CHAPTER 1 Miscellaneous Abnormalities of the Calf Kyle Ortved (The editors wish to acknowledge and thank prior author Or. Gary M. Baxter) RE ‘The umbilicus in calves consists of the urechus, umbilical vein, and paired umbilical arteries (Figure 19-1) ‘These latter structures are often referred to as the umbilical rem rants, The rachus, umbilical vein, and umbilical arteries formally regress after birth to become a vestigial part of the bladder apex, round ligament of the lice, and lateral ligee ments of the bladder, espectively. Infection (subestaneous abscess or disease within the umbilical yemmants), herniation (wonstrangelating or strangulating), or a combination of infection ind herniation sre the primary problems associated with the umbilicus in calves, Each of these problems usually causes enlargement of the mbites; therefore an umbslscal thas is not always synonymous with. an umbilical hernia, Infection of the umbilicus or umbilical cord remnants often ‘occurs in the neonatal period as a result of environmental contamination, but the umbilicus may also be seeded with bcteria froma generalized septicemia/bacteremis. Common bacterial sclates from umbilical infections in calves include Trueperella pyogenes acd Escherichia coli. Ural hernias are the most common bovine congenital defect, with reported incidence between 0.05% and 1.049 (Hayes, 1974). ‘They ean occur in any breed, although they appear to be ryt omen in Hien rican ete The ate en lassfied as uncomplicated vervus complicated, depending on whether a secondary infection exist * ‘Umbilical masses in calves may be divided into five catego 1. Uncomplicated umbilical hernias 2% Unbieal “hernias "with “subcutaneous infection! 3, Umbilical hernias with gmbilical remnant infections 44. Umbilical shecesses/chronic omphalitis 5. Urachal cysts/ruptures Calves with an umbilical shscess or enlarged umbilical stalk may not have concurrent umbilical hernias but may have clinical signs similar to calves with hernias because of the enlarged umbilicus. However, a combination af the history, signalment, and physical examination of the animal is u ally sufficient to accurately diagnose the problem and dif- ferentiate between calves with and withost hernias, Viswal inspection of the mass should be performed to evaluate the size, shape, color, and presence of drainage, Palpation of the mass for consistency, temperature, and presence of pain, should be performed. The presence of a complete or incom= plete hernial ring and reducibility of the contents within the mass should also be determined, Placing the calf in lateral or dorsal recumbency may facilitate deep palpation of the ‘mass (Figure 19-2). Additionally, ultrasound may be per- formed to evaluate the umbilicus, which is especially 540. beneficial in documenting abnormalities in the umbilical remnants (Figure 19-3). There is usually a good correlation between ultrasonographic and surgical findings of infected ‘umbilical remnants in calves. Uncomplicated Umbilical Hernias Uncomplicated umbilical hernias are considered hereditary in cattle and most commonly occur in the Holstein-Friesian breed. Beef cattle appear to be at lower risk of developing ‘umbilical hernias than dairy cattle, These hernias are usually present during the first few days of life and typically enlarge ‘uniformly asthe calf grows. The umbilical mass s completely reducible with « palpable circumferential hersial ring. The hhernial sae may contain antestines (enterocele), abomasum (oet commonly) and omentum, or all three (Figure 15-4). Calves with these hernias are asualy in good condition and rarely show signs of gastrointestinal dysfunction, Strangulation of the small intestine, omentum, or aboma~ sum within the hemial sac is possible, although rare (igure 19°54 and B). Affected calves usually demonstrate signs of abdominal pain and have metabolic derangements (hypochloremic, hypokalemic metabolic alkalosis) caused by sequestration of chloride and hydrogen ions within ‘the abomseal lumen, Chronic hernise may also develop an shomasal-smbiliel fistula in which chloride is lost from the abomasal lumen, resulting in dehydration and metabolic abnormalities (Figure 19-0 and B). Depressed, sick calves with metabolic abnormalities should be stabilized with Buids to correct the metabolic problem before surgery is performed ‘Most calves presented for repair of umbilical hernias are less than 6 months old and have hernias less than 10-em in. length. Conservative treatment options for uncomplicated hernias include hernial clamps, elastrator bands, abdominal support bandages, local injection of irritants around the heenial ring, and daily digital palpation to ieitate the ring. Hernial clamps, elastrator bands, and support bandages are only recommended when the hersia is less than 5 em long, completely reducible, and free from evidence or history ot infection. Support bandages are more effective in calves than, foals because the bovine umbilicus is more cranial and the abdomen more pendulous, preventing caudal slippage of the bandage. Most umbilical hernias longer than 5 em or dem onsteating any evidence of pathology should be repaired sar- ically with an open herniorrhaphy. Umbilical Hernias with Localized Abscesses/Subcutaneous Infection Calves have a higher prevalence of infection associated with umbilical herniae than do