Eyes and Ears Flashcards
What are three surgical diseases most commonly associated with the pinna?
Aural hematomas, neoplasias, and lacerations
What is happening with an auricular hematoma?
Blood is bleeding out and collecting within the cartilage plate of the pinna.
How do aural hematomas usually happen?
Excessive shaking and scratching, probably from a otitis externa
What endocrine disease may lead to an aural hematoma?
Cushings - capillary fragility
As a surgeon, what are your goals in treating an aural hematoma?
Remove the blood/clot, prevent reoccurrence, keep the ear’s shape and appearance
What are some indications for surgically treating an ear hematoma?
Chronic occurance, difficult to remove through aspiration, larger than usual
What are some non-surgical methods of treating an aural hematoma?
Aspiration - high chance of reoccurrence
Aspiration with IV Dex- 88% effective
Aspiration with local dex - 93% effective
Aspiration with local pred - 98% effective
What are some surgical methods of treating an aural hematoma?
drain tube, incisional drainage, ear hematoma kit (practivet system)
What are the types of drains used in aural hematomas?
Passive drains - penrose, teat
Active drains - butterfly catheter with suction tube
What is the method of incisional drainage in aural hematomas?
Incision (straight/S-shaped, dermal punch, laser) -> Concave surface -> removal of clot and irrigation -> Multiple mattress sutures
What direction must the sutures be when placing the suture patterns on an aural hematoma?
Vertical/ same direction with the blood vessels
T/F: when bandaging an ear hematoma surgery, you should use a non-adherent bandage on the incision side, and adherent bandage on the opposite side
True
With lacerations on the pinna, if only one skin surface is affected, how would you treat it?
Second intention healing or suture it closed
With lacerations of the pinna, if two skin surfaces or the cartilage is affected, what type of closure must you perform?
Primary closure. Use deep bites to align the cartilage and superficial bites to align the skin
T/F: Squamous cell carcinoma of the ear is not locally invasive, has less bleeding but high metastatic rates compared to other SCC areas.
False. It is locally invasive, bleeds, and has a low metastatic rate
How would you treat SCC of the pinna?
Pinnectomy (maybe even an ear canal ablation)
What are some predisposing factors that can lead to an animal susceptible to otitis externa?
pendulous ears, narrow canals, excessive hair, excessive cerumen, chronic ear moisture, inappropriate abs, polyps/tumors
When is surgery on an animal with otitis externa indicated?
When there have been multiple failed attempts to treat it medically.
What are some surgical procedures for otitis externa?
Lateral and vertical ear canal resections, total ear canal ablation with lateral bulla osteotomy
What are some indications for using a lateral ear canal resection?
Tumor involving the tragus or the lateral wall of vertical canal
What does performing a lateral ear canal resection do for the ear?
It improves ventilation and also decreases the moisture in the ear, where bacteria love to live in
T/F: when suturing a lateral ear canal resection, you suture the the epithelium and cartilage to the skin to close it
True
What are some complications with the lateral ear canal resection?
Inadequate drainage, infection is continued
What breed of dog do you NOT perform this procedure on?
Cocker Spaniels
What does TECA stand for?
Total Ear Canal Ablation
What are some indications for performing this sugery?
Ceruminous gland adenocarcinoma, extensive benign otitis, middle ear disease
If the lateral ear canal resection fails, what surgery would you perform after?
TECA
What are two nerve damage complications that can happen with aural surgeries?
Horner’s syndrome, facial nerve paralysis
How would you diagnose otitis media?
Palpate lymphs nodes, palpate temporomandibular joint, neuro exam, X-rays, CT, MRI
Define myringotomy
A surgical incision into the ear drum to relieve pressure built up inside
How would you medically manage middle ear disease?
Clean the external ear, perform myringotomy, saline, antibiotics
What are the surgeries procedures used to treat otitis media?
Ventral bulla osteotomy (VBO), and Lateral bulla osteotomy (LBO)
T/F: Middle ear polyps are neoplastic
False.
What are some reasons as to why ophthalmic surgical prep is different from the standard preps?
The eyelid skins are more delicate, so alcohol and detergents can damage the cornea and conjunctiva. Also, ocular surfaces, deep conjunctiva and 3rd eyelid have potential pathogens
T/F: You need to lubricate the eye area before clipping the hairs
True
What % iodine solution do you use to clean the eye for surgery?
0.2% (1:50) in saline solution
T/F: There is a special draping procedure used for ophthalmic surgeries
False. Drape normally
What forceps are used for ophthalmic surgeries?
Bishop-Harmon forceps
What needle holders are used for ophthalmic surgeries?
Derf needle holder
What scissors are used for opthalmic surgeries?
