Brachycephalic Obstructive Airway Syndrome

Brachycephalic obstructive airway syndrome (BOAS) is a combination of anatomical abnormalities present in essentially all brachycephalic breeds to some degree.  These changes include elongation of the soft palate, stenotic nares, a hypoplastic trachea, and secondary eversion of the laryngeal saccules.  

It is commonly recognized that BOAS causes respiratory signs, including sterterous breathing, hypoxia, dyspnea, and potentially respiratory distress and non-cardiogenic pulmonary edema.  What is less obvious is that gastrointestinal signs can result due to the effort to exert the negative airway pressure required to breathe against significant airway obstruction.  Gastroesophageal reflux is usually present to some degree, and sliding hiatal hernias are common.  These can lead to regurgitation and vomiting, which predispose these patients to aspiration pneumonia which can be devastating in a patient with an already compromised respiratory system.  

The negative impacts of BOAS are profound, and the condition worsens over time.  This is why I recommend upper airway surgery for all of my brachycephalic patients, ideally at a young age (e.g. at the time of spay or neuter).  The procedure consists of reducing the length of the soft palate (palatoplasty/staphylectomy), widening of the nares (rhinoplasty), and removing of the laryngeal saccules if they are everted (laryngeal sacculectomy - this is a secondary change, but is frequently present even in young dogs).  Young patients generally recovery very well from the procedure and are routinely sent home the day of surgery.  Older patients with more severe secondary changes have a higher risk for postoperative complications, but still frequently have same-day discharges.  

I have been performing this procedure since I began my career, and I encourage all veterinarians to recommend BOAS surgery at least for every brachycephalic patient undergoing spay or neuter.  To me it is more important than recommending a gastropexy for a Great Dane.  A Dane may have a relatively high risk of GDV, but a Frenchie, without the benefit of airway modification, is guaranteed to have difficulty breathing for its entire life.