Surgical affections of the Ears
Surgical affections of the ears are congenital affections, aural hematoma, otitis, faulty ear carriage, therapeutic otoplasty, necrosis and ulceration of conchal cartilage, neoplasms of ear etc.
The ear is divided in to four parts- the Pinna, external ear cannal, middle ear and Internal ear.
Surgical landmarks of the auricular cartilage of ear in animals are helix, tragus, antitragus and anthelix.
Surgical affections of the Ears in animals are-
- Congenital affections of ear
- Aural Hematoma
- Otitis
- Faulty ear carriage
- Necrosis of conchal cartilage
- Ulceration of conchal cartilage
- Neoplasms of ear
- Therapeutic Otoplasty
Congenital affections of ear
Congenital affections of ear are microtia (small ear), macrotia (large ear) and anotia (absence of ear flap).
Aural Hematoma
Aural Hematoma is the accumulation of blood between the ear cartilage and the skin either in the internal or external aspect due to trauma. It is common in equines, dogs, rabbit and goats.
Read aural hematoma in detail>
Otitis
Otitis is the inflammation of the ear due to infection of the ear in animals.
Faulty ear carriage
Rolling of ear pinnae opposite to the way it is folded by keeping a finger in the external ear canal. An adhesive tape is applied all around starting from the base to 2/3rd of way. The ear must be stretched tightly pulling the scutiform cartilage towards the centre of the head. The tape is left on the ear for 5 days, and the ear is observed for any improvement occurred. If there is no improvement, corrective surgery may be advised after 2 weeks.
Surgical procedure for faulty ear carriage
When the ear sits high on the head and the dog has good control of its base- Remove an elliptical piece of skin on the external surface of the pinnae at the level of break and suture it. The extent of removal skin is critical to avoid medial deviation upon healing.
When the ear breaks at the base of the skull– A longitudinal incision is made at the base of the ear and the s/c tissues are incised to expose the scutiform cartilage. The cartilage is partially dissected from its muscular attachment and moved 12-16mm medially and slightly rostrally from its original position, pulling the base of the year closer to the head.
The cartilage is sutured to the fascia of temporal muscle using non-absorbable sutures in horizontal mattress fashion. An elliptical piece of skin (12-16mm) is removed at the site of the skin incision, according to the extent of lateral deviation. The incision is closed using vertical mattress sutures. 2-3 deep bites including the cartilage has to be taken followed by shallow bites. Tension is placed on the skin and the ear is pulled upward. A gauze sponge rolled into a cone is placed over incision site and ear is bandaged from the base to the tip. Healing will be noticed within 8-10 days.
Necrosis of conchal cartilage
Necrosis of conchal cartilage seen in equines as a result of open wounds/ and infection. There will be a sinus opening on the conchal cartilage leading to gradual destruction and deformity of the ear due to ciccatrical contraction.
Treatment
General line of treatment for sinuses to get rid of necrotic cartilage by the application of caustics or by operation. Plug the ear canal. Operation can be performed in standing position under Local Anaesthesia by incising the skin and concha by straight or “V” shaped incision. Suture the skin of the concha in routine manner.
Post Operative care
Bandage the ear against head and apply E-Collar to prevent further injury. Local and systemic antibiotics should be advised.
Ulceration of conchal cartilage
Ulceration of conchal cartilage is common in long eared dogs.
Etiology
An open wound, repeated shaking of head as in ear canker cause Ulceration of conchal cartilage in dogs.
Symptoms
Small wound with a bleeding surface or wound covered by a scab with red coloured boarders. It gradually increases in area and depth and is very tender on manipulation, itching and scratching by the animal may perpetuate the condition.
Treatment
Cleaning and disinfecting the wound, cauterisation of indolent ulcer, freshening, suturing and immobilising the ear around a conical roll of gauze securely fixed in position. The canker or otorrhoea must be treated.
Local dressing, Systemic antibiotics and E-Collar should be advised.
