Dr. Ameet Singh joins us on the most recent Veterinary Surgery Podcast, discussing an article about folded flap palatoplasty and traditional staphylectomy techniques published in the Journal of the American Veterinary Medical Association.
Veterinary Medicine Career Discussion
Jolle and Ameet discussed their paths into veterinary medicine, with Ameet explaining how his father’s work as a histology professor at a veterinary college in Canada influenced his decision to become a veterinarian. Ameet shared that he often meets current veterinarians who recognize him from his childhood visits to the college.
French Bulldog Soft Palate Study
Ameet presented findings from a study on soft palate geometry in French bulldogs undergoing airway surgery, reporting positive clinical outcomes when either surgical technique was used with aggressive implementation. Dr. Farrell, who is completing her final residency year, was identified as the lead veterinarian on the paper, with additional contributions from the Davis team led by Phil Mayhew. The study involved two institutions and examined both clinical outcomes and CT geometrical changes in the patients.
French Bulldog with Aortic Arch
Ameet shared that he and his family became French bulldog owners about a year ago, including a dog with a persistent right aortic arch that required surgery. When asked about the decision despite knowing about future surgical costs, Ameet admitted it was a “very weak moment” influenced by recently losing family dogs and a connection to the rescue. Ameet reported that the dog, now 1.5 years old, has been doing well despite living in cold winters and hot humid summers, and hasn’t yet required a BOA surgery.
Surgical Approach Discussion for Palatoplasty
Ameet and Jolle discussed surgical approaches for treating a patient’s condition, focusing on whether to perform folded flap palatoplasty or traditional staphylectomy. Ameet expressed a personal preference for the folded flap method due to its oral cavity finishing and exposure of the nasopharyngeal opening, though he acknowledged that other colleagues successfully use traditional staphylectomy. Ameet noted that the folded flap approach may have slightly more post-operative morbidity due to increased inflammation, and mentioned that Dr. Farrell has conducted follow-up trials on tradiational staphylectomy.
French Bulldog Staphylectomy Study Challenges
Ameet discussed challenges with a clinical study on staphylectomy in French bulldogs, noting difficulty in obtaining owner compliance for the required 3-month post-operative CT scans. Jolle observed that the high p-values in the ETT scores indicated the study would likely produce similar results even with additional patients. Ameet explained the difference between the traditional staphylectomy technique, which involves placing stay sutures at the soft palate tip, and the FPP technique, describing how the FPP approach has evolved to remove more cranial palate tissue toward the tonsillar crypts.
Folded Flap Palatoplasty Technique Discussion
Ameet and Jolle discussed the folded flap palatoplasty (FPP) technique, with Ameet explaining that it involves removing the mucosa and superficial muscle layer of the soft palate while folding it forward and suturing it into place. Ameet emphasized the importance of ensuring the nasopharyngeal opening remains unobstructed and highlighted that the technique is particularly useful in cases with difficult anesthesia. Jolle noted that while the FPP seems more complex than the traditional technique, it can be effective, especially for surgeons familiar with the transitional approach.
Palate Measurement Study Discussion
Ameet and Jolle discussed a study on palate measurement techniques, where Ameet explained that while they measured at three different spots (beginning, middle, and end) before and after surgery, the reviewers correctly pointed out that these points were not identical due to tissue changes during the procedure. Ameet acknowledged this limitation but defended their methodology, noting they did their best to standardize measurements across all dogs in the study. Jolle suggested that another potential issue could be that palate changes might occur over the three-month follow-up period, which was chosen as a compromise between owner convenience and adequate healing time.
Brachycephalic Airway Syndrome Treatments
Jolle and Ameet discussed a study on surgical techniques for brachycephalic airway syndrome in dogs, focusing on palate shortening procedures and other common treatments like alar fold and vestibular modifications. They noted that while most dogs showed improved breathing, about 50% had no change in exercise intolerance, highlighting the importance of setting realistic expectations with owners. Ameet explained that complications were minimal in their study due to strict inclusion criteria, with the most severe being temporary difficulty extubating, which was typically managed with overnight intubation or temporary tracheostomy tubes.
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