TUGAS MATA KULIAH

ILMU BEDAH KHUSUS

(Teknik Operasi Aural Hematoma)

TEKNIK OPERASI AURAL HEMATOMA (OTHEMATOMA)

OLEH :

ZUMARA MUFIDA HIDAYATI 1409005001

MIA MONICA 1409005004
NI LUH MADE SISKA YANTI 1409005017
NI PUTU MEGA ANDINI 1409005068
ADE KIKI SINTYA DEWI 1409005103

KELOMPOK 2
KELAS B

LABORATORIUM BEDAH VETERINER

FAKULTAS KEDOKTERAN HEWAN
UNIVERSITAS UDAYANA
TAHUN 2017

i
 RINGKASAN
Aural Hematoma adalah terkumpulnya darah di atas lembaran kartilago telinga.
Aural Hematoma juga disebut dengan Aurikular Hematoma atau Othematoma. Aural
Hematoma sering terjadi pada anjing, kucing, ataupun babi, dan biasanya terlihat pada
permukaan cekung dari daun telinga. Aural Hematoma pada telinga ditandai dengan adanya
benjolan yang tidak terlalu keras pada permukaan konkafnya. Kondisi ini biasanya
unilateral tetapi bisa juga bilateral. Aural Hematoma bisa disebabkan oleh ruda paksa atau
trauma ataupun karena hewan menggaruk dan menggoyang-goyangkan kepala dan telinganya
karena sebab-sebab tertentu. Hewan penderita aural hematoma akan memperlihatkan kondisi
dimana pinna yang bengkak pada bagian dalamnya. Pinna juga terlihat merah dan hangat
saat disentuh. Hewan juga terkadang akan sering menggeleng dan mengaruk telinganya.
Selain itu, kepala hewan penderita akan miring ke satu sisi, dan apabila telinganya di sentuh
akan merasa tidak nyaman dan merasakan kesakitan. Diagnose yang dilakukan pada
penyakit aural hematoma adalah melihat berdasarkan tanda klinis yang muncul dan
pemeriksaan fisik. Penanganan yang paling efektif yaitu dengan melakukan tindakan
pembedahan.

Kata Kunci: Aural Hematoma, othematom, dan telinga.

SUMMARY
Aural Hematoma is the accumulation of blood on top of the ear cartilage. Aural
hematoma is also called Auricular Hematoma or Othematoma. Aural hematoma often occurs
in dogs, cats, or pigs, and is usually seen on the sunken surface of the earlobe. Aural
hematoma in the ear is characterized by a lump that is not too hard on the concafs surface.
This condition is usually unilateral but can also be bilateral. Aural Hematoma can be caused
by forced or traumatic ruda or because animals scratch and shake their head and ears for
certain reasons. Animals suffering from aural hematoma will show the condition where the
pinna is swollen on the inside. Pinna also looks red and warm when we touched it. Animals
will sometimes also shake their heads and scratch their ears. In addition, the animal head of
the patient will tilt to one side, and if his ears are touched will feel uncomfortable and feel the
pain. The diagnosis of aural hematoma is seen based on clinical signs and physical
examination. The most effective treatment is to perform surgery.

Keywords: Aural hematoma, othematom, and pinna.

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 KATA PENGANTAR

Puja dan Puji syukur kami panjatkan kehadirat Tuhan Yang Maha Esa, karena atas
berkat-Nyalah kami dapat menyelesaikan tugas paper mata kuliah Bedah Khusus Veteriner
yang berjudul Teknik Operasi Aural Hematoma ini dengan tepat waktu.
Kami menyadari bahwa dalam penyelesaian paper ini tidak terlepas dari bantuan
beberapa pihak untuk itu pada kesempatan ini kami ingin mengucapkan terima kasih. Kami
menyadari pula bahwa paper ini masih jauh dari kata sempurna, oleh karena itu kritik dan
saran dari semua pihak yang bersifat membangun selalu kami harapkan demi kesempurnaan
paper ini. Semoga paper ini bermanfaat bagi pihak-pihak yang membutuhkan dan dapat
menambah ilmu pengetahuan tentang prosedur pelaksanaan Operasi Aural Hematoma pada
hewan.

Denpasar, September 2017

Hormat kami,

Penulis

iii
 DAFTAR ISI

Cover ....................................................................................................................................... i
Ringkasan/Summary ............................................................................................................... ii
Kata Pengantar ........................................................................................................................ iii
Daftar Isi ................................................................................................................................. iv
Daftar Gambar ........................................................................................................................ v
Daftar Lampiran ...................................................................................................................... vi
Bab I Pendahuluan
1.1.Latar Belakang ........................................................................................................ 1
1.2.Rumusan Masalah ................................................................................................... 2
Bab II Tujuan dan Manfaat Tulisan
2.1. Tujuan .................................................................................................................... 3
2.2. Manfaat Tulisan ..................................................................................................... 3
Bab III Tinjauan Pustaka
3.1. Definisi Hematoma ................................................................................................ 4
3.2. Aural Hematoma .................................................................................................... 4
3.3. Etiologi Aural Hematoma ...................................................................................... 4
3.4. Tanda Klinis Aural Hematoma .............................................................................. 4
3.5. Diagnosis Aural Hematoma ................................................................................... 5
3.6. Penanganan Aural Hematoma................................................................................ 5
3.7. Teknik Pembedahan Aural Hematoma
3.7.1. Prosedur Pre Operasi dan Anestesi .............................................................. 8
3.7.2. Prosedur Operasi .......................................................................................... 9
3.7.3. Hasil dan Pasca Operasi ............................................................................... 11
Bab IV Pembahasan ................................................................................................................ 12
Bab V Simpulan dan Saran ..................................................................................................... 14
Daftar Pustaka ......................................................................................................................... 15

Lampiran

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 DAFTAR GAMBAR

Gambar 1. Aural Hematoma Pada Anjing dan Kucing........................................................... 5

Gambar 2. Teknik Insisi Pada Penanganan Aural Hematoma ................................................ 6
Gambar 3. Teknik Punch Biopsy ............................................................................................ 7
Gambar 4. Teknik Laser ......................................................................................................... 7
Gambar 5. Teknik Drainase .................................................................................................... 8
Gambar 6. Irisan Berbentuk Huruh S ..................................................................................... 9
Gambar 7. Irisan Lurus ........................................................................................................... 9
Gambar 8. Pengeluarah Darah ................................................................................................ 10
Gambar 9. Jahitan di Telinga .................................................................................................. 10
Gambar 10. Penggunaan Bandage dan Elisabeth Collar ........................................................ 11

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 DAFTAR LAMPIRAN

Lampiran 1.
Journal of Surgical Treatment in Dog Auricular Hematoma (Othematoma)

Lampiran 2.
Journal of A Preliminary Report on Aural Hematoma Management with Auricular Pillow
Method
Lampiran 3.
Journal of Aural Haematoma And Its Surgical Management In Non Discript Cat

