2 Flashcards
What is an aural haematoma and how is one caused?
=accum of blood and fluid in pinna due to head-shaking/scratching which splits cartilage
What are the treatment options for aural haematomas?
- CONSERVATIVE: won’t heal v well
- CENTESIS +/- CORTICOSTEROIDS
- INCISIONAL DRAINAGE: sigmoid incsion on underside of pinna w/ penrose drain
When would a pinnectomy be indicated?
necrosis/trauma/neoplasia eg. SCC, mast cell tumour
What are the indications for an LECR?
-mild recurrent otitis externa
-lesions of lat ear canal wall
MAKES MANAGEMENT EASIER (as direct entry to horizontal canal, improves local enviro, facilitates medication)- NOT CURATIVE
Outline how to perform an LECR
- Mark site 1/2 length of vertical ear canal below horizontal ear canal
- Incise skin flap + reflect dorsally. Resect skin flap.
- Use Mayo scissors to cut vertical canal. Reflect cartilage flap distally then cut off half the flap to leave cartilage flap drainboard
- Suture drainboard and opening to horizontal canal
What is a TECA+LBO?
=Total ear canal ablation + lateral bulla osteotomy
Remove entire ear canal + curette debris out of tympanic cavity in tympanic bulla
What are the indications for performing a TECR + LBO?
- end stage ear disease
- failed LECR
- neoplasia
- para-aural avulsion
What are the complications with TECR+LBO?
- deafness (due to fluid in ear)
- facial nerve paralysis (but always check no facial n damage beforehand due to extensive ear disease)
- retroglenoid H+
- altered ear carriage
- Horners syndrome (CATS)
- vestibular disease (by accidentally curretting middle ear structures in tympanic cavity)
- para-aural abscesses
What are the indications for performing a ventral bulla osteotomy?
- isolated otitis media
- nasopharyngeal polyps
What are the complications of VBOs?
- Horners sydnrome (CATS)
- vestibular disease
- hypoglossal n paralysis
What is end-stage ear disease and how is it diagnosed?
=chronic disease w/ occluded ear canal
OTOSCOPIC EVALUATION: often can’t do evaluation as completely occluded. May see bulging, ruptured tympanic membrane
RADS: occluded ear canal + thickened/opacification of bulla wall
Outline some of the core principles of surgical oncology
- Resect tumours with appropriate margin of norm tissue, biopsy tract + scars from prev surgeries
- Ligate vessels to tumour early as cancer cells may shed into bloodstream as tumour manipulated intra-op
- Change instruments + gloves between tumour resection + reconstruction
- Limit use of drains (as may disseminate along them)
- Always remove entire organ/lobe of organ w/ organ masses if poss eg. lung lobectomy, anal sacculectomy
What are radial and deep margins?
RADIAL = lat margin of skin from tumour DEEP = thick fascial planes eg. periosteum, bone, muscle = barriers to infection
What is a pseudocapsule?
Tumour enlarges compresses outside tissue, creates ‘pseudocapsule’ of compressed cancer cells + norm tissue
List the 5 classes of resection
- Marginal resection (resect just outside tumour capsule)
- Intracapsular resection (‘shelling out’ of tumour from within pseudocapsule)
(BOTH LEAVE TUMOUR DEPOSITS- ONLY APPROP FOR COMPLETELY BENIGN TUMOURS) - Local resection (small radial margin of healthy tissue surrounding mass - approp for benign, non-invasive skin tumours or canine mammary tumours)
- Wide resection (wide margin of healthy tissue 2-3cm radial + next unaffected deep margin)
- Radical resection (v wide margin of resection for highly invasive e.g.. osteosarc i.e. amputation, feline injection site sarcoma, feline mammary carcinoma)
