Chirurgia dróg oddechowych. Syndrom brachycefaliczny – cz. III

Respiratory surgery. Brachycephalic Airway Syndrome – Part III

The alapexy is described as an alternative technique which could be considered when excessive flaccidity of the nasal cartilages has lead, or is anticipated to lead, to recurrence of stenosis after conventional wedge alapasty (Ellison, 2004). In this technique the ala nasi is fixed abducted by creation of a permanent adhesion between the ventral edge of the lateral aspect of the ala nasi and the skin lateral to it.

The ventral edge of the lateral aspect of the ala nasi is amputated, leading to an elliptical wound along the alar groove. A matching elliptical incision is made in the skin, 3 to 5 mm laterally to alar wound. The two wounds are sutured together in 2 layers (medial and lateral). As the ala nasi is held abducted by the created adhesion to the skin, the opening of the naris is not dependent on the rigidity of the nasal cartilages and long-term failure is believed to be less likely (Ellison, 2004).

All these techniques have been reported to subjectively result in a significant decrease in upper airway resistance and improvement of breathing. However, although transnasal resistance measurement techniques have been evaluated in dogs (Wiestner et al., 2007), no measurements of the airflow through the nares before and after surgery have been made with any of these techniques to objectively evaluate and compare them. Evidence-based recommendations regarding which technique to favor can therefore not be formulated.

Vestibuloplasty

Vestibuloplasty has been advocated instead of an alaplasty to further improve air flow (Oechtering and Schuenemann, 2010). It involves the dorsomedial and caudal portion of the ala and its transition into the bulbous connection to the alar fold and results in a wide and open vestibule.

Intranasal obstruction

Abnormal configuration of the nasal conchae has been described in brachycephalic dogs (Billen et al., 2006; T.H. Oechtering et al., 2007; Ginn...

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