vi
 BAB I
PENDAHULUAN
1.1.Latar Belakang
Anjing dan kucing merupakan hewan yang sangat digemari masyarakat untuk
dijadikan peliharaan. Pemeliharaan hewan-hewan ini terbilang mudah untuk dilakukan,
namun harus sering dilakukan pemantauan terhadap kesehatan dan kebersihannya oleh
pemilik. Karena dewasa ini timbul banyak sekali penyakit yang kemungkinan dapat
menyerang anjing dan kucing peliharaan apabila pemilik tidak memperhatikan kesehatan
mereka.
Penyakit atau gangguan yang sering menyerang hewan-hewan ini khususnya pada
anjing adalah parasit, bakteri dan jamur. Penyakit-penyakit ini merupakan masalah ringan
apabila pemilik selalu memperhatikan kebersihan hewan peliharaannya, namun akan menjadi
masalah yang serius apabila dibiarkan begitu saja. Salah satu penyakit yang akan timbul
apabila infeksi ini dibiarkan adalah aural hematoma (othematoma).
Hematoma adalah akumulasi darah di luar pembuluh darah. Aural hematoma atau bisa
juga disebut dengan Othematoma ini akan menyebabkan pembengkakan. Pembengkakan ini
disebabkan karena pembuluh darah yang pecah di dalam tutup telinga, antara lapisan dalam
dan di luar tulang rawan. Hal ini menyebabkan telinga terisi dengan cairan darah. Jika tidak
diobati telinga akan menjadi sangat sakit dan akhirnya akan menimbulkan bekas luka yang
serius yang mirip seperti kembang kol. Telinga yang mengalami hematoma biasanya
disebabkan oleh beberapa jenis trauma, seperti ketika hewan peliharaan agresif sehingga
terjadi goresan di telinga. Biasanya ada penyebab yang mendasari untuk menggaruk dan
getaran pada kepala, seperti tungau telinga atau infeksi bakteri dan/atau jamur pada saluran
telinga. Cara penanganan kasus aural hematoma ini juga agak susah karena bisa terjadi
kekambuhan pada kasus yang sudah pernah diobati. Salah satu tindakan yang paling efektif
untuk penanganan kasus ini adalah melalui jalan pembedahan yang biasa disebut dengan
Operasi Aural Hematoma (Othematoma).
Oleh karena ini, penulis mengangkat kasus ini dalam pembuatan paper agar kita lebih
mengetahui tentang aural hematoma (othematoma) serta bagaimana cara-cara penanganan
yang tepat dan bagaimana langkah-langkah dalam melakukan Operasi Aural Hematoma
(Othematoma).

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1.2.Rumusan Masalah
1. Apa yang dimaksud dengan Aural Hematoma (Othematoma)?
2. Bagaimana etiologi dari Aural Hematoma (Othematoma)?
3. Bagaimana gejala dan identifikasi dari Aural Hematoma (Othematoma)?
4. Bagaimana cara mendiagnose dari Aural Hematoma (Othematoma)?
5. Bagaimana pengobatan dari Aural Hematoma (Othematoma)?
6. Bagaimana teknik pembedahan Aural Hematoma (Othematoma)?

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 BAB II
TUJUAN DAN MANFAAT TULISAN

2.1. Tujuan Penulisan

1. Untuk mengetahui penyakit Aural Hematoma (Othematoma).
2. Untuk mengetahui etiologi atau penyebab dari Aural Hematoma (Othematoma).
3. Untuk mengetahui gejala dan identifikasi dari Aural Hematoma (Othematoma).
4. Mengetahui cara mendiagnosa Aural Hematoma (Othematoma).
5. Mengetahui pengobatandantenikpembedahanAural Hematoma (Othematoma).

2.2. Manfaat Tulisan

Tulisan ini diharapkan dapat memberikan informasi dan pemahaman mengenai Aural
Hematoma dan teknik operasinya agar nantinya dapat digunakan sebagai bekal di dunia
lapangan praktisi dokter hewan.

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 BAB III
TINJAUAN PUSTAKA
3.1. Definisi Hematoma
Hematoma adalah akumulasi darah diluar pembuluh darah. Hematoma terjadi karena
dinding pembuluh darah, arteri, vena atau kapiler rusak dan darah bocor ke dalam jaringan-
jaringan di mana ia tidak pada tempatnya.

3.2. Aural Hematoma

Aural Hematoma adalah terkumpulnya darah di atas lembaran kartilago telinga. Aural
Hematoma juga disebut dengan Aurikular Hematoma atau Othematoma. Aural Hematoma
sering terjadi pada anjing, kucing, ataupun babi, dan biasanya terlihat pada permukaan
cekung dari daun telinga (Chethana et all., 2016). Aural Hematoma pada telinga ditandai
dengan adanya benjolan yang tidak terlalu keras pada permukaan konkafnya (Sudisma,
2006). Penyakit ini harus segera di tangani, karena jika tidak segera ditangani, akan terbentuk
fibrin sehingga menyebabkan fibrosis, rasa sakit pada telinga, dan penebalan pada telinga
serta telinga menjadi cacat dengan bentuk seperti kembang kol (Medleau dan Hnilica, 2006).

3.3. Etiologi Aural Hematoma

Aural Hematoma bisa disebabkan oleh ruda paksa atau trauma. Bisa juga terjadi
karena hewan menggaruk dan menggoyang-goyangkan kepala dan telinga. Adanya alergi,
infeksi atau pembengkakan telinga, benda asing, atau parasit telinga (tungau,kutu,infeksi
bakteri atau jamur), dapat menyebabkan rasa sakit, gatal atau iritasi yang akan diatasi oleh
hewan tersebut dengan menggaruk atau menggoyang-goyangkan kepala dan telinga. Perilaku
ini menyebabkan pembuluh darah kecil di telinga pecah dan pendarahan di bawah kulit
membentuk kantong darah di dalam celah telinga. Jika terjadi penimbunan darah pada daerah
tersebut, maka akan terjadi perubahan bentuk telinga luar dan tampak masa berwarna ungu
kemerahan.

3.4. Tanda Klinis dan Identifikasi Aural Hematoma

Hewan penderita aural hematoma akan memperlihatkan kondisi dimana pinna yang
bengkak pada bagian dalamnya. Pinna juga terlihat merah dan hangat saat disentuh. Hewan
juga terkadang akan sering menggeleng dan mengaruk telinganya. Selain itu, kepala hewan
penderita akan miring ke satu sisi, dan apabila telinganya di sentuh akan merasa tidak
nyaman dan merasakan kesakitan.
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 Gambar 1. Aural Hematoma pada anjing dan kucing
(Sumber: Hnilica, Keith A. Small Animal Dermatology: A Color Atlas and Therapeutic
Guide, 3rd Edition.Elsevier, 2011. Dan Chethana et all., 2016).

3.5. Diagnosa Aural Hematoma

Aural Hematoma dapat didiagnosis dari tanda klinis yang khas dan dengan melakukan
pemeriksaan fisik. Tanda klinis dapat dilihat dari adanya pembengkakan di sekitar daun
telinga, baik itu di salah satu daun telinga atau keduanya. Selain itu, diagnose Aural
Hematoma juga dapat dilakukan dengan pemeriksaan fisik, yaitu dengan mem-palpasi sekitar
daun telinga, yang bila diraba akan terasa cairan darah (konsistensi cair dan bisa menjadi
padat apabila darah sudah mengalami pembekuan).

3.6. Penanganan Aural Hematoma

Tujuan dari mengobati hematoma aural yaitu salah satunya untuk membersihkan
kantong yang berisi darah dan mencegah atau setidaknya meminimalkan deformitas telinga
dan jaringan parut. Tanpa pengobatan, hematoma telinga juga akan sembuh dengan
sendirinya , tapi hewan peliharaan sering mengalami ketidaknyamanan. Selain itu, kedua sisi
telinga sering mengalami penebalan, jaringan parut keriput , sehingga telinga tidak akan
terlihat normal kembali.
Metode yang umum digunakan untuk menangani Aural Hematoma yaitu:
1. Metode konservatif, yaitu dengan Auriculocentesis, yaitu pengambilan cairan atau
darah dengan menusukkan needle langsung pada tempat terjadinya hematoma, setelah itu
cairan disedot dengan menggunakan syringe.
2. Metode Pembedahan, disini akan dibutuhkan proses operasi untuk mengeluarkan isi
hematoma dibawah pengaruh anestesi general kemudian dilakukan penjahitan pada
kedua sisi telinga untuk menghindari terjadinya hematoma ulang. Ada beberapa teknik

5
operasi yang bisa digunakan untuk pengobatan aural hematoma, diantaranya yaitu insisi,
punch biopsy, laser atau drainase.
a. Teknik insisi
Teknik ini bagus digunakan untuk pasien yang dapat mentoleransi obat anestesi
general. Teknik ini dilakukan dengan membuat insisi berbentuk S atau secara
longitudinal sepanjang daerah yang mengalami hematoma pada permukaan daun
telinga.

