Brachycephalic obstructive airway syndrome (BOAS) surgery addresses both primary and secondary airway components in a single multilevel procedure, with technique selection driven by individual anatomical findings rather than a fixed staging sequence.Veterinary Clin…+1

The core surgical procedures are staphylectomy, rhinoplasty (alaplasty), laryngeal sacculectomy, and tonsillectomy. Staphylectomy is performed in virtually all surgical candidates; rhinoplasty is added in approximately 74% of cases, laryngeal sacculectomy in 71%, and tonsillectomy in 9%.Journal of the… The combination most frequently performed is staphylectomy plus sacculectomy plus alaplasty, performed together in 65% of dogs.Journal of the…

For soft palate correction, cut-and-sew staphylectomy (standard staphylectomy) and folded-flap palatoplasty (FFP) are the two principal techniques. Standard staphylectomy shortens the soft palate to the mid-to-caudal third of the tonsils with mucosal apposition.Journal of the… FFP resects the ventral oropharyngeal mucosa and a portion of the underlying musculature, then folds the remaining caudal edge rostrally to simultaneously shorten and thin the palate.Journal of the…+1 In French Bulldogs, both techniques produce equivalent reductions in palate length and thickness at the rostral and middle thirds postoperatively, with no significant difference in exercise tolerance test improvement between groups.Journal of the… In English Bulldogs, FFP is likewise not superior to standard staphylectomy.Journal of the… Modified multilevel surgery — which incorporates vestibuloplasty and FFP — carries an 8-fold lower risk of poor prognosis compared to conventional multilevel surgery in pugs, French Bulldogs, and Bulldogs.Journal of the…+1

Rhinoplasty technique options include vertical wedge resection and dorsal offset rhinoplasty. Vertical wedge resection is used in 86% of dogs undergoing alaplasty; dorsal offset rhinoplasty accounts for the remaining 14%.Journal of the…

Laryngeal sacculectomy is indicated when everted laryngeal saccules are confirmed. Laryngeal collapse is present in 73% of BOAS surgical candidates, with low-grade collapse in 62% and high-grade collapse in 11%.Journal of the… Sacculectomy is appropriately deferred when saccule eversion is absent despite laryngeal collapse, when collapse is mild, or when prior sacculectomy has already been performed.Journal of the…

Regarding procedural staging, all components are addressed in a single anesthetic event in the vast majority of cases. Concurrent non-airway procedures are performed in 42–54% of dogs at the same time as BOAS surgery.Journal of the…+1 Among dogs undergoing concurrent non-airway procedures, major short-term complications occur in 13.8%.Journal of the… Only 0.9% of dogs presenting for non-airway procedures require emergent BOAS surgery during the same anesthetic event, confirming that elective concurrent correction is safe in most patients.Journal of the…

Objective disease severity should be established preoperatively to guide surgical planning and set outcome expectations. Whole-body barometric plethysmography (WBBP) provides a BOAS index from 0–100%; breed-specific diagnostic cutoffs for clinically affected dogs are a BOAS index greater than 55% for pugs, greater than 49% for French Bulldogs, and greater than 44% for Bulldogs.Veterinary Surg… Respiratory functional grading assigns grade 0 (BOAS-free) through grade 3 (severe, requiring immediate surgery); grades 2 and 3 indicate clinical disease warranting intervention.Veterinary Surg… A 3-minute trot exercise tolerance test has 93% sensitivity for BOAS diagnosis.Journal of the…

Negative prognostic factors for surgical outcome are older age, abnormal body condition, presence of laryngeal collapse, and use of traditional rather than modified multilevel surgery.Veterinary Surg… The brachycephalic risk (BRisk) score — incorporating breed, history of prior airway surgery, planned concurrent procedures, body condition score, respiratory compromise at admission, and rectal temperature at admission — stratifies dogs into low-, medium-to-high-, and high-risk groups for postoperative complications including death, euthanasia, oxygen support required beyond 48 hours, and temporary or permanent tracheostomy.Journal of the…

Postoperative mortality across BOAS surgery series ranges from 0.9% to 7%, with overall complication rates of 6% to 26%.Veterinary Surg… Pharyngeal swelling causing upper airway obstruction is the primary acute postoperative risk, and emergent temporary tracheostomy is required in a subset of cases.Journal of the…+1 Nebulized adrenaline has been used to reduce laryngeal edema in the immediate postoperative period when upper airway obstruction is life-threatening, as an alternative to tracheostomy.Journal of the…

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