Learning Outcomes

• The practitioner shall understand the rationale for the use of the folded flap palatoplasty
• ...and be able either to perform it or to refer cases for this specific treatment.

Animals presented with brachycephalic syndrome suffer from multilevel obstruction of the airways as well as secondary structural collapse: Stenotic nares, aberrant turbinates, nasopharyngeal collapse, soft palate elongation and hyperplasia, laryngeal collapse and left bronchus collapse are being described as the most common associated anomalies. Although literature used to emphasize an elongated soft palate, fluttering and obstructing the rima glottidis as a primary component of BS, recent radiographic, CT and histological examinations demonstrated an additional pathological thickening of the soft palate, which might play a major role in the nasopharyngeal obstruction. One study demonstrated a positive correlation between the thickness of the soft palate and the severity of the clinical signs. A recent study using CT evaluation of airway dimension showed a significantly thicker soft palate in French bulldogs compared to pugs but no free airway space dorsal to the soft palate in 81% of pugs.

This has led us to developing a surgical technique which aim is not only shortening but also thinning the soft palate which results in widening of the nasopharynx.

Folded Flap Palatoplasty Procedure

The dog is placed in ventral recumbency. The head is restrained with the mouth kept open. The tongue is pulled ventro-rostrally and fixed with a malleable retractor to allow better exposure of the oropharynx. After surgical preparation of the oral cavity, the caudal edge of the soft palate is grasped with forceps and retracted rostrally, until the caudal opening of the nasopharynx can be visualised. The retracted caudal edge is then applied on the ventral mucosa of the soft palate and the point at which the contact is made (usually 1 or 2 cm caudal to the palatine process of the palatine bone) and is marked with an electrocautery cut. The ventral mucosa of the soft palate is then incised in a trapezoidal shape from this mark rostrally to the free edge of the soft palate caudally. Laterally, the sides of the trapezoid passed just medially to the tonsils. The soft tissues under the cut portion of the soft palate are excised together with the ventral mucosa of the soft palate, the palatinus muscles and part of the levator veli palatini muscle. The dissection ends when this portion of the soft palate is reduced to the nasopharyngeal mucosa and submucosa. The caudal edge of the soft palate is retracted rostrally to the rostral edge of the trapezoidal incision. The soft palate is then sutured folded on itself with interrupted monofilament absorbable sutures.

References

1.  Dupré G, Poncet C. Brachycephalic upper airways syndrome. In: Bojrab JM, Monnet E, eds. Mechanisms of Disease in Small Animal Surgery. 3rd edition. Jackson, Wyoming: Teton NewMedia; 2010:298–301.

2.  Dupré G, Findji L, Oechtering GU. Brachycephalic airway syndrome. In: Monnet E, ed. Small Animal Soft Tissue Surgery. 1st edition. Ames, Iowa: Wiley-Blackwell; 2013:167–183.

3.  Dupré G, Findji L. La palatoplastie modifiée chez le chien. Le Nouveau Praticien Vétérinaire. 2004;20:553–556.

4.  Dupré G, Heidenreich D. Brachycephalic syndrome. The Veterinary Clinics of North America. Small Animal Practice. 2016;46:691–707.

5.  Findji L, Dupré G. Folded flap palatoplasty for treatment of elongated soft palates in 55 dogs. Wiener Tierärztliche Monatsschrift. 2008;95:56–63.

6.  Grand JG, Bureau S. Structural characteristics of the soft palate and meatus nasopharyngeus in brachycephalic and non-brachycephalic dogs analysed by CT. The Journal of Small Animal Practice. 2011;52:232–239.

7.  Heidenreich D, Gradner G, Kneissl S, Dupré G. Nasopharyngeal dimensions from computed tomography of pugs and French bulldogs with brachycephalic airway syndrome. Veterinary Surgery. 2016;45:83–90.

8.  Haimel G, Dupré G. Brachycephalic airway syndrome: a comparative study between pugs and French bulldogs. The Journal of Small Animal Practice. 2015; DOI: 10.1111/jsap.12408