Gambar 2. Teknik insisi pada penanganan Aural Hematoma

(Sumber: Tommy Asinga pada Textbook Banfield)
b. Teknik Punch Biopsy
Awali dengan membuat 2 insisi melintang sepanjang 1-2 centimeter pada distal dan
proksimal tepi hematoma untuk mengeluarkan cairan dan menghilangkan fibrin lalu
gunakan 4-6 mm skin biopsy punch untuk membuat beberapa lubang drainasi pada
kulit di daun telinga sisi dalam. Dokter hewan hanya melakukan pengangkatan pada
kulit dan tidak sampai mengenai kartilago. Pembuatan lubang drainase harus
dilakukan secara merata di seluruh area yang mengalami hematoma dengan jarak 10-

6
 15 mm. Lubang drainase dibiarkan tetap terbuka dan dapat sembuh dengan
sendirinya (dengan granulasi).

Gambar 3. Teknik Punch Biopsy

(Sumber: Handbook of Veterinary Procedures dan Emergency Treatment, 9th Edition,
Elslevier,2012).
c. Teknik laser
Pengenalan operasi laser di dunia kedokteran hewan akhir-akhir ini dapat digunakan
untuk menangani aural hematoma, namun mahalnya pelatihan dan biaya peralatan
menghalangi teknik untuk digunakan secara luas. Laser digunakan untuk membuat
beberapa lubang drainase di atas permukaan hematoma. Lubang yang dibuat dengan
laser sembuh dengan granulasi dan dapat sembuh dengan sendirinya.

Gambar 4. Teknik Laser

(Sumber: Hnilica, Keith A. Small Animal Dermatology: A Color Atlas and Therapeutic
Guide, 3rd Edition.Elsevier, 2011.).
d. Teknik drainase
Jarum aspirasi atau drainage tube digunakan hanya ketika hematoma berukuran kecil
dan berumur <24 jam. Karena teknik drainasi ini memiliki resiko kambuh kembali

7
 yang lebih tinggi dan ketidakpuasan klien, maka sebaiknya hanya digunakan untuk
pasien yang tidak bisa mentoleransi anestesi umum. Caranya yaitu dengan membuat
sayatan kecil di distal dan proksimal pada permukaan daun telinga bagian dalam di
atas hematoma. Lalu cairan isi hematoma dan fibrin serta darah yang membeku
dikeluarkan dan rongga hematoma dibilas dengan cairan steril.

Gambar 5. Teknik Drainase pada penanganan Aural Hematoma

(Sumber: Hnilica, Keith A. Small Animal Dermatology: A Color Atlas and
Therapeutic Guide, 3rd Edition. Elsevier, 2011).
3. Antibiotika
Sebagai tambahan, dapat diberikan terapi medis dan menambahkan obat analgesic
yang cukup untuk pasien. Jika ada infeksi pada telinga dapat diberi antibiotic yang sesuai
dengan cara kultur dan uji sensitifitas dari eksudat telinga. Jika kultur bakteri tidak
dilakukan, maka diberikan antibiotic oral broad spectrum terhadap hewan. Pilihan yang
tepat untuk anjing yaitu amoxicillin-clavulanic acid sebanyak 12,5 mg / kg 2x sehari,
cephalexin sebanyak 22-35 mg / kg 2-3x sehari atau enrofloxaxin sebanyak 5-20 mg / kg
1x sehari. Untuk kucing, 10-20 mg / kg amoxicillin-clavulanic acid 2x sehari atau 5 mg /
kg enrofloxacin 1x sehari.

3.7. Teknik Pembedahan Aural Hematoma

3.7.1. Pre Operasi dan Anestesi
1. Pre Operasi
Tahap pre operasi yaitu memerlukan persiapan yang aseptis, mencukur
bulu daerah telinga (Beteg et al., 2011). Menyiapkan bahan dan alat yang
digunakan untuk melakukan prosedur operasi. Bahan dan alat yang dibutuhkan
antara lain : Scaple Blade, Scaple Handle, JarumPembedahan, Gunting Bedah,
Needle Holder, Perban dan Elizabeth Colar.

8
 2. Anestesi
Anestesi yang digunakan adalah anestesi local ditambah dengan
transquilizer atau dengan anestesi umum (Sudisma, 2016). Anestesi yang dapat
digunakan yaitu acepromazine dan ketamine secara intramuscular dengan protocol
sebagai berikut : Pertama diberikan acepomazine 1 mg diikuti dengan ketamine 10
mg, 10 menit setelah pemberian acepromazine (Beteg et al.,2011).
3.7.2. Prosedur Operasi Teknik Insisi
Pertama-tama telinga dicukur terlebih dahulu dan diberi antiseptic. Dibuat irisan
pada bagian konkaf telinga di samping hematoma. Ada tiga macam irisan yang bisa
dilakukan yaitu irisan lurus disepanjang hematoma, irisan berbentuk S dan dua irisan
sejajar (Sudisma, 2016). Sayatan dilakukan dengan pisau bedah, mulai dari pagkal
telinga hingga ke bagian atas, dengan tekan sedang untuk menghindari sectioning kulit
pada sisi eksternal pinna (Beteg et al., 2011).

Gambar 6. Irisan berbentuk huruf S. (Sumber: Beteg et all., 2011)

Gambar 7. Irisan lurus sepanjang hematoma. (Sumber: Beteg et all., 2011)

Selanjutnya, isi hematoma dikeluarkan dengan ditekan dan bagian dalam di kuret
dan di irigasi untuk menghilangkan bekuan darah, adesi dan fibrin dan untuk

9
mempercepat perlekatan (Sudisma, 2016). Bila hematoma sudah terjadi dalam waktu
yang lama maka ada pembekuan darah di telinga sehingga gumpalan ini di hilangkan
dengan hemostat (Beteg et al., 2011).

Gambar 8. Pengeluaran Darah (Sumber: Beteg et all., 2011)

Setelah itu, dilakukan penjahitan dengan sampai 1 Cm pada daerah konkaf
telinga sampai kartilago. Dibuat jahitan yang pararel ( secara vertical lebih baik dari
pada horizontal).

Gambar 9. Jahitan di telinga ( Sumber: Beteg et all., 2011dan Chethana et all., 2016)
Jangan melakukan ligase pada pembuluh darah dan cabang arteri aurikularis
pada daerah konvex telinga. Jangan melakukan penjahitan untuk menutup tepi luka
incise, karena akan berfungsi sebagai drainase. Irisan yang sudah dibuat tadi diperbesar
yaitu diportong tepi-tepinya dengan gunting sehingga terjadi pembukaan selebar +- 4
mm, dapat juga dibuat jahitan matras dengan bahan non absorbable sejajar dengan irisan
tadi. Jahitan dilakukan dari bagian konveks telinga dan menembus daun telinga.
Kemudain telinga dibalut, diganti setiap 3-4 hari. Jahitan dibuka setelah 10 hari
(Sudisma, 2016)

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 Gambar 10. Penggunaan bandage dan Elizabeth collar (Sumber: Chethana et all., 2016
dan Asinga, 2006)
3.7.3. Hasil dan Pasca Operasi
Setiap hari dilakukan pemantauan pasca operasi terhadap status umum pasien,
diberikan antiseptic pada daerah jahitan pada masing-masing dari drainase sayatan
dengan menggunakan tampon yang sudah direndam dalam air garam atau hydrogen
peroksida. Sayatan dibiarkan sebagian terbuka untuk memfasilitasi dainase cairan lebih
lanjut. Perban dan jahitan dilepas dalam waktu 7-10 hari. Penyembuhan berlangsung
dengan cepat dan telinga kembali normal dalam waktu singkat. Selama proses
penyembuhan hematoma, digunakan EliZabeth Collar atau bandage agar anjing tidak
menggaruk telingganya dan mengurangi infeksi (Beteg et al, 2011).

