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Auricular
hematoma: Let's break down the words. Auricular is an
adjective referring to the ear. "Hema" is a
prefix referring to blood.
"Toma"
means swelling, and is the root for our word tumor.
Auricular
hematoma occurs when blood collects between the skin
layers and cartilage of the flap of the ear, known as
the pinna. Blood can be released when the ear is
traumatized, such as an ear that's itchy from infection,
parasites or allergy. The patient scratches at the ears,
or shakes his head in an effort to relieve the itchiness
and the resulting pounding breaks a blood vessel inside
the pinna.
Sometimes
dogs and cats in automobile accidents suffer blows to
the head, leading to hematoma of the ear.
There are
a number of ways to repair auricular hematomas, mostly
surgical. A non-surgical treatment has been described
that involves high doses of corticosteroids, some
administered into the hematoma and some oral. I have
tried it a few times in cases where budgetary
limitations excluded surgery, but have had little
success.
A decade
or so I published a variation of the traditional
surgical repair that has given me impressive results
while also reducing anesthesia and surgery time for most
patients.
My
modification of traditional technique is to first
"support" the area that has not yet begun to
swell by stapling the "inside" (least-haired)
layer of skin to the cartilage underneath. The amount of
surgical time saved is dramatic, because the next step
in closure of the hematoma is extremely tedious and
time-consuming.
Now we
drain the blood from the hematoma. Pet owners frequently
ask why this step alone is not sufficient. The reason
goes back to why the hematoma first developed. With the
skin separated from the cartilage by the pressure of the
bleeding, a space was created. When the body has space
in it, the body is going to fill that space with
something. If we simply drain the hematoma with a needle
and syringe, bleeding may continue, and/or fluid will
collect in the space unless the space is surgically
obliterated. Therefore, even if the blood is removed,
more must be done.
Removing
the blood requires an incision the length of the
swelling, which allows clots and fibrin threads to be
removed effectively. A thorough cleaning reduces
post-operative scarring of the pinna.
Surgical
closure can now begin. Slowly and methodically sutures
are placed from the least-haired side of the ear,
through the skin and cartilage and through the skin on
the other side. Then the same suture is passed back
through the pinna, about 1/2 inch from the initial
placement, and a knot is tied. The procedure is repeated
again and again until the entire hematoma space is
closed.
Cartilage
is a relatively inactive tissue, healing slowly, so
sutures and staples are left in for three to four weeks
to allow complete attachment.
Ears are
a very sensitive part of the body, so we prefer to
remove the sutures and staples under general anesthesia
so as to minimize discomfort.
It is
imperative that the underlying cause of the incident be
discovered and appropriately treated.
Your
pet's doctor would prefer to prevent ear problems rather
than treat them. Your dog and cat's comfort and health
are his primary concerns. Clean your pet's ears weekly
and after every bath. When medication is dispensed for
an ear problem follow the veterinarian's instructions
exactly to prevent pain and complications, including
prevention of auricular hematoma.
———
(Dr.
Jim Randolph
, a veterinarian at
Animal General Hospital
in
Long Beach, Miss.
, can be reached at
South Mississippi Veterinary Medical Association
,
20005 Pineville Road
,
Long Beach, MS
39560. Include a self-addressed, stamped envelope.)
———
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