🔍 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).