Name: 24-04-0236_TTV

Description: 24-04-0236_TTV

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Duration: T00H05M18S

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Upload Date: 2025-01-02T19:35:13.1581000Z

Transcript: Language: EN.
Segment:0 .
My name is Jessica Sun, and today we will be demonstrating how to perform a temporary palatopexy in brachycephalic dogs. This technique can be used in a brachycephalic upper airway crisis as an alternative to prolonged intubation, tracheostomy, or euthanasia. I have no conflicts of interest to disclose. No AI assisted technology was used, and this video has not been funded.
To perform a palatopexy, the patient must be anesthetized or heavily sedated, and is ideally intubated to protect the airway. A sling behind both upper canines can either be held by an assistant or hooked onto fluid poles or other devices for proper positioning. Needle drivers, forceps, suture scissors, and an absorbable monofilament suture in either 2-0 or 3-0 is required.
Here is a video demonstration of the procedure. Once the patient is in position, the needle drivers and forceps are used to identify the leading edge of the soft palate. The needle is pushed through the soft palate going from the ventral aspect to the dorsal aspect, ensuring an adequate bite is taken. The next bite is at the junction of the soft and hard palate. On this patient you can see it is where the pigmented mucosa becomes pink.
The needle should be directed in a dorsal ventral motion. The suture is then tightened to pull the leading edge of the soft palate up to the roof of the mouth. It should not be pulled too tight and the suture should be visible in case they need to be emergently cut or if palatoplasty is pursued at a later date.
The vertical mattress pattern allows the suture not to end up beneath the soft palate to hopefully minimize irritation at the back of the throat. The suture is then cut short. The vertical mattress suture can then be repeated as needed on the other side of the palate, aiming for clear exposure of the trachea when the mouth is held open.
Most patients require between 2 to 5 sutures, depending on their size and how long their soft palate is. If the soft palate is extremely long, sometimes, placing a temporary stay suture can be helpful so that the edge of the soft palate can be clearly identified.
As you can see, there should only be minimal bleeding during the procedure. At the end of the procedure, the airway should be checked to ensure the soft palate is no longer able to occlude the larynx. If so, then additional sutures should be placed.
Here is a before and after picture. As you can see, the soft palate is now tacked to the top of the throat, allowing the endotracheal tube to be easily seen going into the trachea. After the palatopexy is complete, the patient is typically recovered, extubated, and then closely monitored for breathing. Most patients have a marked decrease in stertor and less respiratory effort after palatopexy.

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