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Ear surgery
Fichas del conjunto (44)
- 1What are the names of the 3 pieces of cartilage that make the external ear?- Auricular cartilage
- Annular cartilage
- Scutiform cartilage - 2Where does the opening for the external ear canal sit?Between the Tragus and the antihelix
- 3How many tympanic cavities does the dog have?1
- 4How many chambers are there to the tympanic cavity in the cat?2
- 5Where is the opening to the auditory tube?Within the tympanic cavity
- 6Give 5 indications for ear surgery.- Auricular haematoma
- Neoplasia
- Otitis externa or media
- Trauma/ avulsion
- Para-aural abscess- infection - 7What is seen with auricular haematoma?- Usually secondary to scratching or shaking
- Warm fluctuant non painful swelling on inner surface of the ear
- Left untreated the haematoma will slowly resorb and fibrose leading to potential disfigurement and irritation - 8What are the potential neoplasms (more common) of the ear?- SCC (pre-cancerous lesions: actinic keratosis) on the pinna or ear canal
- Haemangioma/ haemangiosarcoma
- Basal cell tumours
- Mast cell tumours
- Histiocytoma/ adenoma (benign)
- Ceruminous adenocarcinoma (external ear canal) - 9What is ceruminous gland hyperplasia?- Not neoplastic
- Needs biopsy to confirm but very typical appearance
- Very dark brown lesion within the ear (canal or pinnae)
- Multiple lesions - 10What are features of otitis externa-media?- Very common
- Primary causes perpetuated by secondary factors
- Tympanic membrane perforation can lead to progression to otitis media - 11When is surgery indicated for otitis externa-media?When medical treatment fails
- 12What can happen with trauma/avulsion?- Fights, road traffic accidnt and sadistic acts
- Avulsion between auricular and annular cartilage or at the level of the external acoustic meatus
- Fluid, cerumen and debris will accumulate in the proximal portion of the ear canal
- Potential infection -> pain, head tilt and irritiation - 13What is seen with para-aural absecess- infection?- Extension of ear infection
- Incomplete removal of the epithelial lining of the external ear canal/ bulla during a TECA-LBO (<10%) - 14How would you do surgery on the pinna to treat a pinna laceration?- Vertical mattress
- Figure of 8 suture
- Include all tissue (cartilage included) if damaged - 15How else can you perform surgery on the pinna?- Total or Partical resection of the pinna
- Local skin flaps : can be used to repair defect of the lateral aspect pinna - 16What surgery is done for an aural haematoma?- Drained via an elliptical/ sigmoid incision made in the center of the concave aspect of the pinna
- Alternative: use haemostatic sponges as mattress and suture them on concave aspect of the ear - 17What is important about the sutures for an aural haematoma?- Full or partial thickness are placed parallel to the long axis of the pinna
- 18What should be considered being placed after surgery for an aural haematoma?Bandage to maintain the ear in place - some dogs will hate having it done
- 19What is sometimes done instead of operating on an aural haematoma?- Needle drainage and the use of local steroids
- BUT recurrence is very likely - 20What is another name for lateral wall resection?Zepp procedure
- 21What are the indications for the Zepp procedure?- Treatment of benign or malignant mass lesions located near or at the level of the lateral part of the vertical portion of the ear canal
- NOT an indication for treatment of otitis externa - 22What is the technique for the Zepp procedure?- Lateral portion is resected with scissors
- Horizontal canal opening identified
- Simple interrupted suture between cartilage and skin - 23What does TECA stand for?Total ear canal ablation
- 24What is TECA used for?- Performed to treat chronic ear disease not amenable to medical treatment
- 25What is always associated with TECA?Ostectomy of the tympanic ostium (and/or bulla depending on the degree of involvement)
- Recurrence and fistulae if not - 26What is done in a lateral ostectomy of the tympanic bulla (LBO)?- Procedure that follows a TECA (dogs)
- Never performed alone
- Preferred approach to the bulla in dogs
- Cats: ventral approach - 27What are complications of TECA/LBO?- Facial nerve injury
- Haemorrhage from retroarticular vein
- Vestibular signs: inadvertent damage to the round window
- Wound dehiscence
- Chronic sinus tract development (para-aural abscess)
- Ear carriage
- Deafness? - 28What is seen with para-aural abscess/ fistula?- Pain around head
- Pain on opening mouth/ reluctance to eat
- Head tilt
- Lethargy
- Swelling/ draining sinus over surgical site
- Usually 3 to 9 months post-op (up to 3 years) - 29What is the pathophysiology with para-aural abscess/fistula?- Inadequate debridement of middle ear
- Failure to remove all ear canal cartilage
- Osteomyelitis
- Parotid gland damage
- Can happen with cholesteatoma - 30What are the differentials with para-aural abscess?- Migrating foreign body
- Neoplasms - 31How to you diagnose para-aural abscess?CT and contrast
MRI (if neuro signs) - 32What is the treatment for para-aural abscess?- Medical: antibiotic therapy
- Surgical:
1. Lateral approach: if remnant of ear canal, lesion lateral to bulla
2. Ventral approach: if confined to bulla or ventral to it - 33What is the outcome of treatment with para-aural abscess?- Medical = 10-20% success/ may need to be repeated
- Surgical: 70% success but potential complications (facial nerve paralysis. otitis interna, head tilt) - 34What is the prognosis for chronic otitis externa or trauma with TECA/LBO?Good
- 35What is the prognosis for neoplasia with TECA/LBO?- Ceruminous galnd adenocarcinomas: good local control and longterm remission
- SCC: much more guarded prognosis. Very poorly responsive to radiation therapy - 36What is a cholesteatoma?- Epidermic cyst growing in tympanic bulla
- Primary or secondary to otitis externa/media
- Expansive lesion at th level of the bulla
- Neuro signs sometimes present - 37How can you treat cholesteatoma?- Surgical (wide resection)
- Medical (antibiotic long term treatment) - 38What is a ventral bulla osteotomy (VBO)?- Used for removing ear polyps in cats
- Dogs = limited use
- Dorsal recumbency with the neck extended and a sandbag placed under the neck
- Staged procedure if both ears affected - 39What can be used to see if a VBO is needed?Radiographs and CT scan
- 40How is a VBO done?- Ventral incision in upper neck region
- Open both chambers of the bulla
- Cleaning and flushing - 41What are the possible complications of VBO?- Horner syndrome
- Vestibular disturbances
- Polyp regrowth
- Haemorrhage
- Wound drainage
- Damage to auditory ossicles
- Hypoglossal nerve/ facial nerve paralysis or damage (RARE) - 42What is Primary Secretory Otitis media?PSOM or 'Glue ear'
- Fluid in the middle ear incidentally (dogs)
- Moderate to severe pain localised to head or cervical area - 43What is the issue with PSOM?Don't really know why it's caused and also how to treat it (VBO/TECA = don't treat cause)
- Imaging is helping to emerge the diagnosis - 44What is a potential treatment for PSOM?Tympanostomy tube (Grommet) placement
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- (SA ear and pinna surgery - Guillaume Chanoit) 4. Dermatology & Ophthalmology Fichas sobre Ear surgery, creado por Rachael Jones el 07/10/2018.
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- Rachael Jones
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