Lecture 17 4/3/25 STAR SLIDES Flashcards
What are the characteristics of aural hematoma?
-occur with trauma to ear, including scratching, repetitive head shaking, and head rubbing
-should consider allergic or atopic dz
-nearly all cases have evidence of otitis externa
-perform otoscopic and dermatologic exam
-treat underlying disease or recurrence
What are the steps to conservative aural hematoma management?
*drain fluid and flush cavity
-use large gauge needle or stab incision
*corticosteroids
-daily dexamethasone inj., weekly methylprednisolone inj., or tapering dose of oral pred.
What is the prognosis for conservative aural hematoma treatment?
-90% resolution
-drainage alone results in 100% recurrence
What are the surgical management options for aural hematoma?
*teat cannula drain
-drain placed through stab incision into pocket
*active suction drain
-cut off adaptor and make small fenestrations into tubing
-attach to red top tube
*incision of hematoma with vertical mattress sutures to compress cavity
-heals in 3 to 4 weeks
-vertical sutures conserves blood supply
Which incision types can be used when incising a hematoma and placing mattress sutures?
-one long incision
-multiple small incisions made w/ skin punch
-multiple small incisions made w/ laser
What are the characteristics of pinna neoplasia?
-squamous cell carcinoma is most common, esp. in light colored cats
-very locally aggressive
-low rate of metastasis
-main treatment option involves amputation of pinaa 1 to 2 cm beyond gross dz
-other treatments include cryosurgery, laser ablation, chemo, and photodynamic therapy
-should be a differential for any erosive or ulcerative lesion on the ear of light colored cats
What is a partial pinnectomy?
removal of pinna tumor via local excision
Where on the ear is the most skin available for reconstruction following surgery?
base of ear
What are the characteristics of the skin on the internal pinna surface?
-does not appose well; causes folds
-second intention healing best for small masses
-masses on pinna edge have better chance of skin stretching over cartilage
What are the characteristics of feline polyps?
-benign masses from middle ear
-can extend into ear canal or down eustachian tube into nasopharynx
-etiology may be related to URI
-common in young adult cats
What are the clinical signs of feline polyps?
-otitis externa
-otitis media/interna
-nasopharyngeal obstruction
What are the characteristics of feline polyp treatment?
-want to ID polyp in ear canal or nasopharynx, grasp at base, and remove with slow steady traction
-prescribe oral prednisolone at tapering dose for 4 weeks to prevent recurrence
-less than 10% recurrence with pred; 17-50% chance of recurrence without pred
-complications include Horner’s or otitis interna
-may need CT to determine extent with recurrence
-recurrence may require VBO to treat
What are the indications for lateral ear canal resection?
-canal stenosis
-small masses on lateral aspect of vertical canal
What are the characteristics of lateral ear canal resection?
-will not fix any inflammatory condition
-recurrence and infection rates are high if otitis is present
-not recommended for most ear canal diseases
What is the prognosis for lateral ear canal resection?
-good to excellent results in about 50-65% of cases
-dehiscence occurs in around 27% of cases
-procedure can fail due to persistent ear disease
What are the characteristics of vertical ear canal resection?
-indications include vertical canal masses and stenosis
-results are excellent in 72% of cases and improved in 24% of cases
What are the steps to a vertical ear canal resection?
-make a T-shaped incision
-dissect around vertical ear canal
-expose vertical canal and then transect
-with remaining canal, cut into two flaps and sew dorsal and ventral to skin
-result is a new opening into horizontal canal
What are the indications for total ear canal ablation with lateral bulla osteotomy (TECA-LBO)?
-end stage ear disease
-tumors
What are the characteristics of TECA-LBO?
-TECA must be accompanied by bulla osteotomy to drain fluid produced by bulla epithelium
-bulla is located at caudoventral aspect of osseous canal
-referral procedure; difficult with lots of potential complications
-lots of arteries, nerves, and veins around the surgical site
What is the prognosis for TECA-LBO?
-considered excellent in 58% of cases and good in 33%
-hearing is usually unchanged from pre-op status
What are the potential complications of TECA-LBO?
-infection and drainage
-dehiscence
-facial neuropraxia
-facial nerve paralysis
-draining tracts
-inner ear damage
-pinna necrosis
-resp. obstruction
What are the indications for a ventral bulla osteotomy (VBO)?
-otitis media (ONLY)
-nasopharyngeal polyps
What are the characteristics of VBO?
-dogs are much harder to palpate and approach than cats
-cats have a larger bulla that is easier to palpate
-cats have in inner septum in the bulla that must be perforated
-sympathetic nerve fibers can easily be damaged in cats
-will NOT resolve otitis media if it is secondary to ongoing otitis externa
What are the potential complications of VBO?
-hearing loss
-Horner’s syndrome
-vestibular signs
-hemorrhage from internal carotid
