Surgical Diseases of the Ear Flashcards
What are the 3 regions of the ear and what do each consist of?
- External ear (pinna, auditory meatus, and short canal)
- Middle ear (tympanic membrane, auditory tube, and tympanic cavity)
- Inner ear (bony labyrinth, semicircular canals, & auditory ossicles – stapes, incus, malleus)
what is the difference between the canine and feline bulla?
feline has 2 compartments
the ventromedial compartment is larger and cannot be forgotten during procedures!
What are a few of the most important anatomical areas of the pinna that are important for surgical landmarks?
helices
tragus
antitragus
If a patient presents to you with a small laceration on their ear, what is your treatment plan?
suture it closed with a simple interrupted, figure 8, or mattress pattern.
If a patient presents to your clinic with a deep fissure or small mass at or close to the margin of the ear, what is your treatment plan?
partial pinnectomy or wedge excision
If a patient presents to your clinic with a large ear defect, what is your treatment plan?
reconstructive surgery such as a local transposition flap or distant pedicle flap
what is the MOST common injury to the pinna?
aural hematoma – hemorrhage that occurs between the cartilage and the skin secondary to trauma or head-shaking secondary to otitis.
This can hemorrhagic or serosanguinous fluid
What are the 3 treatment options for an aural hematoma?
- drain with intralesional steroid injection (triamcinolone or dexamethasone)
- drain with closed-suction
- surgical drainage + suture placement
what is the concern for injecting steroid into an aural hematoma?
abscess formation due to the glucocorticoids
Describe the method of “drainage with suture” for aural hematoma repair.
incise over the swelling
remove all fluid and fibrin
leave incision open and cut off a ~2 mm strip of tissue (so that it will not heal too fast)
place sutures that oppose all of the layers (skin, cartilage)
you can place stents if necessary.
T/F: you can use a biopsy punch to punch out circles of tissue on the concave side of the ear to repair an aural hematoma
true
in what direction should you place your sutures when repairing an aural hematoma?
parallel to the vasculature
An orange cat presents to your clinic with a raised, erosive lesion along the ear margin. After reviewing the histology, you diagnose this cat with squamous cell carcinoma.
What is your treatment plan?
partial or total pinnectomy +/- ablative procedure, cryosurgery, laser ablation, RT or chemotherapy.
what is the MOST common feline cutaneous neoplasia?
basal cell tumor
what is the 2nd most common feline cutaneous neoplasm?
mast cell tumor
describe the appearance of a sebaceous adenoma
gray/black raised nodule/mass.
FNA results usually determine the surgical plan. But, what do most aural neoplasms require as far as treatment goes?
pinnectomy
When is surgical intervention appropriate for otitis externa?
chronic, end-stage infectious otitis externa in which medical management has failed.
what do radiographs typically show in cases of otitis externa?
what is the limitation of radiography?
external canal stenosis and mineralization
increased soft tissue opacity, thickening, bony lysis, and irregularities of the bullae.
but radiography is not great for looking at internal ear structures/abnormalities.
Lateral ear canal resection (Zepp procedure) is indicated for mildly affected patients with otitis externa. It essentially makes the ear canal no longer “L” shaped by cutting the vertical canal.
What are the goals of the Zepp procedure?
to improve ventilation, reduce secretions, and make cleaning and medication placement easier for the owner.
In what instance would we use the vertical ear canal resection surgery?
this surgery is rare because it is indicated when the vertical ear canal is affected but the horizontal is clear.
what are the indications for a total ear canal ablation?
- pt who is has unresponsive chronic otitis externa and has stenotic canals preventing medication application
- failed previous resections
- neoplasia
What procedure is described by the following:
Make a T incision at the base of the ear.
Dissect around the cartilages of the ear canals to the internal meatus.
Remove tragus + ear canals, but maintain the pinna
Close T incision and place drain
total ear canal ablation
What procedure is usually performed in conjunctive with a TECA and why?
lateral bulla osteotomy to improve the drainage by removing the secretory epithelium. If you did not do this, you would likely get an abscess and/or fistula.
A cat presents to your clinic and the owner reports that he has been having trouble breathing, wont eat, has nasal discharge, has been sneezing and coughing.
You do a physical exam, otoscopic exam, and pharyngeal exam. You already have your diagnosis based on your pharyngeal exam. What is the diagnosis?
feline inflammatory nasopharyngeal polyps
how do you treat feline inflammatory nasopharyngeal polyps?
nasopharyngoscopy + traction removal
A cat presents to your clinic for head shaking. You recently diagnosed this cat with otitis externa that has not resolved with treatment. You perform a CT and diagnose this cat with feline inflammatory bulla polyps.
What is the treatment?
ventral bull osteotomy
this is where the patient is in dorsal recumbency and you go in ventrally. Remove the polyp and the bulla epithelium. Submit these samples to culture and histopathology.
What important structures must you be careful not to damage during a VBO?
linguofacial vein
hypoglossal nerve
facial vein
Leaving behind remnants of polyps is a very common complication of polyp removal.
How do you know you successfully removed the entire polyp?
inspect it post removal, it is comma shaped.
what is the treatment for otitis interna that is refractory to treatment?
VBO
