🔍 Key Findings
- BOAS Is a Multisystem Condition:
- No longer viewed as just soft palate elongation—includes macroglossia, gastrointestinal signs, respiratory collapse, and airway obstruction at multiple levels.
- Anesthetic Management Is Critical:
- High complication rates post-extubation in BOAS patients.
- Use of maxillary nerve blocks reduces opioid needs and intraoperative bleeding.
- Pre-oxygenation improves safety during intubation.
- Standardized anesthetic protocols lower the risk of postoperative regurgitation.
- Soft Palate Surgery Innovations:
- Comparison of Folded Flap Palatoplasty (FFP) vs. standard excision, laser, and bipolar sealing.
- FFP shows promising outcomes but demands careful case selection.
- Data suggests reduced wound dehiscence with newer techniques.
- Nares Surgery Is Essential:
- Nares contribute up to 80% of airflow resistance—ignoring them compromises outcomes.
- Modern techniques include dorsal offset rhinoplasty and ala vestibuloplasty, supported by 3D silicone models for planning.
- Controversial and Adjunctive Procedures:
- Laryngeal saccule removal: still debated.
- Tonsillectomy: considered safe but lacks robust outcome data.
- Turbinates: The LATE procedure (Laser Assisted Turbinectomy) is increasingly used in severe cases, with BOAS Index + breed helping guide candidacy.
- Postoperative Management Advances:
- ICU monitoring, owner-assisted recovery, and proactive support reduce complications.
- Emerging tools include high-flow oxygen, nasotracheal tubes, and nebulized epinephrine for airway management.
- Emphasis on early intervention over waiting for emergencies.
- Outcomes and Prognostic Insights:
- Multilevel surgeries yield better results compared to single-point interventions.
- Early surgery improves anesthesia tolerance for future procedures.
- Not every airway abnormality is correctable—surgeons must set realistic expectations.
- Clinical Takeaway:
- Successful BOAS management requires a multimodal, proactive, and individualized approach that addresses the entire airway and associated systems (airway + GI + anesthesia risk).