foals, This difference may be related to improper care of the umbiliews, increased environ mental contamination, and partial or complete falure of passive transfer, Unlike foals, calves with umbilical infec- tuons do not usually develop septicemia or a patent urachus. Instead the infection remains localized to the umbilicalCHAPTER 19) Figure 1941 A fetus at postmortem showing the umbilical remnants going toward the liver umbilical vein) and urinary bladder (umbilical arteries) Figure 19-2 Palpation of the umbilicus with a calf in lateral recumbency can help discern the nature of the umbilical problem. area. In one study 45% of calves presented for repair of umbilical hernias had evidence of concurrent infection, such as umbilical remnant infections, omphalitis, and subcutaneous abscesses and cellulitis, Calves with an umbilical hernis asso- ciated with subcutaneous infection usually have a history of an enlarged umbilical cord since birth, but the umbilical mass is not present until the calf is seversl weeks old. The calves are generally in good condition, and careful palpation of the mass reveals a reducible dorsal hernia and a tm, nonreducible ventral portion attached to the skin (Figure 19-7), Although there may be local evidence of inilamma- ‘ton, drainage is usually absent, and the hernsal ring is pal- pable. Many of these hernias may be acquired secondary infection-induced weakening of the body wall Surgical removal of the abscess or area of cellulitis or fibrosis, together with repair of the hernia, s the treatment of choice. An open herniorthaphy is recommended because the subcutaneous abscess may extend into one of the rem- nants of the umbilical cord, necessitating mare extensive excision (Figure 19-84-C). In addition, adhesions that involve the greater omentum or abomasum may be present + Miscellaneous Abnormalities of the Calf Sal Figure 19-3 Ukrasound of the umbilicus in a 5-month-old Holstein heifer calf with a large umbilical abscess. Figure 19-4 Schematic diagram of the abomasum protrud- ing into an umbilical hernia, and requite resection. An open herniorthaphy also facilitates closure of the abdomen by eliminating redundant soft tissue (the hernial sac) in the suture line and the need to invert the ‘ombilical remnants Umbilical Hernias with Infection of the Umbilical Cord Remnants Umbilical cord remnant infections include omphalophlebi- tus, omphaloarteritis, and infection/abscessation of the ura chus. More than one umbilical cord remnant may be infec infected umbilical cord remnants, but is, Streptococcus, and Stapkyloo ied. Consequently, drainin coli, Froteus, Entero us species may also be ts should be cultured542 PARTIM © Calf Figure 19-5 A, Nonreducible umbilical hernia in a 3-month- old cat, 8, Small intestine that was trapped in the nonreduc ible hernia. A resection and anastomosis were performed. before surgery of the infected umbilical remnant or abscess cultured alter excision ‘The usual history in calves with umbilical hernias and remnant infections is intermittent purulent drainage from the umbilicus beginning at | to 2 weeks of age, The drainage is often followed by a rapidly enlarging mass several weeks ser. These calves ae often unthrifty and small for their ages and may have concurrent infectious diseases, such a8 septic arthritis, pneumonia, peritonitis, or bacteremia. A complete Dlood count may indicate hyperfibrinogenemia, hyperpro- teinemia, neutrophil-lymphocyte reversal, and mald anemia. ‘The umbilical mass is usually large, broad-based, painful to palpation, and only partly reducible, and the hernial ring is incompletely palpable. In small ealves, deep palpation of the shdomen with the animal in lateral or dorsal recumbency may reveal an enlarged, infected umbilical remnant. An infected enlarged umbilical vein courses dorsocranially toward the liver, and the infected rach or umbilical arter ies course caudodorsally toward the us intemal lige arteries, respectively. Howe the ventral abdomen is the ideal method to document an slmormality in the umbilical remnants, In one study there was good to excellent correlation between ultrasound find ings and actual physical (Surgical or postmartem) findings of the umbilical structures. However, ultrasound was unreli able in documenting concurrent intraabdominal adhesions ‘ Figure 19-6 4, A 1-month-old calf with an abomasal fistula. The calf had a hypochloremic metabolic alkalosis. A belly bandage was applied and surgery was done the following day. B, The calf at surgery. The pyloric part of the abomasum 's evident. sssociated with these infections, which were present in 47% ff the animals in the study. In foals there are reports of wsing laparoscopy to evaluate and, in some instances, ligate and/or resect umbilical cord remnants Unbilical hernias in calves complicated by infections of umbilical cord remnants have been reported to occur in approximately 24% of cases. This figure was calculated from animals presented for surgical repair on umbilical hernias and does not inckide calves that were successfully treated with conservative measures in the held, Therefore this per- centage may reflect an overestimation of the true prevar lence of infections of umbilical cord remnants among all calves with umbilical masses. However, umbilical remnantCHAPTER 19. « Figure 19-7 A3-month-old calf with an umbilical hernia and a draining tract with a fibrous cord ascending toward the urinary bladder. Figure 19-8 A, Removal of a draining tract at the umbilicus iat leads to a large omental abscess. 