Lateral Ear Canal Resection Zepp-Procedure
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Ear canal surgeries in dogs can be performed for diagnostic or therapeutic purposes, or a combination of these. As a therapeutic procedure, surgery can be considered either for definitive treatment or as an adjunct to ongoing medical treatment.
It’s important to select the appropriate type of surgery for chronic ear infections in dog and cats, to avoid either insufficient treatment (and the possible need for revision surgery later) or over treatment, which could expose the patient to a greater number of (or more severe) complications.
Lateral ear canal resection
This surgery is performed when infection is isolated to the external ear canal. By removing part or all of the vertical tube, drainage and air circulation are improved. Infected tissue can be removed at the same time. While this surgery cannot entirely prevent infection, it will help reduce the frequency of infection by improving the structure of the external canal and by allowing easier access to the ear for routine ear cleaning and treatment with medicine.
“Lateral wall resection provides drainage, ventilation, and preservation of hearing.”
- Otitis externa (Ear Infection) has not responded favorably to proper medical management
- Otitis externa has recurred despite proper medical management
- Exposure is needed for biopsy or to remove benign polyp of the canal
- Lateral ear canal resection is primarily indicated in cases of refractory otitis externa in which glandular or epithelial hyperplasia and stenosis are not contributing factors
- The operation entails making parallel incisions in the cranial and caudal aspects of the lateral portion of the vertical ear canal and then leaving the ventral border of the resultant flap intact (in some cases, the cartilage of the flap is also scored). The extent of ventral incisions and dissection is determined by the point at which the vertical canal transitions to the horizontal canal.
- The surgical goal is to have a flap that lays flat at or slightly below the level of the horizontal canal’s base. This provides direct access to, allows aeration of and permits gravity-dependent drainage from the horizontal canal.
- The cartilage flap is sutured to adjacent skin to provide a drain board, while the skin is sutured over the cartilage’s cut edges of the remaining vertical canal.
- The improved aeration and drainage lateral ear canal ablation provides may be curative or at least allow an easier and more successful continuation of medical treatment & ear cleaning.
- “However, in dogs with established hyperplasia or stenosis or in breeds in which this is common (e.g., cocker spaniels), lateral ear canal resection usually fails, so it should not be used.”
- In some cases, the procedure can be used to visualize and excise nonmalignant masses on the medial aspect of the vertical canal that aren’t accessible from the normal opening.
- Topical antibiotic-steroid medication is used
- The ears are taped over the head.
- Suture removal in 14 days
- Failure of the lateral wall resection is often related to failure to recognize and treat underlying systemic disease, irreversible changes in the ear canal
- Failure to drain the horizontal canal properly.
- Stricture of the horizontal canal,
- Presence of concurrent otitis media
- Exudation of the surgical site may continue for many days postoperatively.
- Partial dehiscence of suture line is common.