Brachycephalic Obstructive Airway Syndrome (BOAS): New Surgical Advances an

Brachycephalic Obstructive Airway Syndrome (BOAS) remains one of the most significant welfare challenges affecting brachycephalic dog breeds, including French Bulldogs, Pugs, and English Bulldogs. Characterized by upper airway obstruction resulting from multiple anatomical abnormalities, BOAS can severely impact exercise tolerance, thermoregulation, sleep quality, and overall quality of life.

Current Standard of Care

The established surgical approach focuses on correcting the primary anatomical abnormalities contributing to airway obstruction:

• Resection of stenotic nares through alar fold resection or rhinoplasty

• Correction of elongated soft palate through staphylectomy or palatoplasty

• Removal of everted laryngeal saccules when present

Current evidence continues to support early surgical intervention, ideally before two years of age, to prevent progression to secondary and tertiary airway changes.

Folded-Flap Palatoplasty: An Alternative to Traditional Staphylectomy

A prospective randomized controlled trial by Farrell and colleagues evaluated folded-flap palatoplasty (FFP) against traditional staphylectomy in French Bulldogs.

The study demonstrated that both procedures achieved similar reductions in soft palate length and thickness, with equivalent improvements in exercise tolerance test scores. These findings suggest that FFP can be considered a valid alternative surgical technique when incorporated into a comprehensive multilevel BOAS correction strategy.

CO₂ Laser Palatoplasty May Reduce Tissue Injury

The choice of surgical instrumentation has also become an area of active investigation.

A 2024 histomorphological study comparing CO₂ laser and LigaSure-assisted palatoplasty found that CO₂ laser use resulted in less collateral thermal tissue damage. Reduced thermal injury may translate into improved wound healing, decreased postoperative inflammation, and reduced airway swelling during recovery.

Laser-Assisted Turbinectomy (LATE)

While traditional BOAS surgery focuses on external and pharyngeal airway obstruction, it does not address abnormalities within the nasal cavity.

Laser-assisted turbinectomy (LATE) is an advanced surgical technique aimed at reducing airflow resistance caused by aberrant nasal turbinates. Recent reviews suggest that addressing intranasal obstruction may provide additional clinical improvement in selected patients and represents an important expansion in the surgical management of BOAS.

Macroglossia: A Newly Recognized Contributor

One of the most intriguing developments in BOAS research is the growing recognition of relative macroglossia as a contributing factor to airway obstruction.

Recent studies indicate that brachycephalic breeds have significantly reduced air-to-soft-tissue ratios within the upper airway and possess tongue tissue that is substantially denser than that of mesaticephalic breeds. These findings suggest that tongue size and tissue volume may play a more important role in BOAS pathophysiology than previously appreciated.

Although not yet considered standard therapy, surgical tongue reduction is now being explored as a potential future treatment option.

Progress in Anaesthetic Management

Perioperative complications remain an important concern in BOAS surgery.

Updated anaesthetic protocols incorporating local nerve blocks have been developed to reduce opioid requirements while maintaining effective analgesia. These approaches aim to minimize postoperative complications, particularly aspiration pneumonia and upper airway swelling during recovery and extubation.

The Future of BOAS Management

The contemporary understanding of BOAS has evolved beyond the traditional focus on stenotic nares and elongated soft palate. Emerging evidence highlights the importance of intranasal anatomy, tissue composition, and perioperative management in determining patient outcomes.

As surgical techniques continue to advance, treatment strategies are becoming increasingly individualized, reflecting a more comprehensive appreciation of the complex anatomical and physiological factors underlying BOAS.

References

Wallace ML. Surgical management of brachycephalic obstructive airway syndrome: An update on options and outcomes. Veterinary Surgery (2024). PubMed

Farrell M, et al. Folded-flap palatoplasty and traditional staphylectomy yield similar postoperative soft palate geometry in French Bulldogs. JAVMA (2025). PubMed

Phillips H. Laser-Assisted Turbinectomy in Dogs. Veterinary Clinics of North America: Small Animal Practice (2024). https://www.vetsmall.theclinics.com/article/S0195-5616(2400003-2/fulltext)