SURG3LEC ME: L4.2 - Ear Surgery

LATERAL EAR CANAL RESECTION

• Increases drainage and improves ventilation of the ear canal 

• facilitates placement of topical agents into the horizontal canal

Zepp Procedure

A modification of the original technique for lateral ear resection establishes a “drainboard” and it is known as

1. hyperplasia

2. neoplastic

LATERAL EAR CANAL RESECTION Indications:

1. Patients with minimal ___ of the ear canal epithelium 

2. Small __ lesions of the lateral aspect of the vertical canal 

1. stenosis

2. otitis media

LATERAL EAR CANAL RESECTION Should not be performed in animals with 

1. obstruction or __ of the horizontal ear canal or 

2. concurrent ___ (unless performed in conjunction with ventral bulla osteotomy)  

Hypothyroidism, idiopathic seborrhea

Dogs with underlying disease respond poorly such as __ and __ to LATERAL EAR CANAL RESECTION

Drainboard

restricts hair growth at the horizontal canal opening in LATERAL EAR CANAL RESECTION (Zepp Procedure)

True

T/F: Lateral ear resection is not a cure

cartilage flap

In LECR, Resect the distal half of the __ __ to make the drainboard and remove the skin flap. 

VERTICAL EAR CANAL ABLATION

• Performed when the entire vertical canal is diseased, but the horizontal canal is normal  

• Technique of choice for neoplasia confined to the vertical canal

• Chronic otitis externa

True

T/F: Vertical Ear Canal Ablation provide a better cosmetic appearance of the ear than lateral ear canal resection when an abundance of hyperplastic tissue is present in and around the vertical canal 

T

In VECA, Make a __ shaped incision with the horizontal component parallel and just below the upper edge of the tragus. 

histologic examination 

In VECA, Transect the canal ventrally 1-2 cm dorsal to the horizontal canal and submit the canal for __ __

T

In VECA, Reflect the ventral flap downward and suture it to the skin and close the subcutaneous tissue. Then close the skin in a __-shape

Pinna deformity

after TECA in cats or erect-eared dogs can be a source of dissatisfaction for some owners

TOTAL EAR CANAL ABLATION (TECA)

• Indicated in animals with chronic otitis externa that have failed to respond to medical management  

• Most animals with severe, chronic otitis externa have concurrent otitis media  

• Cases of severe calcification and ossification of the ear cartilage  

• Severe epithelial hyperplasia extends beyond the pinna or vertical ear canal.  

Ceruminous gland adenocarcinoma

TECA is also indicated for Neoplasia of the ear canal such as

1. Seborrhea 

2. Atopy drainage 

3. Food or contact dermatitis 

High percentage of dogs undergo TECA have associated skin diseases such as these 3

dermatologic

Skin diseases should be treated before surgery is planned because effective __ therapy usually benefits the ears also

otitis media

Removing the avenue for drainage of exudative material by performing TECA without treating the __ __ ls disastrous 

bulla osteotomy

Always perform a __ __ in conjunction with a TECA for otitis externa and media

1. Superficial wound infection  

2. Facial nerve paralysis  

3. Vestibular dysfunction  

4. Horner syndrome  

5. Deafness  

6. Chronic fistulations or abscessation  

7. Avascular necrosis of the skin of the pinna 

7 Potential complications of TECA

T

In TECA, Make a __- shaped incision with the horizontal component parallel and just below the upper edge of the tragus (just like VECA)

penrose drain

In TECA, If desired place, a __ __.

MODIFIED TOTAL EAR CANAL ABLATION

TECA procedure for cats

vertical

In Modified TECA for cats, Make a __ incision at the cranial and caudal ends of an elliptic incision centered around the external auditory meatus

lateral bulla osteotomy

In Modified TECA for cats, after __ __ __ and excision of the ear canal, pull the top of the advancement flap to the base of the pinna to determine whether further release of the flap is necessary to reduce tension on the pinna.

Ventral bulla osteotomy

• allows increased exposure of the tympanic cavity and 

• can be performed alone or in conjunction with lateral ear resection. 

• It is the technique of choice when middle ear neoplasia is suspected in cats that have nasopharyngeal polyps.

True

T/F: Ventral bulla osteotomy provides better drainage of the bulla than does lateral bulla osteotomy and allows both bullae to be opened without the need to reposition the animal. 

tympanic cavity

Bulla Osteotomy exposes the __ __ so that the exudate and secretory epithelium can be removed

LATERAL BULLA OSTEOTOMY

• Can be performed in conjunction with TECA in animals with chronic otitis externa and middle ear disease  

• Do not require reposition  

• Preferred when performed in conjunction with TECA

periosteal elevator

In LBO, Bluntly dissect the tissue from the lateral aspect of the bulla using a __ __

Rongeur

In LBO, __ the lateral and ventral aspect of the bulla until the caudal aspect of the middle ear canal is exposed

retro auricular

In LBO, Avoid sharp dissection and curettage of the rostral aspect of the osseous ear canal to reduce the risk of __ __ vein damage

auditory ossicles

In LBO, Avoid curetting in the rostral (dorsal) or rostro medial area of the tympanic cavity so as not to damage the __ __ or inner ear structures.

mandibular rami

In VBO, Draw an imaginary line connecting the __ __ and a second imaginary line along the long axis of the ventral aspect of the head

AURAL HEMATOMAS

is a collection of blood within the cartilage plate of the ear. 

AURICULAR HEMATOMAS

AURAL HEMATOMAS aka

S

In Aural Hematoma, Make an __-shaped incision on the concave surface of the ear and expose the hematoma and its contents from end to end.

fibrin clot

In Aural Hematoma, Remove the __ __ and irrigate the cavity

polypropylene

In AH, Using 2-0 to 3-0 monofilament non-absorbable suture (e.g., ___, polybutester), place 0.75- to 1-cm long sutures through the skin on the concave surface of the ear and underlying cartilage. 

parallel; vertical

In AH, Place the sutures ___ to the major vessels (__ rather than horizontal). 

True

T/F: In AH, Do not suture the incision closed; it should gap slightly to allow for continued drainage.  

14 to 21

For AH, Remove the bandage and sutures in __ to __ days.