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Objective: Surgical correction of stenotic nares, one component of brachycephalic obstructive airway syndrome (BOAS), is not referenced as often in cats as it is in dogs. Similar to dogs, stenotic nares emerge as a significant contributor in the development of BOAS in cats. In this study, we propose that stenotic nares in brachycephalic cats arise from an elongated dorsal lateral nasal cartilage. The aim of this paper is to illustrate a novel surgical technique to alleviate stenosis-associated clinical signs by performing full-thickness bilateral wedge resection of the excessive cartilage., Animals: Seven cats that underwent rhinoplasty with full-thickness bilateral wedge resection along the dorsal lateral nasal cartilage between 2019 and 2022 at Pan-Asia Veterinary Clinic in Taipei, Taiwan., Methods: Clinical data of all cats included in the study were retrospectively reviewed. Surgical procedures were recorded. A full-thickness bilateral wedge resection was made along the dorsal lateral nasal cartilage adjacent to the non-hairy area. The full-thickness wedge resection was then apposed and closed, resulting in the abduction of the wing of the nostrils. Postoperative outcomes were evaluated according to follow-up sessions by the authors, and an owner survey was conducted at least 6 months post-surgery., Results: All cats included in this study had a favourable outcome with no complications reported following surgery. The degree of nostril stenosis was improved, and relapse of clinical signs was not reported. Overall, the quality of life of cats that underwent rhinoplasty was significantly improved., Clinical Relevance: The results support that the innovative procedure described in this study is highly promising and holds great potential in restoring quality of life and halting disease progression of cats with BOAS., (© 2023 The Authors. Veterinary Medicine and Science published by John Wiley & Sons Ltd.)

Objective: To characterize the clinical features of noncardiogenic pulmonary edema (NCPE), etiology, and outcome in dogs and cats. The study also aimed to evaluate associations with mortality., Design: Retrospective study., Setting: University teaching hospital., Animals: Thirty dogs and 1 cat, all client owned., Interventions: None., Measurements and Main Results: Data collected included animal characteristics, clinical history, evaluation of oxygenation, radiographic features, treatments, and outcomes. Causes of NCPE included upper airway obstruction, electrocution, drowning, neurogenic etiology, and unknown. The etiology was known in 21 of 31 cases (68%), while the etiology of the remaining 10 cases (32%) was classified as unknown. The most common cause for NCPE was upper airway obstruction, found in 14 of 31 cases (45%). The majority of thoracic radiographs showed a mixed interstitial-to-alveolar pulmonary pattern with a diffuse distribution (52%). Oxygen therapy was administered to 27 dogs (90%). Furosemide was administered to 12 dogs (40%). The median duration of hospitalization was 48 hours (range: 1-192). Twenty-three animals (74%) survived to discharge. Six dogs were mechanically ventilated, with only 2 of them (33%) surviving to discharge. The requirement for mechanical ventilation was the only parameter associated with mortality (P = 0.03)., Conclusions: NCPE is a heterogenous disease process that is most common in dogs. There are a variety of causes, but upper airway obstruction appears to be the most common. The overall prognosis is good in animals that do not require mechanical ventilation., (© Veterinary Emergency and Critical Care Society 2023.)

Objective: To review various types of noncardiogenic pulmonary edema (NCPE) in cats and dogs., Etiology: NCPE is an abnormal fluid accumulation in the lung interstitium or alveoli that is not caused by cardiogenic causes or fluid overload. It can be due to changes in vascular permeability, hydrostatic pressure in the pulmonary vasculature, or a combination thereof. Possible causes include inflammatory states within the lung or in remote tissues (acute respiratory distress syndrome [ARDS]), airway obstruction (post-obstructive pulmonary edema), neurologic disease such as head trauma or seizures (neurogenic pulmonary edema), electrocution, after re-expansion of a collapsed lung or after drowning., Diagnosis: Diagnosis of NCPE is generally based on history, physical examination, and diagnostic imaging. Radiographic findings suggestive of NCPE are interstitial to alveolar pulmonary opacities in the absence of signs of left-sided congestive heart failure or fluid overload such as cardiomegaly or congested pulmonary veins. Computed tomography and edema fluid analysis may aid in the diagnosis, while some forms of NCPE require additional findings to reach a diagnosis., Therapy: The goal of therapy for all types of NCPE is to preserve tissue oxygenation and reduce the work of breathing. This may be achieved by removing the inciting cause (eg, airway obstruction) and cage rest in mild cases and supplemental oxygen in moderate cases and may require mechanical ventilation in severe cases., Prognosis: Prognosis is generally good for most causes of veterinary NCPE except for ARDS, although data are scarce for some etiologies of NCPE., (© Veterinary Emergency and Critical Care Society 2023.)