11
 BAB IV
PEMBAHASAN
Aural Hematoma adalah terkumpulnya darah di atas lembaran kartilago telinga. Aural
Hematoma juga disebut dengan Aurikular Hematoma atau Othematoma. Aural Hematoma
sering terjadi pada anjing, kucing, ataupun babi, dan biasanya terlihat pada permukaan
cekung dari daun telinga (Chethana et all., 2016). Aural Hematoma pada telinga ditandai
dengan adanya benjolan yang tidak terlalu keras pada permukaan konkafnya (Sudisma,
2006). Kondisi ini biasanya unilateral tetabi bisa juga bilateral. Penyakit ini harus segera
di tangani, karena jika tidak segera ditangani, akan terbentuk fibrin sehingga menyebabkan
fibrosis, rasa sakit pada telinga, dan penebalan pada telinga serta telinga menjadi cacat
dengan bentuk seperti kembang kol (Medleau dan Hnilica, 2006).
Aural Hematoma bisa disebabkan oleh ruda paksa atau trauma. Bisa juga terjadi
karena hewan menggaruk dan menggoyang-goyangkan kepala dan telinga. Adanya alergi,
infeksi atau pembengkakan telinga, benda asing, atau parasit telinga (tungau,kutu,infeksi
bakteri atau jamur), dapat menyebabkan rasa sakit, gatal atau iritasi yang akan diatasi oleh
hewan tersebut dengan menggaruk atau menggoyang-goyangkan kepala dan telinga. Perilaku
ini menyebabkan pembuluh darah kecil di telinga pecah dan pendarahan di bawah kulit
membentuk kantong darah di dalam celah telinga. Jika terjadi penimbunan darah pada daerah
tersebut, maka akan terjadi perubahan bentuk telinga luar dan tampak masa berwarna ungu
kemerahan.
Hewan penderita aural hematoma akan memperlihatkan kondisi dimana pinna yang
bengkak pada bagian dalamnya. Pinna juga terlihat merah dan hangat saat disentuh. Hewan
juga terkadang akan sering menggeleng dan mengaruk telinganya. Selain itu, kepala hewan
penderita akan miring ke satu sisi, dan apabila telinganya di sentuh akan merasa tidak
nyaman dan merasakan kesakitan.
Diagnosa Aural Hematoma diperoleh dari tanda klinis yang khas dan dari
pemeriksaan fisik. Tanda klinis dapat dilihat dari adanya pembengkakan di sekitar daun
telinga, baik itu di salah satu daun telinga atau keduanya. Selain itu, diagnose Aural
Hematoma juga dapat dilakukan dengan pemeriksaan fisik, yaitu dengan mem-palpasi sekitar
daun telinga, yang bila diraba akan terasa cairan darah (konsistensi cair dan bisa menjadi
padat apabila darah sudah mengalami pembekuan).
Tujuan dari mengobati hematoma aural yaitu salah satunya untuk membersihkan
kantong yang berisi darah dan mencegah atau setidaknya meminimalkan deformitas telinga
dan jaringan parut. Tanpa pengobatan, hematoma telinga juga akan sembuh dengan
12
sendirinya , tapi hewan peliharaan sering mengalami ketidaknyamanan. Selain itu, kedua sisi
telinga sering mengalami penebalan, jaringan parut keriput , sehingga telinga tidak akan
terlihat normal kembali.
Metode yang umum digunakan untuk menangani Aural Hematoma yaitu dengan metode
konservatif, yaitu dengan Auriculocentesis, yaitu dengan menyedot cairan hematoma dengan
menggunakan syringe, ataupun dengan metode pembedahan (operasi). Ada beberapa teknik
operasi yang bisa digunakan untuk pengobatan aural hematoma, salah satunya dengan insisi,
punch biopsy, laser atau drainase, namun metode yang sering digunakan yaitu dengan bedah
insisi.
Tahap operasi (insisi) dibagi menjadi beberapa tahap yaitu tahap pre operasi. Tahap ini
yaitu dengan melakukan persiapan yang aseptis, mencukur bulu pada daerah telinga (Beteg et
al., 2011), menyiapkan bahan dan alat yang digunakan untuk melakukan prsedur operasi.
Bahan dan alat yang dibutuhkan antara lain: Scalper blade, Scalper Handle, Jarum
Pembedahan, Gunting bedah, Needle Holder, Perban, Elizabeth Collar. Selanjutya
melakukan anestesi dengan anestesi lokal ditambah dengan transquilizer atau dengan
anestesi umum (Sudisma, 2006). Anestesi yang dapat digunakan yaitu acepromazine
dan ketamine secara intramuscular dengan protocol sebagai berikut: pertama diberikan
acepromazine 1 mg diikuti ketamine 10 mg 10 menit setelah pemberian acepromazine
(Beteg et al., 2011).
Setelah tahap preoperasi telah diselsaikan maka dilanjutkan dengan tahap operasi.
Telinga dicukur, diberi antiseptik. Dibuat irisan pada bagian konkaf telinga di samping
hematoma. Ada tiga macam irisan yang bisa dilkukan yaitu irisan lurus disepanjang
hematoma, irisan berbentuk S dan dua irisan sejajar (Sudisma, 2006). Sayatan
dilakukan dengan pisau bedah, mulai dari pangkal telinga hingga ke bagian atas, dengan
tekanan sedang untuk menghindari sectioning kulit pada sisi eksternal pinna (Beteg et al.,
2011). Isi hematoma dikeluarkan dengan ditekan dan bagian dalam dikuret dan diirigasi
untuk menghilangkan bekuan darah, adesi dan fibrin dan untuk mempercepat perlekatan
(Sudisma, 2006). Bila hematoma sudah terjadi dalam waktu yang lama maka ada
pembekuan darah di telinga. Sehingga gumpalan ini dihilangkan dengan hemostat
(Beteg et al., 2011). Setelah itu, dilakukan penjahitan dengan panjang sampai 1 cm
pada daerah konkaf telinga sampai menembus kartilago. Dibuat jahitan yang parallel
(secara vertikal lebih baik dari pada horizontal).
Setelah tahap operasi kemudian dilanjutkan dengan tahap pasca operasi yaitu dengan
melakukan pengecekan yang rutin pada pasien.
13
 BAB V
SIMPULAN DAN SARAN
5.1. Simpulan
Aural Hematoma adalah terkumpulnya darah di atas lembaran kartilago telinga.
Aural Hematoma juga disebut dengan Aurikular Hematoma atau Othematoma. Aural
Hematoma sering terjadi pada anjing, kucing, ataupun babi, dan biasanya terlihat pada
permukaan cekung dari daun telinga. Aural Hematoma pada telinga ditandai dengan adanya
benjolan yang tidak terlalu keras pada permukaan konkafnya. Kondisi ini biasanya
unilateral tetapi bisa juga bilateral. Penyakit ini harus segera di tangani, karena jika tidak
segera ditangani, akan terbentuk fibrin sehingga menyebabkan fibrosis, rasa sakit pada
telinga, dan penebalan pada telinga serta telinga menjadi cacat dengan bentuk abnormal.
Aural Hematoma bisa disebabkan oleh ruda paksa atau trauma ataupun karena hewan
menggaruk dan menggoyang-goyangkan kepala dan telinganya karena sebab-sebab tertentu.
Hewan penderita aural hematoma akan memperlihatkan kondisi dimana pinna yang bengkak
pada bagian dalamnya. Pinna juga terlihat merah dan hangat saat disentuh. Hewan juga
terkadang akan sering menggeleng dan mengaruk telinganya. Selain itu, kepala hewan
penderita akan miring ke satu sisi, dan apabila telinganya di sentuh akan merasa tidak
nyaman dan merasakan kesakitan. Diagnose yang dilakukan pada penyakit aural hematoma
adalah melihat berdasarkan tanda klinis yang muncul dan pemeriksaan fisik.
Penanganan yang paling efektif yaitu dengan melakukan tindakan pembedahan.

1.1. Saran
Sebaiknya penyakit ini segera di tangani dengan cepat dan tepat, karena jika tidak
segera ditangani, akan terbentuk fibrin sehingga menyebabkan fibrosis, rasa sakit pada
telinga, dan penebalan pada telinga serta telinga menjadi cacat dengan bentuk yang abnormal.
Penanganan yang paling efektif yaitu dengan melakukan tindakan pembedahan.

