ISSN 2398-2942      

Ear: lateral wall resection

icanis
Contributor(s):

Joseph Harari

Gert ter Haar

Synonym(s): LWR, Zepp procedure, Lacroix procedure


Introduction

  • Improve ventilation of the outer ear by resection of part of the lateral cartilage with (Zepp) or without (Lacroix) creating a draining board.

Uses

  • Aim → improve ventilation and/or drainage and so reduce need for repeated medical management in patients with otitis externa Skin: otitis externa.
    Many persistent cases of otitis externa have underlying dermatological problem which must receive attention before this specific surgical management is considered.
  • To minimize opportunity for frictional dermatoses.
  • To remove small tumors limited to the lateral wall of the vertical ear canal.
  • A modification of the technique can be used for neoplasms in the skin (such as mast cell tumors) overlying the vertical ear canal to create a deep margin of resection.

Advantages

  • Preservation of hearing.
  • Less invasive and complicated procedure than total ear canal ablation.

Disadvantages

  • High rate of failure if remaining parts of the verical and horizontal ear canals are diseased and not treated adequately. Therefore, select cases carefully.
  • Does not eliminate the need for on-going/intermittent medical therapy.

Requirements

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Preparation

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Procedure

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Aftercare

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Outcomes

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Prognosis

  • This procedure alone hardly ever solves all clinical signs of chronic ear diseases.
  • Up to 40% of lateral wall resection operations result in failure or continuing ear disease - see reasons for failure. In Cocker Spaniels approximately 90% of the owners are dissatisfied with the procedure, but most owners of Shar Peis are reasonably happy with the results.

Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Sylvestre A M (1998) Potential factors affecting the outcome of dogs with a resection of the lateral wall of the vertical ear canal. Can Vet J 39 (3), 157-160 PubMed.
  • Elkins A D (1991) Surgery of the external ear canal. Probl Vet Med (2), 239-253 PubMed.
  • Lane J G & Little C J L (1986) Surgery of the canine external auditory meatus: a review of failures. JSAP 27 (4), 247-54 VetMedResource.
  • Gregory C R, Vasseur P B (1983) Clinical results of lateral ear resection in dogs. JAVMA 182 (10), 1087-1090 PubMed.
  • Tufvesson G (1955) Operation for otitis externa in dogs according to Zepp's method; a statistical analysis of follow-up examinations and a study of possible, age, breed, or sex disposition to the disease. Am J Vet Res 16 (61 Part 1), 565-570 PubMed.

Other sources of information

  • McCarthy R J (1996) Surgery of the Head & Neck; Lateral and Vertical Ear Canal Resection. In: Complications in Smal Animals Surgery. Lipowitz A J et al (eds). Lippincott, Williams & Wilkins, Philadelphia, PA. pp 114-118.
  • Layton C E (1993) The role of lateral ear resection in managing chronic otitis externa. Semin Vet Med Surg (small animal) 8 (1), 24-29.
  • Getty R (1979) The Ear. In: Miller's Anatomy of the Dog. Evans H E & Christensen G C (eds). 2nd edn. W B Saunders Company, Philadelphia, PA 19105. pp 1059-1072.
  • Rose W R (1978) Small animal clinical otology. Surgery 4. Resection of the lateral wall of the auditory canal. Vet Med Small Anim Clin 73(1), 35-38.
  • Coffey D J (1975) Lateral Ear Drainage for Otitis Externa. In: Current Techniques in Small Animal Surgery. Bojrab M J (ed), Lea & Febiger, Philadelphia, USA. pp 64-67.

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