Chirurgia dróg oddechowych. Syndrom brachycefaliczny – cz. III

Pharyngeal hyperplastic tissues

Tonsillectomy

In brachycephalic dogs, the chronically increased negative pressures and turbulent airflow in the pharynx frequently cause palatine tonsils to be inflammatory and enlarged, and to protrude from their crypts. Their excision has been recommended when they seem to contribute to the pharyngeal obstruction (Singleton, 1962; Harvey and Venker-von Haagan, 1975; Aron and Crowe, 1985). The improvement after tonsillectomy is thought to result from the direct removal of the obstructive tissue, but also from the lateral tension exerted on the soft palate after suture of the tonsillar crypts (Singleton, 1962). As other authors consider it unnecessary, the advantage of tonsillectomy warrants further investigation (Hobson, 1995; Koch et al., 2003; Fasanella, 2011).

Hyperplasia of pharyngeal soft tissues and palatine tonsils is thought to be secondary to the chronic high negative pressures in the pharynx as well as to chronic irritation or inflammation. Similarly to laryngeal diseases (cf. supra), it should be improved when primary obstructive conditions are corrected. However, excision of redundant soft tissues located in the pharynx, especially in its dorsal aspect, has been suggested (Hobson, 1995), although no description of the technique or instrumentation is available in the literature. In our opinion, their specific treatment is therefore rarely necessary.

Tracheostomy

Some authors recommend performing a temporary tracheostomy before surgery to prevent postoperative airway obstruction caused by pharyngeal edema (Hendricks, 1992; Orsher, 1993) or to decrease encumbrance of the pharyngeal area during surgery (Harvey and Venker-von Haagan, 1975). It may not be necessary.The postoperative performance of a temporary tracheostomy has been advocated in the past in 5% to 28% of cases to palliate complications of airway obstruction caused by postoperative pharyngeal or laryngeal edema (Harvey, 1982; Harvey and O’Brien...

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