A feral, domestic shorthair was evaluated for palliative treatment of a pulmonary mass with secondary pneumonia. Because of the patient's temperament and extent of the mass, tracheobronchoscopy, bronchial stenting, and biopsy were elected, followed by adjuvant radiation therapy. Stent placement across the malignantly obstructed bronchus permitted drainage and recruitment of the infected lung lobe. Uncomplicated radiation therapy, stent extension, and debulking due to tissue ingrowth were subsequently performed. Successful palliation was achieved for 323 days with subsequent progressive pulmonary and liver metastases., (© 2022 by American Animal Hospital Association.)

This article discusses updates in brachycephalic and other upper respiratory surgery of dogs and cats, including schemata for classifying brachycephalic dogs in terms of severity of disease and indications for monitoring and treatment, new characterizations of the primary and secondary components of brachycephalic obstructive airway syndrome (BOAS), and updates to traditional brachycephalic airway surgical procedures as well as novel surgeries to treat BOAS, including laser-assisted turbinectomy, the cardiopulmonary effects of brachycephaly on some feline breeds, epiglottic entrapment and retroversion, and upper airway syndrome in Norwich terriers., Competing Interests: Disclosure The author has no commercial or financial conflicts of interest., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Objectives: Brachycephalic obstructive airway syndrome (BOAS) is a common cause of upper airway obstruction in dogs, but is appreciated less commonly in cats. Of the components of BOAS, stenotic nares appear to play a major role in cats. However, the axial deviation of the alar wing, a common cause of nasal obstruction in dogs, is typically not present. We report a series of brachycephalic cats with a ventral nasal obstruction resulting from redundant skin along the floor of the nares. In these cats, surgical techniques developed for dogs were felt to be suboptimal. Our aim is to describe a novel surgical procedure designed specifically to surgically correct stenotic nares in cats with an obstructive fold of skin ventral to the nostril., Methods: Five brachycephalic cats presenting for clinical signs of stenotic nares underwent surgical repair. In each case, a resection of the skin fold followed by a bilateral single pedicle advancement flap technique was performed. Postoperative outcomes were obtained by contacting owners by telephone., Results: All cats had positive outcomes, resulting in immediate reduction of the nasal fold and opening of the nares. Owners noted resolution of stertor and no episodes of respiratory distress. No surgical complications were reported., Conclusions and Relevance: In brachycephalic cats, the ventral skin fold may be a significant contributor to stenotic nares, unlike dogs. Resection of the skin fold, followed by bilateral single pedicle advancement flaps is a novel technique and appeared to be successful for treating stenotic nares in this series of brachycephalic cats.

A cat that underwent bilateral ventral bulla osteotomy (VBO) for treatment of otitis media and otitis interna secondary to bilateral inflammatory polyps, developed upper airway obstruction (UAO) soon after tracheal extubation. The cat was re-intubated but the UAO did not resolve at the next extubation. Eventually, tracheostomy was performed. Upper airway obstruction is a potential postoperative complication of bilateral VBO in cats.

Three cats showing chronic, intermittent respiratory distress associated with increased noise on inspiration were examined. Head, neck and thoracic radiographs were unremarkable and laboratory findings were within normal ranges. In all three cats direct laryngoscopy revealed bilateral redundant arytenoid mucosa, which collapsed into the supraglottic and glottis airways during inspiration. Temporary tracheostomy and endoscopic diode laser excision of the excessive mucosa resolved symptoms in all three cats. Redundant arytenoid mucosa is a rare condition that may cause signs similar to laryngeal paralysis or laryngeal mass in cats. According to our results, diode laser surgery in association with temporary tracheostomy appears an appropriate mode of therapy., (© 2015 British Small Animal Veterinary Association.)

