Upper Airway Reconstruction

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Upper Airway Reconstruction

A category of soft tissue surgery that deals specifically with correcting respiratory irregularities.

The two primary procedures are revision of the nares (nostrils) and reduction of the soft palate. Both stenotic nares and elongated soft palate are congenital (present from birth) and heritable (passed genetically) abnormalities. They are very common in brachycephalic breeds, characterized by wide heads and foreshortened noses and include breeds such as Bulldogs, Pugs, Cavalier Spaniels, Shih Tzus, and Boston Terriers.

Dogs are obligate nasal breathers, which mean they must pass air through their nose, past the oropharynx and into the trachea and lungs. Dogs do not oxygenate well at all when they are mouth breathing, and in fact panting is the main means of controlling body temperature not a means of improved respiration. When the nostrils are occluded, dogs must resort to mouth breathing which is extremely inefficient. The normal function of the soft palate is to close off the nasopharynx when swallowing. In the brachycephalic (short nosed) breeds, the soft palate does not foreshorten in proportion to the skull, allowing the soft palate to hang down into the larynx and trachea. This leads to blockage of the airway at a second point and is the cause of snoring when sleeping and stridor (harsh breathing sounds). The clinical signs of upper airway syndrome include: stridor, snoring, exercise intolerance, cyanosis (blue tinge of tongue and gums), inability to sit still and in severe cases fainting or collapse.

Symptoms:

Upper Airway - brachycephalic breed

Brachycephalic Syndrome otherwise known as “brachycephalic respiratory syndrome” or “congenital obstructive upper-airway disease”. Any breed with a foreshortened head/nose conformation can have congenital changes (stenotic nares, elongated soft palate) that result in upper airway syndrome.

- Labored, noisy breathing (stridor)

- Exercise intolerance

- Cyanosis – tongue or gums turning blue

- Sleep apnea/snoring

 

Procedure:

The revision of stenotic nares is a rhinoplasty that opens the nares.

Consider the tape used to open the nostrils of athletes to help increase oxygen flow. The result of a rhinoplasty procedure is to permanently open the nares thereby increasing air flow and reducing respiratory effort. The nares can be stenotic on only one side or both and are corrected as needed. It would be extremely unusual for a dog affected with stenotic nares to not also suffer from elongated soft palate as well.

Soft palate amputation is the shortening of the soft palate, which is the tissue at the back of the throat that separates a dog’s oral and nasal cavities. If the soft palate is too long, it restricts proper air flow into the trachea and leads to poor oxygenation, exercise intolerance, snoring and sleep apnea.

The procedures that are included in upper airway reconstruction can be done independently or in conjunction, depending on your pet’s symptoms. The initial diagnosis of upper airway problems can be completed by your general practice veterinarian, who will then refer you to a specialist for surgical correction.

After Care:

Hospitalization:

- Your pet will need to stay overnight one night and can go home the day after surgery, discharged during our regular business hours. There will be staff overnight to monitor your animal.

- When you get your pet home, place your pet in a cool/warm (season dependent), quiet and dark room. If you leave your pet alone, he/she will sleep and be comfortable. You can increase your pet’s anxiety by doting. Your pet will have adequate medication for pain so you do not need to worry about discomfort.

Medication:

- A transdermal pain patch will be sutured on to your pet and will provide pain relief for three days following surgery. On the fourth day after surgery, you may remove the patch by clipping the sutures with a nail clipper and peeling it off like a band-aid. Please dispose of the patch by flushing down the toilet. (The transdermal pain patch used for pain relief can cause constipation. Dr. Dew will ask that you feed your pet a certain amount of tuna in oil for 4 days following surgery to prevent constipation. The tuna in oil is to be given in addition to your pet’s regular feedings.)

Food & Water:

- When you get your pet home, offer her a small amount of water. If she drinks it and does not vomit, offer twice the original amount. 2 hours later if no vomiting has occurred, offer ¼ of the amount of food in a normal meal.

- If your pet eats and no vomiting occurs in a 2-hour time period, then you may resume normal alimentation.

- Please call Dr. Dew’s office or your regular veterinarian if your pet does not drink within the first 6 hours of being home or if vomiting occurs.

Other Information:

It would not be unusual for your pet to cough when eating or drinking for 1-10 days after surgery as it acclimates to the new open airway.

Rechecks:

Your pet should be rechecked in 10-14 days by Dr. Dew. Please call Dr. Dew in 1 week with a progress report

Exercise Restriction:

- Limit to short leash walks for 2 weeks. Running, jumping and play activity should be eliminated during this time.

- Limit to short leash walks in the cool of the morning and evening.

- A harness should be used indefinitely to decrease pressure on the trachea.

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