Brachycephalic Obstructive Airway Syndrome (BOAS) is a common condition affecting brachycephalic (flat-faced) dog breeds such as Bulldogs, Pugs, and French Bulldogs. The distinctive facial structure that gives these dogs their cute appearance can lead to a variety of health issues, primarily related to breathing difficulties. BOAS surgery is a corrective procedure designed to alleviate these problems and improve the dog’s quality of life. This article explores BOAS surgery, its benefits, risks, and what to expect during recovery.
What is BOAS?
BOAS is a syndrome caused by the anatomical abnormalities in brachycephalic dogs, which lead to breathing difficulties. These abnormalities may include:
– Stenotic nares: When the nostrils are too small to allow adequate passage of air, making breathing through the nose difficult
– Elongated and/or thickened soft palate: in the vast majority of brachycephalics the soft palate is too long and sits within the opening of the trachea (windpipe) and thus obstructs normal airflow. The elongated soft palate creates turbulent airflow resulting in the increased respiratory noise we hear in brachycephalic dogs, including snoring. (Snoring is NEVER normal!).
– Tonsillar hyperplasia or enlarged tonsils: This is common in brachycephalic breeds due to chronic inflammation and reflux resulting from the pressure gradient created by the narrow airways
– Everted laryngeal saccules: Small sacs that sit in front of the vocal cords. In brachycephalic dogs the increased effort of breathing may result in the saccules becoming swollen resulting in obstruction of airflow. Swollen laryngeal saccules is the first stage of collapse of the larynx, which can cause severe breathing issues.
– Hypoplastic trachea: A smaller-than-normal windpipe, which can limit airflow.
These issues can make it hard for affected dogs to breathe properly, especially during physical exertion or in hot weather, and can lead to snoring, laboured breathing, coughing, gagging, reflux, regurgitation, collapse and death if left untreated.
When is BOAS Surgery Recommended?
We find if the primary problems are addressed at an early age (ideally less than 1.5 years old) then we see less secondary changes, animals then usually require less complicated surgical procedures, and the long term outcomes are improved. However dogs of any age showing signs of respiratory distress benefit from surgery, and can help to prevent the condition from worsening.
If left untreated, BOAS can lead to chronic progressive breathing problems, overheating, a reduced quality of life and a shortened lifespan.
The BOAS Surgery Procedure
BOAS surgery involves several techniques to widen the airways and improve breathing. The specific procedures may vary based on the dog’s condition but often include:
– Staphylectomy/Palatoplasty (soft palate resection +/- thinning of the palate): Shortening and thinning of the elongated soft palate to prevent it from blocking the airways.
– Alarplasty (nostril widening): Surgically widening the stenotic nares to increase airflow through the nostrils.
– Tonsillectomy: Removing the enlarged tonsils
– Sacculectomy: Removing the everted laryngeal saccules to clear the airway
Benefits of BOAS Surgery
The primary goal of BOAS surgery is to improve a dog’s ability to breathe comfortably, and to reduce the secondary airway changes and thickening that inevitably happen with brachycephalic breeds.
Post-surgery, owners often notice a significant improvement in their pet’s quality of life, including:
– Improved breathing: Reduced snoring, coughing, and respiratory effort, especially during exercise or warm weather events.
– Increased activity levels: Dogs can play and exercise without experiencing breathing difficulties.
– Better temperature regulation: Improved breathing makes dogs less prone to heat exhaustion or heatstroke.
– Improved sleep
– Improved sense of smell
– Reduced regurgitation and reflux
– Reduced flatulence
– Longer lifespan: Correcting airway obstruction reduces the risk of long-term health complications from respiratory, gastrointestinal and cardiac issues.
Risks and Complications
As with any surgical procedure, BOAS surgery comes with some risks. Potential complications include:
– Post-operative swelling, which may temporarily affect breathing. Generally swelling is mild in these cases, and can be managed appropriately with medication. However, in severe cases a temporary tracheostomy tube may need to be placed, this will result in the patient being transferred to a specialist Veterinary ICU for recovery.
– Bleeding at the surgical site.
– Anaesthesia-related risks, particularly in brachycephalic dogs who may have difficulty breathing under anaesthesia. The chance of a major anaesthetic complication in dogs is very low – only 0.01%. However, the mortality rate of brachycephalic dogs is published at a higher rate of 5-10%
This highlights why it is so vital that we improve the breathing function of these pets as much as possible and while they are still young prior to the development of secondary changes. Patients are monitored very closely before, during and after surgery to reduce these risks.