14
 DAFTAR PUSTAKA
Anggreni.N.K.W, et all.2015. Teknik Operasi Aural Hematoma (Othematom).Fakultas
Kedokteran Hewan Universitas Udayana. Denpasar
Beteg,F., M. Aurel, K. Andrei, dan S. Laura. 2011. Surgical Treatment in
DogAuricular Hematoma (Othematoma). Bulletin UASVM, Veterinary Medicine.
68(2): 38-42.
O.D Eyarefe, C.O. Oguntoye and B.O. Emikpe. 2013. A Preliminary Report on Aural
Hematoma Management with Auricular Pillow Method.Department of Veterinary
Surgery and Reproduction, University of Ibadan, Ibadan, Nigeria.Journal of Global
Veterinaria 11 (1): 44-48.
D.H.Chethana et all., 2016. Aural Haematoma And Its Surgical Management In Non Discript
Cat. D Veterinary Clinic. Hennur Cross, Bangalore. International Journal of Applied
and Pure Science and Agriculture
Asing, T. 2006. Treating Aural Hematomas. Banfield. Hal 32-42.
Hnilica, Keith A. 2011. Small Animal Dermatology: A Color Atlas and Therapeutic Guide,
3rd Edition. Elsevier.
Sudisma, I.G.N. 2006. Ilmu Bedah Veteriner dan Teknik Operasi. Cetakan 1. Pelangi Sari.
Denpasar.

15
Bulletin UASVM, Veterinary Medicine 68(2)/2011
pISSN 1843-5270; eISSN 1843-5378

Surgical Treatment in Dog Auricular Hematoma(othematoma)

Florin BETEG, MUSTE Aurel, KRUPACI Andrei, SCURTU Laura

University of Agricultural Sciences and Veterinary Medicine,Cluj Napoca,Romania Faculty

of Veterinary Medicine, Surgery Departament BTG@email.ro

Abstract. Dog ear pathology has an important place in the cranial region disorders. By
anatomotopographical disposal the pinna ear dog is vulnerable exposed to traumatic external
agents,inert or animated that can cause various injuries on the ear pinna region(wounds,
contusions, hematoma, vasculocutaneous tear).Aural hematoma is clinically traduced by the
presence of collection within cartilage plate of the ear, that are initially fluid, soft, fluctuating,
but later due to resorption and fibrosis become more firm and reduce it size and volume. For
surgical treatment of ear hematomas were described several techniques (4). Goals of surgery
are to remove the hematoma, prevent recurrence and to maintain natural and aesthetic
appearance of the ear pinna use. The most common procedure is incision of the parietal tissue
of hematoma, evacuation clots of blood and fibrin and to fix cartilage untill scar tissue
formation.

Key words: dog, auricular hematoma, surgical treatment

INTRODUCTION

Aural hematoma or othematoma in dogs is a traumatic condition located at ear pinna,

clinically traduced by the presence of fluctuating hematogenous collections, disposed on the
external(convex) face, that occurs cosecutive of the tear or cut off the blood vessels located
between the cartilage and cutis ear (4).
Othematoma in dog, itself has been studied, but there is divided opinion regarding optimal
time of treatment, surgical technique preferred(1), when to suppress the suture, if drainage is
necessary, if is necessary to perform a protective bandage and for pinna ear reshaping(2).
The purpose of present work was to identify the surgical procedure which applied to
the right time to give the best results and to preserve cosmetics and aesthetic aspects specific
to affected breed, by avoiding the unwanted complications such as wound dehiscence and the
appearance of mutilated coloboma.

MATERIALS AND METHODS

Research and our observations were performed on a number of 15 dogs, different

breed and age, presented for diagnosis and treatment at the Surgery Clinic of Faculty of
Veterinary Medicine, Cluj Napoca, respectively originating from veterinary clinics, between
October 2008 - 2011. Dogs in the study were diagnosed with aural hematoma (othematom)
unilaterall, with a multiple causality (bite, tear, crushing, hanging, otitis).
Somewhat arbitrary, subsequent clinical screening, for surgical treatement, clinical cases were
devided (depending on the presentation time for clinical diagnosis) in two groups as follows:

38
a.Precocious surgical intervention group (less than 3 days after othematoma producing)
b.Tardive surgical intervention group (over 3 days after othematoma producing)
Preoperative we performed aseptical preparation of pinna of the ear affected ear, by
clipping at both sides (convex and concave) and shaving hair after a good moisturising the
region with antiseptic soap.
Surgical treatement of the auricular hematoma.
Anesthetic protocol was done by neuroleptanalgesia (NLA) with acepromazine
(Vetranquil 1%) and 10% ketamine. Anesthetic medication was administered intramuscularly
according to the following protocol: initially we administered acepromazine i.m. 1mg/kc,
followed by Ketamine 10 minutes after acepromazine administration. The dose of ketamine
administered was 10 mg / kc.
Chemical antisepsia of the ear pinna we realized very careful to reduce microbial load
on the cutaneous layer.We did first application of Betadine solution and then wiped the pinna
with dry sterile swab to remove excess solution and evantuale foreign bodies
(hair).Finally we realized again chemical antisepsia with ticture iodine or isopropylic
alcoohol.
Apply a sterile swab in the external orifice of the ear to prevent overflow of
othematoma content in the ear canal. This preparatory time is required to be performed before
even by chemical antisepsia ot tha pinna, because any liquid or discharge that reaches the ear
canal may be complicated by disease of the external or middle ear(3).
"S" shaped incision of the skin and cartilage on the concave (internal) along the length
of the auricular hematoma(3). Incision performed with the scalpel, starting from the base of
the ear and going to the top of the ear, by moderate pressure to avoid sectioning the skin on
the convex side (external) of pinna(4).Incision edges were plain to prevent formation of
adhesions which cause further changes of the ear aspect (fig. 1).

Fig. 1. S- shape drainage incision of aural hematoma

Drainage of the auricular hematoma content, was performed after opening the parietal
incision(5). Depending on the length of evolution, content drain spontaneously partial in the

39
opening, completed with digital compression from exterior for a more complete drainage(fig.
2).

Fig. 2. Digital compression from exterior to drainage the content

Othematoma cavity lavage after drainage.After removal of the othematoma content for
stripping of all debris, clots and tissue fluids, we performed a lavage with saline, and
sometimes used hydrogen peroxide.
Suture pexy of the pinna structure. Suture technique applied is defining performance in
obtaining the earliest possible healing without complications and to preserve the phenotypic
appearance of the patient. The suture was performed with 3-0 Prolene not resorbable,
monofilament with needle.Suture was a total perforating suture ( skin on the face of internal -
concave, cartilage and skin of the external-convex face) in separate points, applied parallel to
the axis of the pinna and parallel with major vessels(5).Applied suture points were 0.5 to 0.75
cm loop length, with the appearance of a "U" vertical. (fig. 3a and 3b).We apllied many
sutures to avoid pocket formation in which fluids can accumulate(4,6). The distance between
two adjacent points was a maximum 1cm.

a b Fig.3. Performing suture of pinna structure

40
 Suture points were applied over the whole surface of the pinna which was affected by
othematoma.
Daily was performed postoperative monitoring of general status of the patient, local
antisepsia of the suture pexy(4), respectively of the incision drainage, using appropriate
tampons soaked in saline or hydrogen peroxide.

RESULTS AND DISCUSSIONS

As a result of surgical treatmentof auricular hematoma all 15 dogs undergoing well the
surgery, assisted by an adequate general anesthesia, which ensured operative confort and
conducting surgical maneuvers in good condition. Also operate all dogs evolved favorable
postoperative.
Preoperative protocol compliance, preparing animals for surgery, conduct surgical
maneuvers as described protocol, led to successful intervention, while the othematoma
surgery incumbent difficulties, risks and unforeseen events both intraoperatively and
especially in the postoperative evolution. Postoperative clinical evolution was conducted also
under normal conditions as a result of conduct and compliance with postoperative therapy.
Regarding the postoperative results of surgery in aural hematoma, postoperative
evolution we can affirm that were monitored for 21 days. We planned this monitoring period
because literature data are duabile and most of them require maintenance of the pinna pexy
suture for 21 days and suture removal should be made after that time. This determined us to
design the study to take into account these elements to see in surgical technique applied the
minimum necessary to maintain pinna suture. Therefore cases were monitored daily in the
first five days postoperatively and then at 7 days and 14 days after surgery. In the first five
days after the surgery we found a moderate increase in body temperature by 0.3 to 0.5 C.
The clinical examination of the ear pavilion in all cases we found an increased
sensibility or pain, the animals reacted significantly to topical treatment maneuvers of the
suture and drainage incision. Sensibility and pain persisted in most cases until day 3-5 after
surgery, then painful phenomena disappeared and started itching, accompanied by a
scratching tendency within 3 days postoperatively. At the pinna ear was found a slight
inflammatory swelling and from the incision drainage a serous fluid. Oedema and secretion
rd
persisted until 3 day postoperative, on day 5 to a crust was present, and on day 7 the crust
was well consolidated and when trying lift it, remained a simply denudated surface, with
slight bleeding.At 7 days after surgery, ear position is normal, respecting specific profile of
breed and congener ear.
We had no cases of postoperative surgical infection or other complications regarding
wound dehiscence. In two cases we observed a reaction of rejection a few sutures in day 5-10
with yellow exudate expressing an aseptic character. Rejection phenomenon was controlled
by local antisepsiawith Betadine solution after draining the fluid expressed, and for sutures
that rejection phenomena were not attenuated in 48 hours we have suppressed the suture. 3-0
Prolene suture that Iused were very well tolerated, to 14 days healing process is completed.
th th
Suppression of suture was performed in the 14 OR 15 postoperative days.