Upper airway obstruction can be due to a variety of causes in small animal patients and is often life threatening if left untreated. Placement of a temporary tracheostomy tube may be necessary in the most severe cases of upper airway obstruction until definitive therapy can be implemented. This paper discusses the indications, technique for placement, maintenance, and complications associated with temporary tracheostomy in dogs and cats., (© 2013 Elsevier Inc. All rights reserved.)

Upper airway obstruction is a potentially life-threatening problem in cats and for which a noninvasive, sensitive method rapid diagnosis is needed. The purposes of this prospective study were to describe a computed tomography (CT) technique for nonanesthetized cats with upper airway obstruction, CT characteristics of obstructive diseases, and comparisons between CT findings and findings from other diagnostic tests. Ten cats with clinical signs of upper airway obstruction were recruited for the study. Four cats with no clinical signs of upper airway obstruction were recruited as controls. All cats underwent computed tomography imaging without sedation or anesthesia, using a 16-slice helical CT scanner and a previously described transparent positional device. Three-dimensional (3D) internal volume rendering was performed on all CT image sets and 3D external volume rendering was also performed on cats with evidence of mass lesions. Confirmation of upper airway obstruction was based on visual laryngeal examination, endoscopy, fine-needle aspirate, biopsy, or necropsy. Seven cats were diagnosed with intramural upper airway masses, two with laryngotracheitis, and one with laryngeal paralysis. The CT and 3D volume-rendered images identified lesions consistent with upper airway disease in all cats. In cats with mass lesions, CT accurately identified the mass and location. Findings from this study supported the use of CT imaging as an effective technique for diagnosing upper airway obstruction in nonanesthetized cats., (© 2013 Veterinary Radiology & Ultrasound.)

A 2 yr old castrated male cat presented to an emergency referral facility for several episodes of gagging, nonproductive coughing, and increased respiratory effort. He was diagnosed with inspiratory stridor and referred to another emergency referral practice for further diagnostics. Three separate, sedated oral examinations, nasal computed tomography (CT), rhinoscopic biopsies, and tracheoscopy showed no structural causes for the cat's stridor. An endotracheal wash was consistent with feline asthma. Blood work showed a peripheral eosinophilia and exposure to Dirofilaria immitis (D. immitis). The feline asthma was treated with albuterol, fluticasone, dexamethasone sodium phosphate, and terbutaline. Despite aggressive therapy for feline asthma, the cat had several episodes of severe inspiratory respiratory distress and stridor secondary to an upper airway obstruction. After 3 days of hospitalization, a temporary tracheostomy was performed and no further episodes of respiratory distress were noted. The tracheostomy tube was removed 3 days later, and the cat was discharged on the fourth day. At a 14 mo follow-up examination, the client reported no further episodes of respiratory distress, coughing, or gagging. To the authors' knowledge, this is the first report of dynamic upper airway obstruction secondary to feline asthma.

Brachycephalic airway syndrome (BAS) is a group of primary and secondary abnormalities that result in upper airway obstruction. Several of these abnormalities can be addressed medically and/or surgically to improve quality of life. This article reviews potential complications, anesthetic considerations, recovery strategies, and outcomes associated with medical and surgical management of BAS.

A 9-month-old intact female Persian cat presented with recurrent pulmonary edema secondary to an elongated soft palate. Endoscopic evaluation of the pharynx and larynx showed that the elongated soft palate was overlying the epiglottis. Partial resection of the soft palate was performed and the cat showed no further respiratory signs. This report is the first description of elongated soft palate causing airway obstruction in a brachycephalic cat.

Surgery of the upper airway is performed in dogs for the correction of brachycephalic airway syndrome and laryngeal paralysis and for temporary or permanent tracheostomy. Although technically simple to perform, upper airway surgeries can lead to the development of significant postoperative complications. This article reviews complications associated with common surgical conditions of the upper airway. It involves a discussion of brachycephalic airway syndrome and associated respiratory and gastrointestinal complications. It also covers laryngeal paralysis with a focus on unilateral arytenoid lateralization and the complication of aspiration pneumonia. The condition of acquired laryngeal webbing/stenosis and potential treatment options is also discussed. Finally, tracheostomies and associated complications in dogs and cats are reviewed.