Stevens tenotomy scissors
What’s the name of the speculum used for ophthalmic surgeries?
Barraquer eyelid speculum
Besides direct cotton tips and sponges, what are somethings you can use to stop bleeding in the blood?
Cautery, phenylephrine, 1:10,000 epinephrine
What often causes eyelid lacerations?
Trauma
How many layers do you need to close when suturing up an eyelid laceration?
Two.
What suture pattern should you use to close an eyelid laceration?
Figure of 8
How much of the canine eyelid tumor is needed before treating it like a laceration?
1/3 minimum
T/F: Most canine eyelid tumors are benign
True
What cutting pattern do you use to remove a canine eyelid tumor?
H-Shaped resection
What are two methods of eyelid reconstruction?
Single pedicle advancement flap, lip to lid flap (for lower eyelid)
What kind of tumor is most common in feline eyelid tumors?
Squamous cell carcinoma
T/F: The darker the skin on the cat, the more likely it is to have SCC
false. lighter skinned
Which species, dog or cat, more commonly has eyelid agenesis?
Cat
How old must the animal be before performing surgery on the animal with eyelid agenesis?
> 4 months
What surgical procedure do you use to treat eyelid agenesis?
Dziezye Millichamp mucocutaneous pedicle graft
What are some clinical signs of entropion?
Asymptomatic, but irritation, epiphora, corneal erosion/ulceration
T/F: congenital entropion is usually unilateral
False. Bilateral
How old should the dog be to surgically correct entropion?
> 8 months old
What are some predisposed breeds for entropion?
Chow chow, Shar-Pei, Saint Bernard
What is the acquired form of entropion represent?
Lid spasm from an underlying cause.
T/F: Acquired entropion is usually unilateral
True
What are four surgical options to treat entropion?
Eyelid tacking, Hotz Celsus, Modified Hotz Celsus, Arrowhead resection
What is the modified Hotz-Celsus procedure used for specifically?
Medial canthal entropion
What is something you must do in a modified Hotz-Celsus before cutting?
Isolate the lacrimal puncta!
What areas of the eyelid are arrowhead resections for?
Concurrent upper and lower lateral canthal entropion
What are two causes of acquired ectropion?
Contraction of scar tissue and overcorrection of entropion
If needed surgical treatment, what two methods would you use to treat ectropion?
Wedge resection
V-Y blepharoplasty
What is the most common sign with a defect in the nasolacrimal system?
Epiphora
What are so tests to measure nasolacrimal function?
Jones 1 test, flushing, dacryocystorhinography, CT, MRI
What are four diseases of the nasolacrimal system?
Punctal aplasia, micropunctum, trauma/scarring, KCS
How would you test for trauma in the nasolacrimal system?
Bubble test
Inject air into puncta and look for bubbles
How do you treat a tramatic wound on the NLS?
Cannulation of both lacerated sides
What surgical diseases can the nictitating membrane have?
Everting nictitating membrane, prolapsed membrane (cherry eye), neoplasia
How would you treat an everting nictitating membrane?
Surgical excision
What surgical methods can be used to treat a prolapsed nictitating membrane (cherry eye)?
Orbital rim anchoring technique, Morgan pocket technique
How does an anchoring technique for cherry eye work?
Make an incision in the anterior conjuncitva, pass suture through the hole and engage the periosteum, then make a purse string around the gland and tie it off
How does a Morgan Pocket technique work?
Makes parallel incisions in the bulbar conjunctiva, and connects those without fully closing the incision (to let tears drain)
What is the most common neoplasia of the nictitating membrane?
SCC
How would you treat a neoplastic nictitating membrane?
Excise all of it
When would you want to perform an enucleation?
Painful non visual eye
Neoplasia and non-responsive infections
What are the two surgical techniques of enucleation?
Subconjunctival, transpalpebral
How is the subconjunctival enucleation performed?
Lateral canthotomy, excuse eyelid margin and 3rd eyelid, separation of conjunctiva, muscles and tendons, ligate and sever optic nerve
How is the transpalpebral enucleation performed?
Suture eye closed, cut around the palpebral fissure, dissect along the orbital walls and remove entire eye
What is exenteration?
The removal of all viscera in the target organ
What indication is a transpalpebral enucleation performed?
Neoplasia
When should you enucleate a traumatic proptosis?
When 2 or more rectus muscles are ripped, or is the globe is ruptured
How often do traumatic proptosis dogs regain vision?
20%
How would you treat traumatic proptosis?
Temporary tarsorrhaphy for 2-3 weeks
What are some indications for a temporary tarsorrhaphy?
eyelid reconstruction, entropion, lacerations, mass removals, proptosis
