BOAS Flashcards

1
Q

What are the 8 components of BOAS

A

1) Elongated soft palate
2) Redundant pharyngeal folds
3) Stenotic nares
4) Macroglossia
5) Aberrant Nasal turbinates
6) Hypoplastic trachea
7) Everted Saccules
8) Laryngeal collapse

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2
Q

What causes secondary changes which further narrow the upper airway

A

1) Negative pressure (stenotic nares, etc.) from secondary factors everted laryngeal saccules, everted tonsils, laryngeal collapse
2) Edema, erythema, swelling
3) Further narrow the upper airway

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3
Q

What noises might you hear from BOAS patients

A

1) Nasal snorting (stertor) from nasal or elongated soft palate
2) Stridor can also occur

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4
Q

in BOAS, what causes further narrowing of the upper airway?

A

edema, erythema, swelling from negative pressure from secondary components (everted laryngeal saccules, everted tonsils, laryngeal collapse)

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5
Q

What secondary components cause edema, erythema, swelling from negative pressure

A

laryngeal saccules, everted tonsils, laryngeal collapse

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6
Q

What are the GI disease components of BOAS

A

1) Regurgitation
2) Sliding Hiatal Hernias
3) Gastritis
4) Inflammatory GI disease - reversible with treatment

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7
Q

BOAS dogs have what other diseases

A

37% esophagitis
89% gastritis
Hiatal hernia (up to 40%), french bulldogs

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8
Q

nostrils of the dog are called

A

nasal aperature

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9
Q

alar fold typically collapses

A

medially (dynamic component)

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10
Q

What is Poiseuille’s Law?

A

Flow is proportional to radius ^4,

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11
Q

How do you know if a soft palate is elongated

A

Laryngeal exam (light plane of anesthesia, ventral recumbency, tongue in neutral position)

Hold the tongue and lift the soft palate with an instrument

it will be too long if the soft palate extends beyond the tip of epiglottis

if intubated use palatine tonsils (divide length into thirds) - cut to middle and caudal 1/3 of tonsil

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12
Q

How do you know the long palate is elongated if the patient in intubated

A

if intubated use palatine tonsils (divide length into thirds) - cut to middle and caudal 1/3 of palantine tonsil

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13
Q

What could happen if the soft palate is cut too short

A

rhinitis and increased risk of aspiration pneumonia

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14
Q

What are everted saccules

A

the everted mucosa of the laryngeal ventricle

negative pressure is generated during inspiration

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15
Q

_____% of english bulldogs have hypoplastic tracheas

A

53.9%

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16
Q

What are aberrant nasal turbinates

A

nasopharyngeal turbinates: 21% of brachycephalic breeds
-Hypertrophy
-Occlusion of nasopharynx as they extend caudally there
-80% of pugs (originally reported) but many have them

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17
Q

What can you do for aberrant nasal turbinates

A

Laser ablation
-96% of french bulldogs and 65% of pugs show regrowth at 6months

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18
Q

What are you concerned about when you hear high pitched noises in a breathing BOAS dog

A

laryngeal collapse

19
Q

What is laryngeal collapse

A

loss of cartilage structure that becomes weak and soft

causes inspiratory stridor - high pitched, wheezing sound

20
Q

What sounds do you hear with laryngeal collapse

A

inspiratory stridor
-high pitched
-wheezing sound

21
Q

What are the 3 stages of laryngeal collapse

A

1) Laryngeal saccule eversion
2) Cuneiform cartilage adduction
3) Corniculate cartilage adduction

22
Q

How do you treat laryngeal collapse

A

Prevention is best, treat the treatable conditions because not the best treatments

+/- laryngeal tie back
permanent tracheostomy * is the best treatment

23
Q

T/F: laryngeal tie back is a good method for treating laryngeal collapse

A

False- doesnt look good

24
Q

What is the best treatment for laryngeal collapse

A

permanent tracheostomy (hard sell)

25
How do you treat stenotic nares
1) Vertical Wedge Resection 2) Punch Biopsy 3) Nares amputation 4) Alapexy
26
How do you treat elongated soft palate
1) Staphylectomy - shortening soft palate 2) Folded Flap palatoplasty - for long and thic
27
shortening of the soft palate
Staphylectomy
28
T/F: sacculectomy for everted saccules is controversial
True
29
How do BOAS dogs typically present
Snoring, stertor High pitched wheeze, stridor restlenessness at night/apnea exercise and or heat intolerance dyspnea syncope Gi signs: vomiting and regurgitation
30
For BOAS dogs, how do you treat in emergency
Cool environment oxygen therapy sedation dexamethasone (0.25mg.kg IV) for inflammation
31
Why are thoracic rads important for BOAS workup what 4 things are you looking for?
Pneumonia (aspiration) - treat before sedating Hiatal hernia Tracheal size Pulmonary edema
32
What should you do when inducing BOAS dogs with anesthesia
-No stress -Hyperoxygenation: mask -Quick induction -Quick atraumatic intibation (small tube) -Electrocardiogram (vagal tone from GI disease )
33
Why are sacculectomy for everted laryngeal saccules controversial
Sacculectomy - had more complications more had non-treated group. moderate (>48 hours, mild cough, dyspnea) and severe (dyspnea, regurgitation requring tx, temp trach, tx for pneumonia, ventilator, euthanasia, death) complications
34
T/F: avoid cautery when doing staphyloectomy
True
35
Where do you cut the soft palate
just at the border of the middle 1/3 and caudal 1/3 of the palatine tonsil
36
How do you suture a staphylectomy
Simple continuous- apposing oral and nasal mucosa good apposition to prevent scar tissue
37
Alternative surgical techniques for elongated soft palate
1) CO2 laser- cuts and seals tissue, oxygen 2) Bipolar vessel sealant device 3) Folded Flap Palatoplasty- treats long and thick palates
38
Folded Flap Palatoplasty- treats
long and thick palates
39
Methods for stenotic nares tx
1) Vertical Wedge Resection 2) Horizontal Wedge Resection 3) Trader's 4) Punch Biopsy 5) Alapaexy
40
How do you recover dogs from BOAS sx
-Delayed extubation -Calm environment -Prepared with: sedation / reversal agent, induction agent, small ET tubes and laryngoscope, suction, supplemental oxygen Dex SP 0.25mg/kg IV during surgery
41
What are some common complications of BOAS sx
-Regurgitation/vomiting -Nasal discharge -aspiration pneumonia -palate too short: rhinitis, aspiration pneumonia -suture failure of nose and collapse -need for temporary tracheostomy (3-5%) -Severe dyspnea and death (3-5%)
42
What should you give BOAS dogs if you notice post-op GI signs
Omeprazole 0.7 mg/kg POq24h Cisapride 0.2-0.5mg/kg PO TID
43
What percent of dogs have significant improvement and good to excellent outcome
94%
44
What should you do for aftercare for BOAS sx
-Discharge later in the afternoon or following day -Analgesia -Soft food for 7 days --Ecollar for nares -Recheck exam in 2 weeks +/- short course of steroids of Nsaids -if GI signs post-op Omeprazole or Cisapride -Harness -Weight management