Recovery and Aftercare
Our preference is to get these patients home asap after surgery where they will be significantly less stressed and anxious.
After BOAS surgery, most dogs require a few days of rest and close monitoring to ensure they are recovering well. Once home, owners should follow their veterinarian’s aftercare instructions carefully, which may include:
– Restricted activity: Keeping the dog calm and limiting exercise for a few weeks.
– Medication: Administering prescribed pain relief and antibiotics to prevent infection.
– Monitoring: Watching for any signs of breathing difficulty, swelling, or infection.
Most dogs begin to show improvement within a few days, with full recovery taking about 2-4 weeks. Regular follow-up visits with the veterinarian are important to assess healing and ensure long-term success.
BOAS surgery can be life-changing for brachycephalic dogs. The prognosis is excellent for young animals. They will breathe much more easily and with significantly reduced respiratory distress. Their activity level can markedly improve. Older animals have a less favourable long-term prognosis, especially if the process of laryngeal collapse has already started. While the thought of surgery may be daunting for pet owners, the benefits far outweigh the risks for dogs with BOAS.
With proper care and veterinary expertise, most dogs recover very well and enjoy an improved quality of life post-surgery.
Whilst we manage and treat BOAS syndrome in brachycephalic dogs of all age, we advocate for the proactive management of BOAS syndrome. We recommend that all brachycephalic dogs have a consultation at 1year of age to assess their risk factor for BOAS, and to discuss how we can improve your dog’s health and quality of life.
FAQs
1. What is Brachycephalic Obstructive Airway Syndrome (BOAS)?
BOAS is a condition that affects brachycephalic (flat-faced) dog breeds like Bulldogs, Pugs, and French Bulldogs. It results from the anatomical features of their skull, which can lead to breathing difficulties due to obstructed airways.
2. What causes BOAS?
BOAS is caused by several anatomical abnormalities, including narrowed nostrils (stenotic nares), elongated soft palate, and an undersized trachea, which all contribute to obstructed airflow.
3. Which breeds are most commonly affected by BOAS?
Breeds with brachycephalic features are most affected, including:
- English Bulldogs
- French Bulldogs
- Pugs
- Shih Tzus
- Boston Terriers
4. What are the symptoms of BOAS?
Common symptoms include:
- Snoring or noisy breathing
- Difficulty breathing, especially during exercise
- Excessive panting
- Gagging, coughing, or retching
- Heat intolerance
- Cyanosis (bluish gums or tongue)
- Fainting or collapse in severe cases
5. Is BOAS painful for my dog?
BOAS is not typically painful, but it can cause significant discomfort and stress. Over time, if left untreated, it can lead to serious health problems such as respiratory distress, which can be life-threatening.
6. Can BOAS be treated?
Yes, BOAS can be treated. Mild cases may only require weight management, lifestyle adjustments, or medications. Severe cases often benefit from surgical interventions such as widening the nostrils or shortening the soft palate to improve airflow.
7. How do I know if my dog needs surgery for BOAS?
Your veterinarian or a specialist will assess your dog’s airway function, severity of symptoms, and overall health to determine if surgery is necessary. Common indicators include persistent breathing difficulties and episodes of collapse.
8. What can I do to help prevent BOAS symptoms in my dog?
Some steps you can take include:
- Managing your dog’s weight
- Limiting exercise in hot weather
- Avoiding stress and over-exertion
- Providing a cool, calm environment
- Regular veterinary check-ups to monitor airway health
9. Is BOAS curable?
While surgery can significantly improve symptoms and quality of life, BOAS is generally a lifelong condition. Regular monitoring and care will be necessary to manage it effectively.
10. Are brachycephalic dogs more prone to heatstroke because of BOAS?
Yes, brachycephalic dogs are more vulnerable to heatstroke due to their compromised breathing. Their inability to pant effectively to cool down makes them more prone to overheating, especially in hot and humid conditions.
11. What is the prognosis for dogs with BOAS after surgery?
The prognosis is generally good, with many dogs experiencing significant improvement in their ability to breathe, exercise, and lead a more comfortable life. However, regular follow-ups are essential to monitor for any ongoing or new issues.
12. Can BOAS affect cats?
Yes, while less common, some brachycephalic cat breeds, such as Persians, can also suffer from BOAS-like symptoms.