Small Animal Soft Tissue Surgery Q&A 17

A four-year-old, female Weimaraner developed this swelling overnight. The dog has no history of otitis and does not scratch her ears. The owner reports the the dog is kept in a fenced-in yard and enjoys running up and down the fence-line with the neighbor’s dogs.

Question	Answer		Article
What is the diagnosis?	Aural hematoma: blood accumulation between the cartilage layers of the pinna from ruptured branches of the great auricular artery on the inside of the auricular cartilage.		Link to Article
List three potential causes for this condition.	Causes include trauma, parasites, otitis, aural foreign body, and ear canal tumors or polyps. This dog’s hematoma was due to trauma.		Link to Article
Describe several procedures to correct this problem. Make sure to discuss postoperative management.	There are numerous ways to repair aural hematomas. Simple drainage of the hematoma with a large gauge needle and bandage the ear. Multiple aspirations may be needed over a period of days to weeks (greater chance for recurrence). Lance the hematoma on the concave surface of the pinna with a scalpel blade. Clot and fibrin are removed and mattress sutures are placed parallel to the incision. The incision edges are not reapposed and sutures should penetrate the full thickness of the ear. Knots are tied on the convex surface of the ear. The number of sutures is determined by the amount of dead space that must be closed. Postoperatively, ears may or may not be bandaged. The bandage is removed after 5–7 days and the sutures in 21 days. Other necessary protective devices that may be used are Elizabethan collars, neck shields or stockinette placed over the ears. A sutureless technique involves elliptical incision over the swelling with removal of the clot and fibrin. The ear is bandaged over a roll of gauze or cast padding positioned on top of the head, making sure that the incision is open and exposed. The incision is covered with a dressing and changed as necessary. The incision heals by second intention and the ear is left bandaged for three weeks. Placement of a bovine teat cannula through a stab incision into the hematoma. Fluid and fibrin are removed and the teat cannula is sutured in place with a figure-of-eight pattern. The owner is instructed to massage the ear twice daily and force fluid out of the hematoma. The cannula is left in place for three weeks and, as a minimum, an Elizabethan collar is placed to avoid self-trauma to the area.		Link to Article