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Surgery > Surgery for ear disease > Flashcards

Surgery for ear disease Flashcards

1
Q

external ear =

A

pinna + vertical and horizontal canals

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2
Q

middle ear =

A

tympanic bulla

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3
Q

local blood supply around ear

A
  • caudal auricular br. of external carotid a.
  • maxillary artery: rostroventromedial aspect of horizontal canal near tympanic mb
  • retroglenoid vein: anterior to horizontal canal at external meatus
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4
Q

what nerve innervates the pinna?

A

auriculopalpebral branch of facial nerve

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5
Q

which nerve runs along the dorsal promontory of the tympanic bulla?
CS if it is damaged?

A

Sympathetic nerve -> horner’s

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6
Q

where does the facial nerve exit?

A

stylomastoid foramen to caudal to external meatus

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7
Q

2 types of external ear canal sx

A
  1. vertical ear canal resection

2. total ear canal ablation

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8
Q

middle ear surgery

A

ventral bulla osteotomy

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9
Q

indications for external ear canal sx

A
  • otitis externa
  • neoplasia
  • trauma
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10
Q

most common ear neoplasia in dogs?

A

Ceruminous gland adenoma/adenocarcinoma

–> slow to met, local disease minimally invasive to aggressive

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11
Q

DDx for ceruminous gland adenoma in a dog

A

hyperplastic, ‘inflammatory’ polyps of ceruminous gland

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12
Q

most common ear neoplasia in cats

A

SCC –> locally aggressive –> penetrate ear canal

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13
Q

3 factors to consider for sx of ear neoplasia

A
  1. Diagnosis and stage of disease
  2. Local extent of disease (potential for infiltration disease beyond ear canal)
  3. Location of lesion w/in ear canal
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14
Q

Blunt trauma can result in avulsion of the external ear canal at which points?

A
  1. auricular cartilage at annular cartilage junction (weak membranous connection point)
  2. Entire ex. ear canal at meatus
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15
Q

Preoperative treatment of ears with (???) may reduce inflammation

A

aggressive systemic therapy - ABs, short course of corticosteroids

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16
Q

Indications for vertical ear canal resection

A
  • isolated neoplasia of the proximal vertical canal (no structural changes to horizontal canal - cartilage of the ear becomes good barrier for tumours)
  • traumatic avulsion of vertical ear canal
17
Q

VECR post op considerations

A
  • no bandaging!

- E-collar

18
Q

what are some technical complications to VECR?

A
  • facial nerve palsy, hematoma, granulomas, dehiscence, cellulitis/drainage
19
Q

why are VECR more commonly performed in cats than dogs?

A

Usually the horizontal canal is quite well preserved w/ tumours in cats but dogs tend to get otitis and horizontal canal involvement

20
Q

indications for TECA

A
  • severe end-stage otitis externa
  • neoplasia
  • trauma
21
Q

what changes might you see on CT for a dog with end stage otitis externa?

A
  • extra bone
  • abnormal fluid/soft tissue in ear canal
  • uneven level of bony meatus
22
Q

what must you sample before closing a TECA?

A

culture contents of bulla to know post-op treatments

23
Q

TECA post op care

A
  1. closed-suction drain 24-36hrs w/ bandage over drain
  2. Systemic ABs w/ C&S (3-4wks if osteomyelitis present)
  3. Monitor/treat facial palsy (KCS)
24
Q

early complications of TECA

A
  • facial palsy, cellulitis/drainay, dehiscence, vestibular injury, fistulation, haematoma, fatal haemorrhage
25
Q

what is the risk of facial palsy with TECA?

A

relatively high - 22% but 75% resolve

26
Q

how are cat bullas different from dogs?

A

cats have relatively larger bullae w/ septum diving into dorsomedial and dorsolateral compartments

27
Q

why would you do a myringotomy?

A

to culture contents of middle ear/clean

28
Q

when is a bulla osteotomy indicated?

A
  • alone - if appropriate medical management has failed (middle ear infection)
  • to remove otopharyngeal polyps
  • combined w/ a TECA - confirming disease, addressing concurrent otitis media
29
Q

goal of a bulla osteotomy

A

obtain bacterial and histologic samples + remove epithelial lining and debris

30
Q

which approach to the bulla can be performed as an isolated procedure?

A

the ventral bulla osteotomy - better access with this approach esp. cats

31
Q

describe the ventral approach to a bulla osteotomy

A

between the larynx and angular process of mandibular ramus -> penetration in to the floor of the bulla

32
Q

what structures are at risk during a ventral approach to a bulla osteotomy?

A
  • linguofacial vein

- hypoglossal n

33
Q

complications of ventral bulla osteotomy

A
  • horner’s syndrome (cats)
  • vestibular injury
  • seroma/wound complications
34
Q

what are lateral ear canal resections used for?

A
  • facilitate cleaning + adminstration of topical agents
  • aerate the ear
  • giselle doesn’t like them

Surgery (22 decks)

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