A comparison of harmonic and traditional sharp staphylectomy techniques in 15 brachycephalic dogs

Abstract

Objectives The objective was to compare sharp staphylectomy and staphylectomy using harmonic focus shears, assess surgical time, intraoperative haemorrhage and outcome. Our hypothesis was that harmonic staphylectomy would result in reduced surgical time, decreased intraoperative haemorrhage and greater relative improvement. Materials and Methods Dogs that were presented to Highcroft Veterinary Referrals between July 2020 and September 2021 with brachycephalic obstructive airway syndrome and underwent surgical correction were prospectively enrolled. Surgical technique was randomised, and surgical time, staphylectomy time, intraoperative haemorrhage, hospitalisation and change in patients' Cambridge BOAS Grade at a 14‐day recheck were recorded. Results Fifteen dogs were enrolled: seven dogs underwent sharp and eight underwent harmonic staphylectomy. Nine patients returned for follow‐up, four of seven and five of eight, respectively. Harmonic staphylectomy was associated with less haemorrhage (0 versus 9 cotton buds) and a shorter average staphylectomy time (3 minutes 36 seconds versus 14 minutes 50 seconds). No statistically significant differences were observed in total surgery time, number of nights hospitalised, or change in Cambridge BOAS Grade. An average of 0.68 mm of thermal necrosis was seen at the cut edges of soft palates removed by harmonic staphylectomy. Clinical Significance Harmonic staphylectomy can result in a reduction in staphylectomy time and degree of intraoperative haemorrhage compared to sharp staphylectomy, with no deleterious impact on postoperative recovery or the long‐term outcome of patients.

Evaluation of the addition of adrenaline in a bilateral maxillary nerve block to reduce hemorrhage in dogs undergoing sharp staphylectomy for brachycephalic obstructive airway syndrome. A prospective, randomized study

“…Reduced hemorrhage also prevents unnecessary blood loss, reduces the risk of aspiration of blood and the formation of clots in the nasal cavity prior to other procedures, such as correction of stenotic nares, which is commonly performed following staphylectomy 9,16,18 . The difference in median hemorrhage between the two treatment groups was 6.13 g or 5.78 mL, which the authors deem to be a clinically significant volume.…”

“…An additional risk of excessive hemorrhage is aspiration of blood. 9,11 The surgical field (soft palate, maxilla, and nose) in dogs is innervated by the maxillary nerve, a branch of the trigeminal nerve, which can be blocked peripherally with the application of local anesthetics. 12 Peripheral nerve blocks are often performed in dogs undergoing surgery to reduce the requirement of inhalational anesthetic agents and inhibit the sympathetic response to noxious stimuli.…”

“…The intraoperative complication rate is not well described in the literature; however, hemorrhage can obscure the surgical site and make visualization of the nasopharyngeal mucosa and oropharyngeal mucosa difficult. The bleeding comes from the palatine branches of the ascending pharyngeal artery and palatine muscle, which is thicker and more vascularized in brachycephalic dogs compared with mesocephalic dogs 8–10 . After the palate has been cut with scissors it is oversewn 6,7 .…”

“…Ensuring both the nasal and oral mucosa are included in the suture is essential for hemostasis during and after surgery and for appositional healing. An additional risk of excessive hemorrhage is aspiration of blood 9,11 …”

“…The bleeding comes from the palatine branches of the ascending pharyngeal artery and palatine muscle, which is thicker and more vascularized in brachycephalic dogs compared with mesocephalic dogs. [8][9][10] After the palate has been cut with scissors it is oversewn. 6,7 Ensuring both the nasal and oral mucosa are included in the suture is essential for hemostasis during and after surgery and for appositional healing.…”