinetics) to manage gastroesophageal reflux or regurgitation. • Follow-Up: Patients are usually signed off at 7-10 days post operatively. Additional surgeries may be required if BOAS-related issues persist or if new problems, such as laryngeal collapse, develop.