CONCLUSIONS

Auricular hematoma(othematoma) is a traumatic collection located on the convex face of

the auricular pinna, which occurs in most breeds of dogs regardless of age, sex, genaral
status.

41
 Auricular hematoma(othematoma) is a condition if is not adequately treated, unaesthetic
ear sequelae results, and compromise the phenotypic appearance breed specific. Surgical
technique described in this study provide successful healing without unaesthetic
postoperative complications.
Large incision, completely drainage, on time and correctly suture pexy performed and
applied, complete with control and monitoring of patients healing,are the key elements of
successful surgical treatement.
Precocious drainage of the aural hematoma, regardless of its cause, leads to the limitation
of postoperative complications wich compromise aesthestic and cosmetic appearance of the
breed-specific.

REFERENCES

1. AITHAL HP, KINJAVDEKAR P, AMARPAL, MAITI SK, PAWDE AM, SINGH GR.
2000, Treatment of aural haematoma with local administration of dexamethasone in dogs.
Indian Veterinary Journal, 77, 619-621.
2. BOJRAB, MJ, CONSTANTINESCU, GM., 1998,: Sutureless technique for repair of
aural hematoma. Baltimore, Williams and Wilkings, 97-98.
3. CHAKRABARTI A, PAL B, DAS B., 1994, Treatment of a hematoma in the dog. A non
surgical approach. Indian Veterinary Journal, 71 (10), 1229-1230.
4. FOSSUM THERESA WELCH, H. B. SEIM III, C S. HEDLUND, A. L. JOHNSON, K. S.
SCHULZ, M. D. WILLARD, A. BAHR, G. L. CARROLL, 2002, - Small animal surgery,
p.307-310, Mosby Elsevier
5. SOBTI VK, SINGH KI, SAINI NS, SHARMA SN., 1994, A simple surgical technique
for treatment of aural haematoma in dogs analysis of 50 clinical cases. Indian
Veterinary Journal, 71, 1030-1031.
6. SWAIM, SF, BARDLEY, DM., 1996, Evaluation of closed suction drainage for treating
auricular hematomas. Journal of the American Animal Hospital Association, 32, 36-43.

42
Global Veterinaria 11 (1): 44-48, 2013
ISSN 1992-6197
IDOSI Publications, 2013
DOI: 10.5829/idosi.gv.2013.11.1.73196

A Preliminary Report on Aural Hematoma Management with

Auricular Pillow Method
1
O.D Eyarefe, 1C.O. Oguntoye and 2B.O. Emikpe

1
Department of Veterinary Surgery and Reproduction, University of Ibadan, Ibadan, Nigeria
2
Department of Veterinary Pathology, University of Ibadan, Ibadan, Nigeria

Abstract: Background: Aural hematoma management is associated with auricular cartilage scarification, pinna
deformity and recurrence which are unacceptable dogs owners. A simple management method with minimal
anesthetic requirement and postoperative patients stress, coupled with reasonable management cost and
acceptable cosmetic outcomes is presented. Method and findings: Dogs presented at the Veterinary Teaching
Hospital, University of Ibadan, Nigeria, with aural hematoma from January 2012-January 2013 were enrolled.
Each hematoma was incised, drained and the pinna packed over cotton padded hard core as auricular pillow
and supported with a non-adherent compression bandage over the head between 7-12 days. The surgical
outcome of this method was compared with conventional methods used previously from 2002-2011 in the
same hospital. The pinna healed with least scarification and restored morphology. The method has a
comparative anesthetic, patient stress and cost advantages over other conventional methods. Conclusion: The
auricular pillow method of aural hematoma management could be a better approach to the management of aural
hematoma which is still a challenge in most clinical setting.

Key words: Aural Hematoma Pillow Compression

INTRODUCTION shaking or scratching may increase the hematoma causing

An aural hematoma is a collection of blood or serum
within the cartilage plate of the pinna which presents as
fluctuant, fluid-filled swelling(s) on the concave surface
of one or both pinna [1]. It is the most common physical
injury of the pinna with irritation from fly bite, otodectic
mange and otitis as inciting causes [2]. Aural hematoma
ranked eighth among the most common veterinary
surgical procedures in North America [3] and the fifth
commonest surgical conditions in Veterinary practice in
South West, Nigeria [4].
The etio-pathogenesis of the condition is linked
with vigorous head shaking or ear scratching caused by
pain or irritation from trauma, otitis externa [1,5-8], or
neoplasia and sometimes without evidence of ear disease
[9]. This event results in the rupture of the branches of
the caudal auricular arteries that penetrate the cartilage,
or fracture of the auricular cartilage; causing a blood
filled pinna [2]. Often, the bleeding within the cartilage
continues until pressure within the hematoma cavity
equals the pressure of the feeder arteries. Further head
more separation of the cartilage [2]. As hematoma increase
in size, the cushioning effects of the hematoma dissipate
the shearing forces applied by the shaking and
scratching. Delay in treatment leads to hematoma
maturation and with fibrinolysis forms a sanguineous
seroma. With chronicity, granulation tissues form on the
cartilage walls of the hematoma [2] and without treatment,
fibrosis and contraction thickens and deform the ear
(cauliflower contracture) [10].
Several methods have been designed for aural
hematoma management with therapeutic objectives
focused at: identifying and treating the source of
irritation, incision and establishment of drainage,
maintenance of tissue apposition and prevention of
reoccurrence. The Marshall-Putney technique, reported
by Joyce [11], describes a method where an incision is
made on the lateral surface of the pinna and the auricular
cartilage to drain the hematoma. Buttons are then used to
spread the pressure using through and through mattress
sutures. Wilson [12] described a method in which a
needle is used to aspirate the aural hematoma fluid,

Corresponding Author: O.D. Eyarefe, Department of Veterinary Surgery and Reproduction,

University of Ibadan, Ibadan, Nigeria.
44
 Global Veterinaria, 11 (1): 44-48, 2013
followed by flushing of the cavity with saline and
placement of a through and through penrose drain and
attached at each end with non-absorbable sutures.
An alternative method [12, 13] is with the use of a teat
cannula which is inserted at the distal end of the pinna
the drain is often left in situ for 3 weeks. The outcome
using this method was reported to be good in 40 out of 47
cases. Reported complication was related to the patient
removing the tube and poor cosmetic results. Kagan [14]
also reported aural hematoma treatment in nine cases
with an indwelling drain and concurrent compression of
the ear by bandaging the ear to the head for 1014 days.
Fossum et al. [1] reported a treatment method in which
following a full length incision of the hematoma, several
simple interrupted sutures are placed through the concave
surface of the pinna and the underlying cartilage parallel
to the line of incision and the major vessels to obliterate
the dead space. A light protective bandage is placed
over the ear and the ear is supported over the head.
Bandage and sutures are removed in 10-14 days.
Despite various surgical management methods
employed in the treatment of this condition, a
significant number recur with further cartilage
scarification and worsen postoperative cosmetic
outcome [11, 15]. These undesirable outcomes
suggest a need for research in the management methods
for aural hematoma. In this paper, a simple management
Fig. 1: Management of aural hematoma with auricular pillow method
45
method which offered an acceptable cosmetic outcome
is described. The dearth of information in literature on this
method, coupled with comparative advantages of this
method over other widely reported methods informed this
report.
MATERIALS AND METHODS
Materials: Pebbles of varying sizes, cotton wool, a roll of
adhesive tape, cut gauze sponges.
Methodology: Following premedication with intramuscular
injection of 0.1% atropine sulphate (0.04 mg/kg), 3%
pentazocine (2.0mg/kg) and sedation with 2% xylazine
(2mg/kg) and aseptic preparation of the pinna (Figure 1a),
a full length curvilinear incision is made on the
concave side of the pinna over the hematoma (figure 1b).
The hematoma content was evacuated, cavity flushed
with normal saline and examined for cartilage damage
(figure 1b). A sterile pebble of relative to the size of the
hematoma is selected and padded with cotton wool and
further with gauze bandage to serve as auricular pillow.
The pinna was packed with the pillow support at the
convex side and supported over the head with an
adhesive tape (Figure1c). The incision was covered with
a non-adherent compression bandage for wound fluid
absorption and strapped in place with adhesive tape
 Global Veterinaria, 11 (1): 44-48, 2013