Punch resection alaplasty is a previously unreported surgical technique for the management of stenotic nares. Nine dogs underwent the procedure in conjunction with soft palate resection and/or laryngeal sacculectomy. Three dogs and two cats were treated with the novel punch resection alaplasty technique alone. Symmetrical resection was achieved, providing excellent cosmesis. Good to excellent results were achieved in all cases, with owners feeling that their pet's overall well being was improved following surgery.

Objective: To determine clinical outcome of permanent tracheostomy in cats with upper airway obstruction., Design: Retrospective case series., Animals: 21 cats., Procedures: Medical records were reviewed for information on history, signalment, clinical signs, results of preoperative clinicopathologic testing, cause of upper airway obstruction, surgical procedure, postoperative complications, and outcome., Results: Causes of upper airway obstruction included neoplasia (squamous cell carcinoma [n = 6] or malignant lymphoma [2]), inflammatory laryngeal disease (5), laryngeal paralysis (4), trauma (3), and a laryngeal mass of unknown cause (1). Fourteen cats had dyspnea in the immediate postoperative period; dyspnea most often resulted from mucous plugs at the stoma or elsewhere in the respiratory tract. Eleven cats died, including 6 cats that died while hospitalized after surgery and 5 cats that died after discharge; 7 cats were euthanatized, most often because of progression of neoplasia; and 2 were still alive at the time of the study. The remaining cat was lost to follow-up after discharge from the hospital. Overall, median survival time for the 20 cats for which information was available was 20.5 days (range, 1 day to 5 years). Cats that underwent permanent tracheostomy because of inflammatory laryngeal disease were 6.61 times as likely to die as cats that underwent permanent tracheostomy for any other reason., Conclusions and Clinical Relevance: Results indicated that permanent tracheostomy was an uncommon procedure in cats with upper airway obstruction that was associated with high complication and mortality rates.

Continuous positive airway pressure (CPAP) has been is used widely in humans to manage obstructive sleep apnoea syndrome, but it has not been widely used in animals. A brachycephalic cat, with previously undiagnosed laryngeal paralysis, that developed acute upper respiratory tract obstruction on recovery from anaesthesia, is presented. The condition was managed by CPAP, delivered via a facial mask.

This retrospective study reports the presence and incidence of nasal turbinates in the nasopharynx (nasopharyngeal turbinates) in a population of brachycephalic dogs and cats exhibiting signs of upper respiratory disease. Medical records were reviewed for 53 brachycephalic dogs and 10 brachycephalic cats undergoing upper airway endoscopy. Nasopharyngeal turbinates were identified in 21% of brachycephalic animals, including 21% of dogs and 20% of cats. Pugs accounted for 32% of all dogs in the study population and 82% of dogs with nasopharyngeal turbinates. The presence of nasopharyngeal turbinates may play a role in upper airway obstruction in the brachycephalic airway syndrome.

Tracheostomies can be used to provide a patent airway in animals with upper airway obstruction but have been reported to be more difficult to manage in cats than in other animals. The purpose of this study is to retrospectively describe the indications, complications and outcome of cats undergoing tracheostomy. Twenty-three cats underwent tracheostomy for laryngeal mass (n=13), trauma (n=5) and upper airway swelling (n=5). Major and minor complications were recorded in 10 and 17 cats, respectively. Seventeen cats were discharged to home, four cats were euthanased and two cats died in hospital. Complications with stoma healing were reported in one cat. Of seven cats discharged with a permanent tracheostomy, one cat is alive and six cats survived at home for between 2 and 281 days. Although complications are common, temporary tracheostomies can be beneficial for conditions in which the underlying cause can be treated. Despite risk of occlusion, permanent tracheostomies can be effective palliative procedures for cats with severe upper airway disease.

The advent of pulmonary function testing in small animals has opened the door to new interpretations of old diseases. This article reviews the salient features of airway pathophysiology in dogs and cats that relate to the interpretation of newly developed airway function tests.

