Tonsillectomy and Staphylectomy using 4limb Marclamp
- Abbie Tipler
- 7 hours ago
- 4 min read
A working reference on two of the most frequently performed components of multilevel BOAS surgery — what they treat, how they're done, and what the evidence says about complication risk.
Audience — general & referral practice veterinarians
Scope — palatine tonsils & soft palate, within the wider BOAS airway
Video Content
This video demonstrates how I perform tonsillectomy and staphylectomy in BOAS cases.
Video created at VSS Jindalee as part of our Brachycephalic Care Unit
The Marclamp can be purchased here
Recognising the case that needs surgery
Diagnosis starts with a genuinely thorough history — the airway itself usually cannot be examined in the conscious patient, so owner-reported signs carry the diagnostic weight until the dog is anaesthetised.
I have created a separate blog post that covers how I recommend history taking is performed for airway cases that can be found here.
In short, ensure to ask specifically about:
Waking during sleep, or sleeping in unusual positions to maintain an open airway
Exercise intolerance — inability to sustain activity beyond ~30 minutes and recover within 5 minutes
Coughing (raising suspicion of secondary aspiration),
Regurgitation or other gastrointestinal signs (flatulence)
Noisy breathing, snoring, reverse sneezing
Stridor and stertor
Collapse or cyanosis in severe cases
These signs justify booking the patient for definitive imaging (CT or radiographs) and airway examination under general anaesthesia, with surgery performed accordingly. A functional grading scheme (grade 0, unaffected, through grade 3, severely affected) is a useful common language for staging severity and tracking outcome; grades 2–3 are generally considered to warrant surgical correction.
How I decide:
If there are clinical signs associated with BOAS, or the patient cannot happily exercise for at least 30 minutes and recover quickly (in around 5 minutes, or negligible) then in most cases I am recommending surgical intervention.
If signs are worsening, I am also recommending surgical intervention. Airway disease only goes in one direction - WORSE. Therefore, intervention earlier when the risk is lower, is indicated in most patients.
Tonsillectomy
Removal of the palatine tonsils.
Indications
Always performed as one component of multilevel BOAS surgery rather than a standalone.
Outside the BOAS context, tonsillectomy is also indicated for tonsillitis, tonsillar neoplasia, trauma, or obstructive lesions such as lymphoglandular polyps.
Instrumentation & technique options
The oropharynx is a small, hard-to-visualise working space, so positioning matters: a mouth gag (a spring-loaded or ratcheted gag) holds the jaws open, and a mix of long- and short-handled instruments is needed to reach comfortably. The endotracheal tube cuff is snuggly fitted to avoid blood dripping down the trachea. Alternatively and additionally, the pharynx can be packed with a swab.
Clamping technique combined with brief pulse of bipolar electrocautery
A haemostat is applied across the tonsillar base for around 1-2 minutes. I use metzembaum scissors cranially then use a short burst of bipolar cautery caudally as demonstrated in the video.
Staphylectomy (soft palate resection)
Correction of a primary obstruction, caused by an oversized soft palate.
"Oversized" rather than "elongated"
Oversized is the more accurate descriptor than the traditional elongated, because thickness — not just length — is what drives interference with airflow, swallowing, and the ability to exercise.
Extended palatoplasty / H-palatoplasty
A modification of the free-edge technique that I use, as demonstrated in the video.
Why no Folded flap palatoplasty (FFP) technique for me?
Here, the caudal soft palate is folded rostrally on itself and sutured in place. Hypothetically this is meant to address the length and thickness. I think this is misleading because an appropriately performed staphylectomy does just this by addressing length and thickness (the thick part is resected). My other major concern with folded flap palatoplasty, is the risk of dehiscence, which is high.
References & further reading
Findji L, Dupré G. Folded flap palatoplasty for treatment of elongated soft palates in 55 dogs. Kleintierpraxis 2008.
Holloway A, Higgins R, et al. Split staphylectomy to address soft palate thickness in brachycephalic dogs: 75 cases (2016–2018). J Small Anim Pract 2022.
Fracka M, et al. Risk factors for complicated perioperative recovery in dogs undergoing staphylectomy or folded flap palatoplasty: seventy-six cases (2018–2022). Vet Surg 2024.
Prospective CT-geometry comparison of folded-flap palatoplasty and traditional staphylectomy in French Bulldogs undergoing airway surgery. Vet Surg 2025.
Multi-institutional retrospective comparison of surgical techniques and short-term complication rates in 413 brachycephalic dogs. J Am Vet Med Assoc 2026.
Complications of canine tonsillectomy by clamping technique combined with monopolar electrosurgery — a retrospective study of 39 cases. BMC Vet Res 2022.
Comparative study of a bipolar vessel-sealing device (LigaSure) vs. standard clamp/Parker–Kerr technique for canine tonsillectomy (Belch et al., as cited in the above).
Respiratory obstruction due to tonsillar lymphoglandular polyp in a brachycephalic dog: a case report. BMC Vet Res 2021.
Liu N-C, et al. Functional grading scheme and modified multilevel surgery (alavestibuloplasty, folding flap palatoplasty, partial tonsillectomy, ventriculectomy, partial cuneiformectomy) for BOAS.
Poncet C, et al. Long-term results of upper respiratory syndrome surgery and gastrointestinal tract medical treatment in brachycephalic dogs — cited for the aerodigestive relationship; verify full citation before use in a reference list.
Mayhew PD, et al. Prospective evaluation of the effect of upper airway surgery on gastrointestinal signs in brachycephalic dogs — cited for the aerodigestive relationship; verify full citation before use in a reference list.
Brachycephalic obstructive airway syndrome overview, tonsillectomy technique comparison. Veterian Key (clinical reference chapter).
Comments