(Figure 1d, 1e). The bandage was changed daily Drainage: Drainage was effective. The un-sutured full
within the first three days post surgery during length incision enabled unhindered flow of wound
which wound and drainage effectiveness was exudate. The dorsolateral pressure from the adhesive
assessed and the packing was removed between tape strap also enhanced evacuation of wound fluid
14 and 28 days. (Figure1c).

Comparison with Other Conventional Methods:
The pillow method was compared with the suture and
drains methods on the basis of materials for procedure,
anesthetic requirement, postoperative analgesia, expertise
involved, time involved, cost, chances of recurrence and
cosmetic outcome.
RESULT
With early presentation and proper treatment of the
inciting causes, the authors had an impressive and
acceptable outcome in 100 % of cases. The effectiveness
was assessed by evaluating the following:
Compression: The auricular pillow provided a ventro-
dorsal pressure which was countered by a corresponding
gravitational force and dorso-lateral force from the
adhesive tape strap thus obliterating the dead space
(Figure 1c, 1d).
Cost Implications: The pillow method requires less
surgical materials, drugs, time and expertise compared
with the other conventional methods. (Table1).
Cosmetic Outcome: The pillow method have better
cosmetic outcome compared with the other conventional
methods (Table 1, Figures 2).

Table 1: Comparison of the pillow method with other conventional aural hematoma management methods.
Pillow method Suture method (Fossum et al., 2007) Cannula/Drains method (Wilson, 1983)
Materials for procedure Cotton wool, pebble,adhesive Nylon sutures, cotton wool, adhesive Teat cannula/ penrose drains, cotton wool,
tape, bandage tape, bandage, adhesive tape, bandage,
Anesthesia Mild sedation/analgesia General anesthesia Deep sedation or general anesthesia
Postoperative analgesia Not necessary: operative analgesia Strong opioid due to pain from Strong opioid due to pain from drain
sufficient for post operative pain. skin and cartilage sutures tacking sutures.
Expertise involve low highest lower
Time involved less most more
Inferred cost less Most more
Chances of recurrence Not yet recorded Mostly due to suture granuloma and less
lacerations
Cosmetic outcome Interestingly wonderful Good if there is no poor suture poor
placement and drainage and recurrence
( Cechner, 1990)

Fig. 2A: A dog treated with pillow compression method by the authors. Observe healing with ears erect without
support.
B: Dog treated with suture method

46
 Global Veterinaria, 11 (1): 44-48, 2013
Recurrence: The authors have not recorded recurrence
after the treatment of the inciting cause. The suture
method (Figure 3) has inherence deficiencies such as
suture induced lacerations and granulomas that
encourages recurrence.
Comparison of Pillow Method with Other Conventional
Methods: This was as shown in Table 1.
DISCUSSION
Several methods have been reported in literature for
the management of aural hematoma [7, 12, 14, 16-19].
The disparity in management methods depend on the
management objectives of the clinician/surgeon. The teat
cannula and drains methods [13,14] were suggested for
aural hematoma management with minimal fibrin deposits
[1]. The amount of fibrin deposits in a hematoma,
however, cannot be clinically evaluated without exposure
of the hematoma cavity. This deficiency coupled with lack
of compression of dead space and continual trauma to the
auricular cartilage from head shaking often makes this
method non-satisfactory and prone to poor cosmetic
outcome [14]. A full length hematoma incision with
drainage and suture placement has been reported by
some authors [1]. The method was used to achieve
drainage and compression objectives and has been used
by the authors too (Figure 2B). The deficiencies in the
method include: the need for general anesthesia and a
strong postoperative analgesia due to the associated
pain. It also requires placement of several sutures on the
fractured and traumatized auricular cartilage to occlude
dead space. Besides, following healing, the sutures cut
through the auricular skin resulting in lacerations, further
irritation and hematoma recurrence (Authors personal
observations). Also, recurrence and permanent scaring
may result from poor drainage, poor suture placement, or
inadequate suture numbers [7].
The method presented in this paper is a modification
of surgical incision, drainage and compression bandage
method [18]. The pillow method satisfies the three basic
principal objectives (Drainage, compression and auricular
cartilage healing) emphasized in aural hematoma
management [12]. The full length incision enhances
complete evacuation of hematoma contents and
evaluation of the auricular cartilage for extent of damage.
Drainage is further enhanced by non-closure of the
incision and a dorsal-lateral force produced by the
non-adherent compression bandage and adhesive tape
strips placed over the pinna and anchored to the head.
47
Compression is further produced by the dorsal-ventral
gravitational force and a counteracting ventro-dorsal
reaction force from the pillow in accordance with
Newtons third law of motion [20]. The combination of
drainage, compression and packing produces auricular
cartilage quiescence and rest from trauma induced
violent headshaking leading to cartilage healing and
restoration of pinna morphology following the procedure.
Although the use of a pebble as the pillow hard core may
be unacceptable in some modern setting, the pebble may
be replaced with a more suitable material to satisfy the
principle and achieve the objective of placement. It is
noteworthy however, that pebbles are universally
available materials which could be obtained at no cost
for the procedure especially in a poor resource setting.
The auricular pillow method with its characteristic better
drainage, compression, less cost of materials and minimal
expertise, coupled with appreciable cosmetic outcome
could be a better approach to the management of aural
hematoma which is still a challenge in most clinical
settings.
REFERENCES
1. Fossum, T.W., S.H. Cheryl, A.L. Johnson,
K.S. Schulz, H.B. Seim, M.D. Willard, A. Bahr and
G.L. Carroll, 2007. Aural hematomas and Traumatic
lesions of the pinna. In Textbook of Small Animal
Surgery 3rd Edition : Eds.,Theresa Welch Fossum:
Elsevier science, Morsby Inc Publishers, pp: 307-312.
2. Henderson, R.A. and R. Homes, 2002. Pinna. In
Textbook of small animal surgery 3rd edition.
Eds., Slatter Douglas: Saunders W.B. Publishers,
2: 1737-1740.
3. Johnson, A.L., C.L. Greenfield, L. Klippert,
L.L. Hungerford, J.A. Farmer and A. Siegel, 1993.
Frequency of Procedure and Proficiency expected of
new Veterinary School Graduates with regard to
Small Animal Surgical Procedures in private practice.
Journal of American Veterinary Medical Association,
202: 1068-1070.
4. Eyarefe, O.D., T.O. Alonge and E.O. Fayemi, 2011.
The incidence of intestinal obstructive diseases in
selected veterinary clinics and hospitals in South
Western Nigeria. Nigerian Veterinary Journal,
32(1): 36-39.
5. Dubielzig, R.R., J.W. Wilson and A.A Seireg, 1984.
Pathogenesis of Canine Aural Hematoma. Journal
of American Veterinary Medical Association,
185: 873-875.
 Global Veterinaria, 11 (1): 44-48, 2013
6. Fraser, G., W.W. Gregor, C.P. Mackenzie,
J.S.A. Spreull and A.R. Withers, 1970. Canine ear
disease. Journal of Small Animal Practice, 10: 725-754.
7. Cechner, P.E., 1990. Suture technique for repair of
aural hematoma. In Current Techniques in Small
Animal Surgery. 3rd Edition; Eds., M.Joseph
Bojrab: Lippincott Wlliams & Wilkins publishers,
pp: 133-135.
8. Mikawa, K., T. Itoh, K. Ishikawa, K. Kushima,
K. Uchida and H. Shii, 2005. Epidemiological and
Etiological Studies on 59 Aural Hematomas of 49
Dogs. Japanese Journal of Veterinary Anesthesia &
Surgery, 36(4): 87-91.
9. Joyce, J.A., 1994. Treatment of canine aural
hematoma using an indwelling drain and
corticosteroids. Journal of Small Animal Practice,
35: 341-344.
10. Eger, C.E. and P. Lindsey, 1997. Effects of otitis on
hearing in Dog characterized by brain stem auditory
evoked response testing. Journal of Small Animal
Practice, 38: 380.
11. Joyce, J.A., 2000. Canine Aural hematoma. Waltham
focus, 10(4): 4-9.
12. Wilson, J.W., 1983. Treatment of auricular hematoma,
using a Teat-tube. Journal of American Veterinary
Medical Association, 182: 1081-1083.
13. Swain, S.F. and D.M. Bradley, 1996. Evaluation of
closed-suction drainage for treating auricular
hematoma. Journal of American Veterinary Medical
Association, 32: 36-43.
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14. Kagan, K.G., 1983.Treatment of canine aural
hematoma with an indwelling drain. Journal of
American Veterinary Medical Association,
183: 972-974.
15. Kuwahara, J., 1986. Canine and feline aural
hematoma: clinical, experimental and
clinicopathologic observations. American Journal of
Veterinary Research, 47: 2300-2308.
16. Swaim, S.F. and D.M. Bradley, 1996. Evaluation of
closed-suction drainage for treating auricular
hematomas. Journal of the American Animal
Hospital Association, 32(1): 36-43.
17. Dye, T.L., H.D Teague, D.A. Oswald and
S.D. Ferreira, 2002. Evaluation of a technique using
the carbon dioxide laser for the treatment of aural
hematoma Journal of American Animal Hospital
Association, 38(4): 385-390.
18. Bojrab, M.J. and G.M. Constantinescu, 1990.
Sutureless technique for repair of aural hematoma.
In Current Techniques in Small Animal Surgery. 3rd
Edition; Eds., M.Joseph Bojrab: Lippincott Wlliams
& Wilkins publishers, pp: 135-136.
19. Blattler, U., O. Harlin, R.G. Matterson and
F. Rampelberg, 2007. Fibrin sealant as a treatment
for canine aural haematoma: a case history.
Veterinary Journal, 173(3): 697-700.
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 Aural Haematoma And Its Surgical Management In Non
Discript Cat
*Chethana.D.H, Shwetha.K.S, Narasimha Murthy and Shashwath.B.S
D Veterinary Clinic
#4/1, 10th Cross, 10th Main, HBR 5th Block, Maruthi Layout, Hennur Cross, Bangalore-43
*Corresponding Author: Dr.Chethana.D.H

