Head and Neck Surgery

Antitragus

what is structure A?

Tragus

what is structure B?

Anthelix

what is structure C?

Scapha

what is structure D?

structures of the external ear?

vertical canal

horizontal canal

cartilages

glands (e.g. seruminous)

hair

the middle ear is also known as the

tympanic cavity

structure of the middle ear that connects to the nasopharynx

eustachian tube

species with a middle ear that is divided into two compartments by a septum

cat

structures of the inner ear?

labyrinth

semicircular canals

pinna laceration tx options?

Manage as wound

Primary wound closure

Pinnectomy

when can pinna lacerations be treated with primary wound closure?

If adequate and healthy tissue is present

Injury occurred within 6 hours

Suture patterns to close skin of pinnae lacerations?

Simple interrupted

Ford interlocking

Suture patterns to close skin and cartilage of pinna laceration together?

Vertical mattress

Figure of eight

criteria for partial or complete pinnectomy?

malignant tumor

ulcerated tumor

painful tumor

a ? thickness partial pinnectomy is indicated for malignant tumors

full

painful hemorrhage within layers of the pinna causing the layers of cartilage to separate due to trauma or an autoimmune response

aural hematoma

aural hematoma tx?

Address underlying cause

Treat quickly

Continuous drainage

Steroids/PRP possibly

TF needle aspiration of aural hematoma is an effective treatment

F

Methods for continuous drainage of aural hematoma?

teat cannula

penrose drain

closed suction drain

S shaped incision

circular fenestration

goals of aural hematoma tx?

remove clot

remove fibrin

close dead space

provide cosmesis and function

prevent recurrence

Indications for external ear surgery?

Stenosis

Poor/no response to medical management

Ear masses

Dystrophic mineralization

Trauma

TF most external ear surgeries are salvage procedures

T

Best diagnostic imaging method for evaluation of ear canal, extent of disease, and secondary changes from otitis externa/media?

CT

three most common surgical procedures employed for otitis externa?

Lateral wall resection

Vertical canal ablation

Total ear canal ablation and lateral bulla ostectomy (TECALBO)

rarely indicated procedure through which the lateral wall of the vertical canal is opened

lateral wall resection

indications for lateral wall resection?

Small tumor of lateral wall

Mild otitis externa affecting vertical canal

Congenital stenosis

rarely indicated procedure through which the vertical canal is removed and an opening is created for the horizontal canal

vertical canal ablation

vertical canal ablation indications?

Small tumor of vertical canal

Mild otitis externa affecting vertical canal

Congenital stenosis

TF lateral wall resection and vertical canal ablations are useful and effective procedures to treat otitis

F

commonly fails if treating otitis and becomes stenotic

procedure defined by complete removal of the vertical and horizontal canal as well as the lateral wall of the bulla that requires special equipment

total ear canal ablation and lateral bulla ostectomy (TECALBO)

indications for TECALBO?

severe chronic otitis

neoplasia

Steps of TECALBO?

Make incision around ear canal opening

Incision along vertical canal and make a flap for erect ears

Elevate auricular muscles from canal

Elevate canal from opening of bulla

Remove lateral wall of bulla

Remove epithelial lining from bulla cavity

Lavage

Culture and submit for histopath

Complications of TECALBO?

Facial nerve injury (temporary vs. permanent)

Deep infection (draining tract/abscess)

Hemorrhage

Damage to inner ear

Pinna necrosis

Airway swelling

Incisional complications

Loss of hearing

more common and temporary facial nerve injury that results from stretching of the nerve after ear surgery - resolves in 6-8 weeks

neuropraxia

failure to ? in a TECALBO can and often will result in infection/abscesses and draining tract formation within weeks to a year of surgery

remove all of the canal cartilage and epithelial lining of bulla

TF facial nerve injury is a very serious and life-threatening complication following ear surgery

F

mainly cosmetic, need to lubricate eyes with artificial tears to prevent corneal ulcers

important vessels to avoid when performing ear surgery?

retroarticular vein

external carotid

performing a bilateral TECABO raises the risk of what complication?

airway swelling

TF inner ear clinical signs that appear AFTER ear surgery are typically permanent

F

typically resolve in time

TECABO post op care?

Pain management

Abx and change based on culture

Incision care