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AAA Fall 2024 > Surgical Diseases of the Ear > Flashcards

Surgical Diseases of the Ear Flashcards

1
Q

ID

A
  1. Medial border of helix
  2. Apex
  3. Lateral border of helix
  4. Scapha
  5. Antihelix
  6. Antitragus
  7. Tragus
  8. Intertragic Incisure
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1
Q

What nerves supply motor vs. sensory to external ear?

A

Motor = facial (CN7)
Sensory = vagus (CN10)

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2
Q

Arterial supply to ear canal

A

Great auricular artery- branch off external carotid

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3
Q

Pinna

Your feline patients got into a scuffle with its other housemate cat and suffered lacerations to its pinna. How would you treat this wound?

A
  1. Anesthetize cat and clean/prepare wound for cutaneous sx
  2. Suture the skin only via simple interrupted appositional sutures
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4
Q

Pinna

How would you treat a small mass wound that is close to the margins of the lateral border of the helix?

A

Via wedge excision or partial pinnectomy

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5
Q

Pinna

Describe drainage with close-suction active drain for auricular hematoma tx

A
  1. Remove a butterfly catheter’s adapter end and create small fenestrations into tube’s free end
  2. Insert free end into hematoma via stab inision and suture into place via purse-string and fingertrap suture
  3. Poke needle into vacuum blood tube to create constant suction
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6
Q

Pinna

Describe incisional drainage for auricular hematoma tx

A
  1. Incise all over swelling
  2. Remove any clots & fibrin
  3. Place staggering parallel rows of full-thickness (skin, cartilage, skin) interrupted mattress sutures over entire abnormal region of the pinna, PARALLEL to the vascular supply

PARALLEL b/c pinnal necrosis can ensue if vasculature is occluded

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7
Q

Pinna

What drug can you inject into an auricular hematoma cavity following drainage?

A

Methylprednisolone (0.5-1.0cc)

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8
Q

Pinna

Why is it imperative to bandage a dog’s ear after hematoma drainage?

A

Bandage compresses pinna against auricluar cartilage to prevent further trauma from shaking and head-shaking

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9
Q

Pinna

Raised or erosive painful lesion that is locally invasive into the auricular cartilage

A

Squamous Cell Carcinoma - cats > dogs

Cats w/ SCC present w/ bleeding, cracked, non-healing wounds of the ear margins
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10
Q

Pinna

How can SCC be treated (3)?

A

Options:
1. Partial pinnectomy
2. Total pinnectomy
3. Pinnectomy + vertical canal ablation when lesions are extensive

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11
Q

Pinna

UVB-induced neoplasia of the pinna

A

Hemangioma and hemangiosarcoma
- most common in light-colored cats

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12
Q

Pinna

Prognosis for hemangiosarcoma tx in cats?

A

Surgical excision median disease-free interval = 9.5mo

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13
Q

Pinna

Most common feline cutaneous neoplasm
- what does the lesion look like?
- Tx?

A

Basal Cell Tumors
- small, slow-growing, well-demarcated
- raised, white-to-hyperpigmented nodules
- Surgical excision is usually curative

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14
Q

Pinna

2nd most commonly dx cutaneous tumor in cats

A

Mast Cell Tumors
- those involving the pinna account for 59% of all MCTs arising in head region
- benign, well-circumscribed, discrete lesions

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15
Q

Pinna

How are MCTs treated?

A

Wide incisions needed to cure: 2cm margins (one fascial plane deep)
- Pinna: longitudinal pinnectomy (peripheral mass) or total pinnectomy (central mass)

16
Q

External ear canal

When is surgical intervention indicated for otitis externa/media?

A

Chronic, end-stage infections that have failed medical therapies

Normal ears: Staphylococcus, Pseudomonas, Streptococcus, Proteus spp.

Pathologic populations: S. intermedius or pseudintermedius, P. aeruginoas, Proteus mirablilis, E. coli, Cornyebacterium spp., Entercoccus spp., and Streptococcus spp.

Yeast infection: overpopulation of commensal Malassezia pachydermatis

17
Q

External ear canal

Otoscopic findings in otitis externa?

A

Proliferative changes in epithelial lining of ear canal
- hyperkeratinization
- hyperplasia of sebaceous and ceruminous glands
- infiltration w/ inflammatory cells -> stenotic canals, fibrosis, mineralization -> occlusion

18
Q

External ear canal

Why is imaging of tympanic bulla important in otitis externa evaluation?

A

To evaluate for tympanic membrane rupture, a common sequela to severe otitis externa that will progress to otitis media and interna if untreated

19
Q

External ear canal

ID the issue

A

otitis media
- fluid filling the right tympanic bulla w/ an intact tympanic membrane + small accumulation of fluid in left bulla

20
Q

Sx of the external ear

Goals of Lateral EAR CANAL (wall) resection (3)

A

“Zepp Procedure”

  1. Improve ventilation at the corner of the “L”
  2. Reduce secretions, serve as prevention
  3. Medical Mgmt: will help reduce the frequency of infection by improving the structure of the external canal and by allowing easier access to the ear for routine ear cleaning and treatment with medicine
21
Q

Indications for lateral EAR CANAL (wall) resection (3)

A
  1. Congenital canal stenosis
  2. small tumors at/near tragus
  3. early OE
22
Q

Contraindications for lateral ear canal (wall) resection sx (2)

A
  1. end-stage OE
  2. horiztonal canal stenosis
23
Q

Vertical canal ablation (vertical ear canal resection) indications (3)

A

Performed when the vertical ear canal is severely diseased but the horizontal is unaffected (RARE- seldomly performed)
1. Hyperplastic otitis
2. Severe truama
3. Neoplasia

24
Q

TECA/Total ear canal ablation: indications (4)

A
  1. Failed tx via ear canal resection
  2. Extension of disease into middle ear
  3. Unresponsive to chronic OE due to stenotic canals
  4. Mgmt. of ceruminous gland adenocarcinomas
25
Q

What structure do you need to be cautious of when performing TECA?

A

Facial nerve- monitor for signs of facial nerve paralysis post op (inability to blink, drooping ear, drooping upper lip, drooling from one corner of mouth, decr. tear production -> dry eyes)

26
Q

What is the #1 disease indicating TECA sx in cats?

A

Inflammatory polyps (60%)

27
Q

Why is lateral bulla ostetomy (LBO) often performed in conjunction w/ TECA?

A

Secretory events of the ear begin in the bulla, and move up ear via “secretory escalator”. If TECA performed, these secretory contents have nowhere “up” to go, so need to create opening to allow for drainage
- RECALL that cats have two separate chambers per bulla while dogs only have one, so need to cut into BOTH for cats!

28
Q

What is the #1 cause of otitis media in cats?

A

Inflammatory Polyps!!
- locations: bulla or nasopharynx

29
Q

CS + TX of feline inflammatory polyps based on location

A
  1. Bulla: head shake, scratching, OE, Horner’s syndrome -> TX = VBO
  2. Nasopharynx: dyspnea, dysphagia, nasal d/c, sneezing, coughing -> TX = traction removal
30
Q

Ventral Bulla Osteotomy
1. Indications
2. Potential complications post op (3)

A
  1. Feline inflammatory polyp of middle ear
  2. Horner’s, vestibular signs, hearing loss
31
Q

Tx for otitis interna

A

establish some form of drainage to the middle ear via VBO, plus ABX and corticosteroids to aid w/ inflammation

OI = inflammation to CN8!

AAA Fall 2024 (15 decks)

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