Surgery of the Ear - DAH

Question 1

An aural hematoma is

Answer 1

A collection of blood between the cartilage plate and skin of the ear

Question 2

Aural hematoma occurs commonly in which animals?

Answer 2

Dogs and cats

Question 3

Aural hematoma is characterized by

Answer 3

Fluctuant, fluid filled swelling on the concave surface of the pinna (a portion or the entire concave surface may be involved)

Question 4

Cause/risk factors of an aural hematoma

Answer 4

Unknown

May be due to head shaking or scratching at the ear due to irritation or pain

Question 5

How does head shaking lead to an aural hematoma

Answer 5

Cartilage fracture and rupture of ear vessels, resulting in bleeding

Question 6

Aural hematoma signalment includes

Answer 6

Dogs and cats with otitis externa are at an increased risk of developing this

Question 7

Animals with an aural hematoma have a history of

Answer 7

Violent head shaking or acute or chronic otitis externa. Some animals may have no history of previous ear disease

Question 8

Physical exam findings for animals with an aural hematoma includes

Answer 8

An fluid filled, soft and fluctuant hematoma initially. Which later may become firm and thickened, giving the ear a cauliflower appearance

Question 9

Radiography/CT of skull of animals with aural hematoma may show evidence of what?

Answer 9

Middle ear involvement

Question 10

How is an aural hematoma treated medically?

Answer 10

1) Treatment of underlying disease

2) Aspirate the hematoma using a needle. The hematoma usually recurs after aspiration

Question 11

What is the surgical treatment for aural hematoma

Answer 11

Removal/drainage of the hematoma is the treatment of choice

Question 12

What are the objectives of surgical treatment of aural hematomas

Answer 12

To remove the hematoma, prevent recurrence and preserve the cosmetic appearance of the pinna

Question 13

Surgical treatment of aural hematomas are done within a few days of hematoma appearance. Why?

Answer 13

To avoid enlargement and fibrosis

Question 14

What are the 3 surgical techniques used to treat aural hematomas

Answer 14

1) Removal and drainage by incision using scapel or laser
2) Needle aspiration and drainage via a teat cannula
3) Use of two stab incisions and a latex drain

Question 15

Outline the steps (10) involved in removal and drainage of aural hematoma by incision using scapel or laser

Answer 15

1) Make an s-shaped incision on the concave surface of the ear in a longitudinal direction to expose the hematoma from end to end
2) Remove the fibrin clot & irrigate the cavity
3) Place 1-cm-long sutures through the skin on the concave surface of the ear and underlying cartilage
4) The skin on the convex side of the ear may or may not be included into the sutures
5) Place the sutures parallel to the major ear vessels
6) Place enough sutures in order to eliminate pockets & prevent fluid accumulation
7) Do not ligate branches of the great auricular artery seen on the convex surface of the ear
8) Allow the incision to gape slightly for continued drainage
9) Place a light protective bandage over the ear & support the ear over the head
10) Remove sutures & bandage in 10-14 days

Question 16

Needle aspiration and drainage via a teat cannula for an aural hematoma is indicated when

Answer 16

There is minimal fibrin present

Question 17

Outline the steps (4) involved in removal and drainage of an aural hematoma by needle aspiration and drainage via teat cannula

Answer 17

1) Trim half of the collar of the teat cannula to allow it rest comfortably against the ear
2) Aspirate the contents of the hematoma using a large needle (14G or 16G) inserted into the hematoma at its most distal margin
3) Insert the cannula through the needle hole and suture it to the ear
4) Do not bandage or support the ear over the top of the head

Question 18

What other method could be used in the removal and drainage of an aural hematoma in replacement for needle aspiration

Answer 18

A 1/4 inch fenestrated latex drain can be used instead of a teat cannula

Question 19

Outline the steps ( 4) used in the removal of aural hematomas using two stab incisions and a latex drain

Answer 19

1) Make a stab incision at the proximal & distal limits of the hematoma
2) Empty the hematoma of fluid and fibrin & use a mosquito or alligator forceps to bring the drain into the hematoma cavity
3) Suture the ends of the drain to the skin where they protrude from the cavity
4) Place a light bandage over the ear