The objective of this study was to describe a standardised and non-invasive method for exhaled breath condensate (EBC) collection in cats and to test whether determination of hydrogen peroxide (H(2)O(2)) in EBC might be used as marker of lower airway inflammation. The technique of barometric whole body plethysmography for cats was combined with a system to condense the effluent air from the plethysmograph, allowing simultaneous EBC collection and respiratory pattern measurement. H(2)O(2) was determined spectrophotometrically. Eighteen experimental cats were used to investigate the impact on EBC volume and EBC H(2)O(2) of plethysmograph ventilation rate, collection duration, sample stability, within-day and day-to-day variability. After determination of a standardised EBC collection procedure, correlation analyses between EBC H(2)O(2) and bronchoalveolar lavage (BAL) cytology of healthy and allergen-challenged Ascaris suum (AS)-sensitised cats were performed. A significant and positive correlation between EBC H(2)O(2) and bronchoalveolar lavage (BAL) neutrophil% was found in healthy cats (P < 0.001, r = 0.55), whereas in AS-sensitised cats, correlation with BAL eosinophil% was significant (P < 0.005, r = 0.61). H(2)O(2) was increased after an allergen challenge in AS-sensitised cats (n = 6, 0.56+/-0.12 versus 1.08+/-0.35 micromol/L, P < 0.05). This study proposes a non-invasive, well tolerated and repeatable method of EBC collection for cats and suggests that EBC H(2)O(2) might be used as non-invasive biomarker for monitoring lower airway inflammation.

A novel endoscopic approach for the removal of nasal polyps from a cat with upper respiratory obstruction is described. The cat's small oral cavity prevented polyp removal via traditional nasopharyngoscopy and the owner declined rhinotomy because of concerns about postoperative morbidity. Access to the nasopharynx was achieved by introducing an endoscope via gastrotomy and passing the instrument orad through the esophagus into the nasopharynx. Compared with traditional endoscopic approaches, this approach provided superior exposure of the nasopharynx and facilitated use of a larger scope and instruments than would have been possible using retroflexed nasopharyngoscopy. Multiple polyps were readily removed using this approach. The procedure was well tolerated, with minimal surgical morbidity.

Objective: To determine clinical signs, physical examination findings, radiographic features, and concurrent diseases in cats with laryngeal paralysis, as well as evaluate the outcome of medical or surgical management., Design: Retrospective study., Animals: 16 cats., Procedure: Medical records from January 1990 to April 1999 were examined for cats with laryngeal paralysis. Signalment, clinical signs, physical examination findings, cervical and thoracic radiographic findings, laryngeal examination results, and clinical outcome were reviewed., Results: No breed or sex predilection was identified in 16 cats with laryngeal paralysis. The most common clinical signs included tachypnea or dyspnea, dysphagia, weight loss, change in vocalization, coughing, and lethargy. Clinical signs were evident for a median of 245 days. Airway obstruction was apparent on cervical and thoracic radiographic views in 9 cats. Examination of the larynx revealed bilateral laryngeal paralysis in 12 cats and unilateral laryngeal paralysis in 4 cats. The 4 cats with unilateral disease were managed with medical treatment, and 3 of these had acceptable long-term outcomes. Seven of 12 cats with bilateral paralysis underwent surgery; procedures performed included left arytenoid tie back, bilateral arytenoid tie back and ventriculo-cordectomy, and partial left arytenoidectomy. One cat was euthanatized as a result of complications from surgery., Conclusions and Clinical Relevance: Laryngeal paralysis is an uncommon cause of airway obstruction in cats. Cats with less severe clinical signs (often with unilateral paralysis) may be successfully managed with medical treatment, whereas cats with severe airway obstruction (often with bilateral paralysis) may benefit from surgical intervention.

