LATERAL EAR RESECTION(Zepps operation)

LATERAL EAR RESECTION: ZEPP’s PROCEDURE.:

LATERAL EAR RESECTION: ZEPP’s PROCEDURE. By : TOUQEER AHMED

otItis::

otItis : Otitis is an inflammation of the ear canal. Otitis is common in specific dog breeds such as, the Cocker spaniel and German shepherd. ETIOLOGY Bacteria, fungi, yeast, parasites, foreign objects, trauma, polyps and cancer. Types- OTITIS INTERNA OTITIS MEDIA OTITIS EXTERNA

Slide 3:

Appearance of a Cocker spaniel with severe otitis externa of both ears. Note the severe cauliflower-like thickening at the area of the ear canal.

HOW Dogs can be predisposed to otitis ? :

HOW Dogs can be predisposed to otitis ? Pet’s genetic tendency. Pets with the most hair have the poorest air flow and the greatest incidence of infection. Activity: swimming Ear microenvironment: parasites, increased cerumen , increased hair, narrow canals Endocrine disease: hypothyroidism Environment: humidity Trauma: exuberant ear cleaning

signs::

signs: Head shaking Pawing, rubbing at the ear Discharge from the external ear canal Pain when the head is touched Pain when the mouth is opened Head tilt Circling Leaning to one side Rolling Vomiting

Diagnosis.:

Diagnosis. PHYSICAL EXAMINATION Using an otoscope , to retrieve foreign matter from the ear canal, and to check for tumors.

Contd..:

Contd.. RADIOGRAPHIC DIAGNOSIS. CT scan of a pug with blockage of the ear canal (green arrow) from chronic infection. The middle ear (red arrow) is filled with fluid and tissue and the bone surrounding it has become thickened.

HOW THE SURGERY WORKS:

HOW THE SURGERY WORKS The ear canal of the dog and cat consists of both a vertical portion and a horizontal portion, making a “J” shaped ear canal. Because of the vertical portion,it is thought that infectious debris and wax has a harder time draining and this is an important factor why dogs and cats have so many ear infections.

Contd...:

Contd... In Zepp’s operation get rid of the vertical ear canal and only contend with a horizontal ear canal. This allows- Discharges to flow straight from the short horizontal tube leading from the eardrum. Improved drainage- Better air circulation(to allow the ear to dry out) Medication is more easily applied deep into the ear canal where it is most often needed.

Lateral Ear Canal Resection (“Zepp”) Procedure:

Lateral Ear Canal Resection (“ Zepp ”) Procedure

Procedure.:

Procedure. Preparation and disinfection of site. A piece of skin(T-shape) is removed immediately ventral to tragus, almost double the length of dist. between edge of tragus & orifice of auditory meatus . Incision is made parallel to & about 1 cm from the edge of tragus & the ear cartilage & surrounding tissue are severed by 2 approx. parallel incisions.

Contd..:

Contd.. The excised portion is then turned down & laid into the wound prepared previously, by removal of skin, where it is sutured by catgut. Finally the edges of the cartilaginous flap are also sutured. Fig: The lateral ear canal is opened and a “drain board” is formed from the outer canal wall.

Slide 13:

Normal ear The dotted line indicates first set of incisions, through the skin and cutting the round ear canal in half lengthwise The dissected ear canal is pulled down and the flap is sewn to the skin. Circle indicates the new opening of the ear canal

Slide 14:

Appearance of a lateral ear canal resection 10 days after surgery. The Q-tip is resting on the new drain board and the horizontal portion of the ear canal sits just above it.

Potential Complications of Surgery:

Potential Complications of Surgery Facial nerve paralysis- This nerve is damaged during surgery in 25-50% of dogs, and in 10-15% the damage is permanent. Affected dogs may be unable to blink after the surgery, and the lip on the damaged side may droop. Fig: Facial nerve paralysis and a head tilt, lip and tongue drooped on the left side, and this Pug required eye ointment because he could not blink.

Contd...:

Contd... Within the middle ear are the openings to the inner ear, which contains the organs for hearing and balance. These openings can be damaged during surgery & some animals may have head tilts due to loss of balance. The lining in the ear canal and middle ear produces secretions that keep the surfaces moist and healthy. These linings must be removed completely or the animal will develop sores that drain fluid after the surgery site has healed.

AFTERCARE:

AFTERCARE Use of an Elizabethan collar to protect the delicate incisions from scratching. 10-14 days at which time any external sutures can be removed. Topical and oral medication will continue to be used.

THANKS...:

THANKS...