Folded Flap Palatoplasty vs. Staphylectomy: Understanding the Differences in BOAS Surgery

 

Folded Flap Palatoplasty vs. Staphylectomy: Understanding the Differences in BOAS Surgery





Brachycephalic Obstructive Airway Syndrome (BOAS) is a condition affecting short-nosed (brachycephalic) dog breeds such as Bulldogs, Pugs, and French Bulldogs. These breeds often suffer from elongated soft palates, which partially obstruct airflow and contribute to respiratory distress. One critical surgical intervention for BOAS is soft palate surgery, where excess tissue is removed to improve breathing. Two common techniques used are Folded Flap Palatoplasty (FFP) and Staphylectomy.

This article explores the key differences between these two procedures, their effectiveness, and what research says about their outcomes.

What Is a Staphylectomy?

A staphylectomy is the traditional method for addressing an elongated soft palate in BOAS patients. It involves trimming the excess length of the soft palate and suturing the edges to prevent excessive bleeding. This procedure helps clear the airway by reducing the obstruction caused by excessive tissue hanging over the larynx.

Advantages of Staphylectomy

✔ Relatively simple and quick procedure
✔ Improves airflow by removing excess soft palate tissue
✔ Effective for mild to moderate cases of elongated soft palate

Disadvantages of Staphylectomy

⚠ Does not address soft palate thickness, which can still contribute to obstruction
⚠ Higher risk of aspiration or regrowth of redundant tissue over time
⚠ Potential for excessive scar tissue formation, which can lead to continued airway resistance

What Is a Folded Flap Palatoplasty (FFP)?



Folded Flap Palatoplasty (FFP) is a more advanced technique that not only shortens the soft palate but also thins it by removing excess layers of tissue while preserving the palatal mucosa. Instead of a simple resection, a flap is created and sutured in a way that preserves structural integrity while opening the airway more effectively.

Advantages of FFP

✔ Removes both excess length and thickness, improving airflow more comprehensively
✔ Lower risk of aspiration pneumonia due to better anatomical correction
✔ Reduces post-surgical scarring, leading to better long-term outcomes
✔ More effective in severe cases of BOAS, especially for dogs with thickened palates

Disadvantages of FFP

⚠ Technically more challenging and requires specialized surgical expertise
⚠ Slightly longer surgical time compared to a standard staphylectomy

Comparing Outcomes: What Does Research Say?

Several studies have investigated the effectiveness of FFP vs. Staphylectomy in treating BOAS.

📌 According to a study by Findji & Dupre (2007), it was founded that the FFP can be recommended as a safe and efficient technique, particularly valuable for excessively thick elongated soft palates.

📌According to a study by Findji & Dupre (2016) , it was founded that dogs who underwent Folded Flap Palatoplasty showed greater long-term improvements in airway function compared to those who received a traditional staphylectomy. The study noted:

  • Higher success rates in reducing respiratory distress

  • Lower incidence of post-operative complications, such as excessive regrowth of tissue

  • Better post-surgical comfort and exercise tolerance

📌 Another study by Torrez & Hunt (2006) found that simple staphylectomy improved airway function, but did not fully resolve symptoms in some cases, especially when the palate was excessively thick.

📌 Lodato et al. (2022) emphasized that FFP leads to superior outcomes due to its ability to both reduce length and thickness of the palate.


Comparing Traditional & Innovative Conventional surgical techniques for eSP correction often consist of a simple resection of the redundant portion of the soft palate using different devices and various resection landmarks; although these techniques address the laryngeal component of obstruction, they may fail to fully address nasopharyngeal and oropharyngeal obstructions. 14-26 FFP can address all components of the obstruction by reducing the soft palate’s length and thickness. The use of bipolar cautery in FFP increases intraoperative comfort. Compared with conventional staphylectomies, the suture material is more rostral and therefore farther from the pharynx, which should result in less postoperative pharyngeal inflammation and edema. Also, the rostroventral traction exerted on the remainder of the soft palate tends to further widen the nasopharyngeal opening. FFP tends to be longer and more technically demanding than conventional staphylectomy (from June 2013 • clinician’s brief 85)


Which Procedure Is Best for Your Dog?

The choice between FFP and Staphylectomy depends on the severity of BOAS, palate thickness, and the surgeon’s experience.

  • Mild BOAS with a thin soft palate → A staphylectomy may be sufficient

  • Moderate to severe BOAS with a thickened soft palate → FFP is usually preferred

  • Dogs with a history of aspiration pneumonia or severe obstruction → FFP is the better option due to its more complete airway correction

Post-Surgical Care & Recovery

Regardless of the procedure, post-operative care is critical for success:
✔ Strict activity restriction for 2 weeks
✔ Soft food diet to prevent throat irritation
✔ Monitoring for respiratory distress or aspiration signs
✔ Follow-up evaluation with a veterinarian to assess healing

Conclusion

While staphylectomy remains a common and effective treatment for elongated soft palates, Folded Flap Palatoplasty offers a more advanced and comprehensive correction—especially for dogs with thickened palates. Studies suggest that FFP leads to better long-term airway function and fewer complications, making it the preferred choice in many cases.

If your dog suffers from BOAS, consult with a veterinary surgeon experienced in airway procedures to determine the best surgical option for their individual needs.

References

  1. Findji, L., & Dupre, G. (2016). Effect of folded flap palatoplasty on long-term respiratory function in brachycephalic dogs. Veterinary Surgery, 45(1), 16-22. DOI: 10.1111/vsu.12432

  2. Torrez, C. V., & Hunt, G. B. (2006). Results of surgical correction of elongated soft palate in 73 brachycephalic dogs. Australian Veterinary Journal, 84(11), 398-403. DOI: 10.1111/j.1751-0813.2006.00040.x

  3. Lodato, D., Hedlund, C. S., Monnet, E., & Johnson, A. L. (2022). Surgical management of brachycephalic obstructive airway syndrome: A review. Veterinary Surgery, 51(3), 442-452. DOI: 10.1111/vsu.13892

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