Neoplasms of ear
Neoplasms of external ear are common in dog and cats. examples are Ceruminous gland carcinoma, Ceruminous adenocarcinoma, Squamous cell carcinoma, Malignant melanoma and Inflammatory polyps.
Therapeutic Otoplasty
Therapeutic Otoplasty or Therapeutic ear cropping in dogs is cutting off the floppy part of a dog’s ear in surgical condition. It not practiced nowadays as fancy surgery.
General Considerations
The therapeutic otoplasty surgery is performed generally at 9-12 weeks of age. At this age, the cartilage can usually be trained to stand erect. The chance of the ear successfully standing after surgery decreases with age. Surgery only shapes the ear. Even when performed at 12 weeks of age there is no guarantee that both ears will stand erect after surgery. Whether or not the ear stands up well has to do with the strength of the ear cartilage.
Procedure
General anaesthesia, Sternal recumbency and head raised with a towel or platform placed beneath it.
Prepare the pinnae and top of the head for aseptic surgery and drape it. Plug the ear canal.
The length of the pinnae to be retained has to assessed. It can be done in two methods-
- Mark a point on the medial edge of the pinnae in level with the inner canthus of the eye (3). Then mark the midpoint of the extra portion (2-3) as the length to be retained.
- As per the wish of the owner /Standard specified
A triangular skin incision is made just beneath the tragus and antitragus cartilage where the ear joints the head. A sterile ruler is used to measure along the rostral boarder of the ear and a small nick is made at the desired length. Both the ears are extended fully with the tips together, and a second nick is made in the other ear to ensure the identical length.
Stretch one of the ears and apply a straight Doyen’s clamp/ Ear clamp extending approximately two thirds of the way from the desired length nick to the tragus cartilage and the outside edge even with the nick at the top of the ear and the natural fold of the ear distally. After placing forceps on both the ears, compare to ensure identical positioning.
A straight cut to the middle and distal one third of the ear is made with a blade (No.11 BP blade) directed towards the edge of the intestinal forceps. The forceps are removed and the bleeding can be controlled by digital compression / mosquito forceps.
The distal third of the incision is made with finely serrated cartilage scissors. With the part of the ear to remain held in a normal standing position, the incision is continued to blend the distal third of the ear into the dogs head thr’ a smooth and even cut.
The rough edges are trimmed, and parts of tragus and antitragus cartilages are removed to ensure a smooth appearance.
Interrupted sutures are used to close the skin over the cut portion of the tragus cartilage and the skin defect distal to these cartilages. The main incision is closed with a simple continuous pattern along the edges of the ear with the skin covering over the cartilage using monofilament suture, preferably cotton. Avoid the tip of the ear pinnae to ½” without sutures and end the suture without keeping a knot.
The opposite ear is trimmed in the same manner and compare the shape.
Post operative care
Ears should not be taped until most of the scabs from the surgery have healed. For the first 7 days, the puppy will have to carry ears raised on a wire frame/rack/splint/or tampon with stitches holding the edges closed.
A week later, or some 10 days after cropping, the stitches will have to be removed. Again, for 7 to 10 days the pup will continue with the ears taped erect until all the cut edges are healed. Use mild antiseptics to clean the ear. It is very important that the pup’s ears remain raised on frame until they are completely healed, one must be extremely patient and persistent during this period.
Immobilisation of ears
Prepare a foam base with a stay as a straight post attached to the foam base, affix the post to the ear, above the cartilage ‘nub’ inside the ear, Place the sticky side of the stay (with the base attachment facing outward!) just above the ‘nub’, Fix the stay over the tip of the ear, Fix the base to the ear, Fix the base and connecting both ears.
Locally fabricated frame can be fixed to the head, Taping of ears to top of the frame.
Complications
- One or both ears may fail to stand erect
- Moist dermatitis
- Irritation of the skin secondary to the tape adhesive
- Ear infection
- Scarring
- Immune suppression
Potential reasons for cropped ears not to stand erect
- The cartilage within the pinna is too thin to support the weight of the ear
- The ear crop was too long for the size of the ear
- The ears are “set too low” on the dog’s head
- Scar tissue formed along the ear margin