Abstract
A Six years old female cat presented to private clinic, Bangalore with complaint of swollen
at left ear flap since two days, associated with ear scratching since many days. On examination the
left ear pinna was swollen, soft to touch and evinced pain on palpation. The condition was
diagnosed as the aural haematoma. Linear incision was made on the swollen part and removed
blood clots and fibrin debris and ear flaps are closed by horizontal suture pattern and with post
antibiotic therapy finally pet was recovered uneventfully.

Key words: Cat, Scratching, Haemotoma.

I. Introduction
An aural hematoma is the accumulation of serosanguineous fluid or blood within the pinna. It
is frequent disorder in dogs, cats and pigs. Aural hematomas are the most common physical injury of
the pinna and they are most apparent on the pinnas concave surface. When Pets vigorously shake
their heads or scratch their ears, trauma to the ears causes the blood vessels and capillaries in the
pinna to rupture (Henderson et al., 2003). When these vessels break blood pools in the space between
the skin and cartilage, creating a hematoma. This condition is usually unilateral, but it can be
bilateral. Hematomas should be drained as soon as possible. If they are left untreated, fibrin
formation can occur, leading to fibrosis, contraction and thickening, potentially leaving the ear with a
deformed cauliflower-like appearance (Medleau and Hnilica, 2006).
There are various methods of treatment for the arual haemotoma include Simple aspiration is
the most conservative treatment and relieves acute pain, but recurrence is common. Surgical drainage
decreases procedure. This method is best method and it includes Silastic drain placement, Teat
cannula placement, closed suction catheter system, Incisional drainage, Carbon dioxide (CO2) and
laser procedure.

II. Clinical Observation

Female cat about six years presented to veterinary clinic with a history of scratching of left
ear since so many days and swollen era flap since 2 days, no history of external trauma, but intense
head-shaking and sudden increase in the size of the ear flap was noticed by owner.
On physical examination oral and congectival mucosa was normal, rectal temperature: 101.5 0F,
heart rate: 80 beats/min, respiratory rate: 19 /min, capillary refill time about <2 s. The swollen left
ear was hot to touch and pet was evinced pain on palpation. Based above parameters it was
diagnosed as the aural haematoma of left ear pinna. Pre surgical haemato-Biochemical parameters
were within normal range.

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 International Journal of Applied and Pure Science and Agriculture (IJAPSA)
Volume 02, Issue 07, [July- 2016] e-ISSN: 2394-5532, p-ISSN: 2394-823X

III. Treatment
Food and water withhold for 12hr before surgery. Pet was weighing around 3 Kg, Pet was
subjected to pre-anaesthesia include atropine sulphate 0.02mg/kg and ceftriaxone 25-30 mg/kg body
weight subjected general anaesthesia with a combination of both xylaine(4mg) and Ketamine
(30mg/kg). Surgical site was aseptically prepared with alternative of both povidone iodine and
surgical spirit. Elliptical incision was made on the affected part, followed by opening of the ear flap
and removed all the blood clots, debris and flushed with counter irritant (iodine solution 5%) and
finally affected part was scarified with BP blade. Both ear flaps skin closed with simple horizantal
interrupted sutures pattern using non-absorbable suture material (Trulon R). wound dressed with
povidone iodine ointment and bandaged with cone pattern. Pet was recovered within 15 minute after
the surgery and for post operatively gave melaxicam 0.2-0.3 mg/kg. Advised the owner to follow
Syrup SPORIDEXR 125 mg bid for seven days with every alternative day wound dressing finally
suture removed on 10th day after surgery.

Fig. 1 Swollen ear flap Fig. 2 Horizontal suture pattern

Fig.3 Cone bandage Fig.4 Removing of suture on 10th day

IV. Discussion
Aural haematoma frequently observed in dogs, cats ,pigs and rarely occurring some times in
sheep mainly because of scabies. In canine and feline practices different procedure are there for
treating the aural haematoma. Normally suturing will be done by passing the needle through and
through the skin of the ear flap, since this pattern causes shrinking and disfiguration of the ear pinna.
In the present case, we followed simple interrupted horizontal suturing pattern without involving the
skin of the dorsal surface of the ear pinna. There are different techniques are available for the
treatment of aural haematomoa in cats but the treatment procedure followed in the present case
seems to be very safe and right technique.

@IJAPSA-2016, All rights Reserved Page 2

 International Journal of Applied and Pure Science and Agriculture (IJAPSA)
Volume 02, Issue 07, [July- 2016] e-ISSN: 2394-5532, p-ISSN: 2394-823X

Bibliography
[1] Henderson RA, Horne R. Pinna. In: Slatter D, ed. Textbook of small animal surgery. 3rd ed. Philadelphia, Pa:
Saunders, 2003; 1737-1741.
[2] Medleau L, Hnilica KA. Small animal dermatology: A color atlas and therapeutic guide. 2nd ed. Philadelphia, Pa:
Saunders, 2006.
[3] Dawn E. Logas and Jamie R. Bellah In: Diseases of the Ear chapter 107. Diseases of the External Ear and Pinna. pp
no 1045-1054.

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