The results of clinical and pulmonary functional evaluation of 24 cats with bronchopulmonary disease and 15 healthy cats are presented. Affected cats had historical evidence of excessive reflexes (coughing, sneezing); physical evidence of airway secretions (crackles), obstruction (wheezing), and increased tracheal sensitivity; radiographic evidence of bronchial and interstitial lung disease; and cytological evidence of airway inflammation or mucous secretions. Bacterial isolates from healthy and affected cats were predominantly Gram-negative rods, indicating that bronchi of cats are not always sterile and that normal flora should be considered in interpreting cultures from cats with suspected bronchopulmonary disease. Cats were grouped according to relative disease severity based on scored historical, physical, and radiographic abnormalities. The mean (+/- standard deviation) baseline lung resistance measurement in healthy cats was 28.9 cm H2O/L/s (+/- 6.2 cm H2O/L/s), whereas in mildly, moderately, and severely affected cats it was 38.3 cm H2O/L/s (+/- 21.5 cm H2O/L/s), 44.8 cmH2O/L/s (+/- 7.7 cm H2O/L/s), and 105.2 cm H2O/L/s (+/- 66.9 cm H2O/L/s), respectively. In healthy cats, dynamic lung compliance was 19.8 (+/- 7.4), whereas in mildly, moderately, and severely affected cats it was 14.7 mL/cm H2O (+/- 3.8 mL/cm H2O), 17.7 mL/cm H2O (+/- 6.9 mL/cm H2O), and 13.0 mL/cm H2O (+/- 7.9 mL/cm H2O), respectively. Thus, airway obstruction was present in many of the affected cats. Based on acute response to the bronchodilator, terbutaline, airway obstruction was partially reversible in many affected cats, although the degree of reversibility varied. Furthermore, based on bronchoprovocation testing, 6 (of 7) affected cats evaluated also had increased airway responsiveness to aerosolized methacholine.

Intermittent positive-pressure ventilation (PPV) is an invasive means of respiratory support that is indicated in animals with central and peripheral neuromuscular disease, as well as in those with primary disorders of the lung parenchyma. We reviewed the medical records of 34 dogs and 7 cats treated with PPV. The animals could be allotted to 2 groups; group 1 (21/41) had primary failure of ventilation attributable to neuromuscular disease or airway obstruction, and group 2 (20/41) had primary pulmonary parenchymal disease. Mean inspiratory time was 1.02 +/- 0.2 seconds (range, 0.6 to 1.5 seconds). Mean inspiratory flow was 26.9 +/- 18.5 L/min (range, 7 to 87 L/min), and was positively correlated with body weight (R = 0.57). Mean set respiratory rate was 19.6 +/- 10 breaths/min (range, 5 to 60 breaths/min), with mean tidal volume of 15.5 +/- 6.2 ml/kg of body weight. Positive end-expiratory pressure (PEEP) was required in 14 of 20 dogs in group 2. Mean peak airway pressure in group 1 was 21.6 +/- 6.3 cm of H2O, whereas in group 2 it was 32.9 +/- 12.5 cm of H2O. The higher peak airway pressure in group-2 dogs reflected poor lung compliance and the use of PEEP in dogs with parenchymal lung disease. Mean duration of PPV was 28.2 +/- 29.4 hours (range, 2 to 137 hours). The overall survival rate was 39% (16/41).(ABSTRACT TRUNCATED AT 250 WORDS)

Tracheal obstruction was suspected in a 1-year-old female domestic shorthair cat. Clinical signs consisted of inspiratory and expiratory dyspnea and cyanosis. The cat did not improve when treated with oxygen, epinephrine, prednisolone sodium succinate, and aminophylline. Bronchoscopy revealed obstruction of the trachea and carina by a 2.5-cm twig and needles from a Douglas fir tree. Needles had migrated into distal airways. The cat was euthanatized at the owner's request.

Tracheostomies are performed to bypass life-threatening obstructions of the upper airway or to facilitate surgical procedures in the head and neck region. Neither tube tracheostomy nor permanent tracheostomy is a cure for any particular disease; however, both can be important for patients' supportive or palliative care. Perioperative problems are anticipated with either tube tracheostomy or permanent tracheostomy. Obstruction of the tube or stoma is the most common and devastating problem. Careful and diligent management of tracheostomy patients can circumvent many problems and allow the patient to breath with less difficulty.

This article presents an overview of the clinical features of upper airway obstructive disorders. It includes more detailed discussions of certain common conditions such as brachycephalic airway syndrome, laryngeal paralysis, and upper airway obstruction due to trauma, foreign bodies, extraluminal masses, and tumours of the larynx and trachea.