Aural Surgery

Aural Surgery

1. Aural haematoma

   • Tx
     • Provide drainage
     • Prevent reccurance
       • Tx underlying otitis
     • Centesis +/- corticosteroids
       • 0.2% dexamethasome
       • 1:10 dilution
       • Small volume
     • Incisional drainage
       • Sigmoid incision
       • Apoositional suture pattern spaced <1cm apart over pinna
       • Usually without stents
       • Penrose drain or teat cannula
   • Aetiology
     • Collection of blood within the cartilage plate
     • Cartilage usually split - originates from the branches of the great auricular artery within cartilage
     • Scratching and head shaking - trauma
     • Often with associated otitis externa

2. Pinnectomy

   • Indications
     • Trauma
     • Neoplasia
       • SCC
       • MCT
       • MM
       • Histiocytoma
     • Necrosis
   • Total pinnectomy
     • Squamous cell carcinoma
     • Good prognosis
     • Complete excision
     • Adequate margins
   • Can perform a repair once it is deemed recurrance is unlikely

3. External ear canal

   • Lateral ear canal resection
     • Aims
       • Improve local environement
       • Facilitate medication
       • Provide direct entry to horizontal ear canal
       • Not curative
     • Indications
       • Mild recurrent otitis axterna
       • Lesions on lateral wall of vertical canal
     • Contraindications
       • Avanced otitis externa
       • Advanced otitis media
     • Zepp procedure
       • Establishes a drain board
         • Limited hair growth at opening
       • Cerumen produced at the base of the canal moves up to the opening
       • Cerumen dries and falls off the drainage board.
     • Procedure
       • 1. Perform skin incision at pre tragic and inter tragic incisure
       • 2. Continue rectangular incision down to expose the auricular cartillage
       • 3 Cut auricular cartilage of vertical canal to horizontal canal opening and fold down to the skin incision border to create the drain board
       • 4. Appose edges of epithelial tissue and skin
   • Total ear canal ablation and lateral bulla osteotomy
     • Indications
       • Chronic otitis externa
       • Recurrent otitis media
       • Failed LECR
       • End stage ear disease
       • Occluded ear canal
       • Para aural abscessation
       • Canal avulsion
       • Neoplasia
     • Otoscopic evaluation
       • Occluded horizontal ear canal
       • Ruptured/Bulging tympanic membrane
     • Clincal evaluation
       • Chronic disease and canal occlusion
     • Imaging
       • Increased bulla opacity
       • Occlude/mineralised ear canal
       • Thickening of the bulla wall
     • Complications
       • intraoperative - retroglenoid haemorrhage
       • Facial nerve damage
         • Exposure conjunctivitis
         • Lose palpebral reflex
         • Drooling
         • Drooping lip and ear
         • Drop food from mouth
       • Vestibular disease
         • Lose balance on one side
         • Nystagmus
         • Positional strabismus
         • Head tilt
         • Vestibular ataxia
       • Horners
       • Deafness
       • Altered ear carriage
       • Para-aural abscess
         • Sinus tract
         • Pain and swelling
         • Leave epithelial lining to middle ear
     • Removal of the ecternal ear canal, exposure of the tympanic cavity
   • Ventral bulla osteotomy
     • Indications
       • Isolated otitis media
         • Common in cats
         • Rare in dogs
       • Management of nasopharyngeal polyps
     • Approach ventrally
       • retract digstricus muscle medially
       • Styloglossal and hypoglossl muscles and n laterally
     • Complications
       • Horners syndrome
       • Vestibular disease
       • Hypoglosal n paralysis

4. Middle Ear polyps

   • Aural or nasopharyngeal mass
     • Benign, fibrous, pedunculated
     • Inflammatory
   • Differentials
     • Chronic otitis media
     • Middle ear neoplasia
     • Nasopharyngeal neoplasia
     • Ear canal neoplasia
   • Dx
     • Middle ear changes
     • Histopath
     • No signs of malignancy
     • Nasopharyngeal mass
   • Management
     • Traction
       • LECR for exposure
       • Coticosteroids
       • 30-50% recur
       • 43% develop horners
     • Bulla osteotomy +/- Total ear canal ablation

5. Cholestastoma

   • Progressive growth
   • Epidermoid cyst lines by keratinised epithelium containing keratin debris