短头综合症.ppt

Brachycephalic Complex Dr. D.J. Krahwinkel Brachycephalic Complex A series of congenital upper airway obstructions occurring in short-nosed dogs cats Brachycephalic Complex Stenotic nares Elongated soft palate Everted laryngeal saccules Hypoplastic trachea Tonsil prolapse and pharyngeal folds Clinical Signs Begin in early life Snoring Stertorous breathing Gagging, coughing mucous Prone to heat stroke Breeds Affected Bulldog Pug Boxer Pekingese Boston terrier Persian cat Surgical Procedures for Brachycephalics Stenoic nares correction (Rhinoplasty) Amputation of Elongated Palate Excise everted laryngeal saccules Tonsillectomy? Excise pharyngeal folds Preoperative Preparation Radiograph trachea Withhold food 24 hours, water 12 hours Corticosteroids to reduce swelling Antiemetics (prone to vomit postoperative) Perioperative antibiotics Prep with povidone iodine solution Anesthetic Management Sedation to reduce excitement Preoxygenation Rapid induction and intubation Isoflurane anesthetic Stenotic Nares Physical Exam Collapsed external nares Open-mouth breathing Rhinoplasty Soft Palate Resection Physical Exam(Under Sedation) Soft palate obstructs larynx Palate may be aspirated into laryngeal opening How Much Palate? Slight overlap with epiglottis Caudal 1/3 of tonsil Palate Resection Techniques Electroscalpel Crossclamp and oversew Cut and oversew Laser Everted Saccules Occurs secondary to nares and palate If palate and nares corrected, this doesnt occur Is an eversion of the lining of the laryngeal ventricles Wait 30 days to see if inversion Laryngeal Sacculectomy Postoperative Care Anesthesia maintained 10-15 minutes Patients recovered with oxygen Corticosteroids and antibiotics NPO for 24 hours to reduce vomiting Postoperative Complications Frequent and potentially severe Swelling may obstruct airway Airway hemorrhage Vomiting and aspiration pneumonia Change in phonation “Webbing”