8, The abscess removed. C, The abscess opened. Miscellaneous Abnormalities of the Calf 543 infection should be suspected in calves with large umbilical masses, especially f the animal is unthrifty. ‘The urachus is the most frequently infected umbilical remnant associated with umbilical masses in calves ( ). Dysuria, pollakiuria, pyuria, and eystitis are all poten: tial sequelae to urachal abscesses/infections in calves. These clinical signs may occur because of direct communication between the abscess and bladder lumen or by mechanical interference with normal bladder filling and emptying. For alll surgery that involves umbilical remnant infections, the surgeon should be prepared to extend the incision and drape the site accordingly in some of the urachal infections that extend to the bladder, the trachal stalk and Inmen of the bla tunctly separsted. Surgical excision of the infected urachus combined with repair of the hernia is the treatment of choice. Urachal infections that extend to the bladder require excision ofthe apex ofthe bladder and ligation af the umbil- cal arteries ( ). The entire urachus, umbilical Abscess in rach: Urachal remnant. The urachs is the most commonly inf ‘umbilical remnant, Figure 19-10 The urinary bladder oversewn following removal of a draining tract that involved the urachus, umbil ical artery remnants, and apex of the urinary bladder.344 PARTIM © Calf arteries, hernial tissue, and overlving skin are removed cn loc to prevent contamination of the abdomen. ‘Omphalophlebitis may be localized along the umbilical vein or may extend the entire length of the vein and involve the liver, Infection that progresses to the liver can result in multiple liver abscesses, septicemia, bacteremia, and ‘unthriftiness. Localized umbilical vein abscesses that do not involve the liver can usually be surgically ligated and removed en bloc (Figure 19-11). This is ideal and preferable if the infection is localized. Umbilieal vein abscesses that extend to and involve the liver ate handled by a matsupialization technique. The abscess is exited from the abdomen through 4 Separate incision in the right-paramedian area of through the cranial aspect of the ventral median incision (igure 18-124 and #). With either technique, the wall of the infected umbilical vein must be secured to the ventral body swall in a two- or three-layer closure to prevent leskage and peritonitis. The advantages of incorporating the vein within the existing ventral incision are that only one abdominal incision is required and the infected umbilical vein does not need to be passed intraabdominally to 2 paramedian posi: ton, whereas the disadvantage is the entire incision could Decome contaminated. After surgery, the marsupialized tract is irigated with dilute povidone iodine until closure by second intention. However, the tracts should not be lavaged under pressure, especially in calves younger than 2 months of age, because the lavage solution may enter the systemic circulation through the liver and cause serious adverse reac- tions. Both marsupialization techniques have been reported to be very successful at resolving umbilical vein infections in cealves. In addition, the umbilical vein stalk may be subse ‘quently removed en bloc at a second surgery once the infee- tion has completely resolved. The authors have tried to avoid marsupialization in more recent cases by resecting as much of the infected tract and treating the animal with antibiotics for a longer period of time. Omphaloarteritis is the least common infection of an ‘umbilical cord remnant. Normally, the umbilical arteries retract into the abdomen a& birth, thus minimizing the risk of infection. One or both arteries may be infected anywhere slong their course. Intestinal strangulation is reported to be an ancommon sequela of omphaloarteritis, Surgical ligation and resection of the involved arteries, umbilical mass (and, at times, resection of the apex of the urinary bladder), and overlying skin during repair of the umbilical hernia 1s the treatment of choice, The omentum may be adhered to the arteries, requiring careful dissection and ligation Umbilical Abscesses/Chronic Omphalitis Umbilical abscesses are common sequelae to cizcumseribed fomphalitis, The umbilical mase often occurs shortly after birth but may develop any time between birth and 2 years of age. Similar to calves with infections of umbilical rem- nants, these calves are often unthrifty and may have evidence of infectious diseases in organs remote from the umbilicus. ‘The umbilical mass is usually warm, painful to palpation, nonredcible, and firm or fluctsant. No hernial ing is pal- pable and drainage is uncommon (Figure 19-13). Diagnosis ff an umbilical abscess is based on physical examination, characteristics of the umbilical mass, and aspiration of pur. Tent material from the mass. Ultrasound may also be used to document the presence of purulent material within the ‘umbilicus. Most umbilical abscesses will respond to drainage and lavage of the abscess cavity (Figure 19-13B-D), Systemic sntimicrobials may or may not he indicated. Chronic infec- tion of the umbilicus may lead to a thickened, fibrotic umbil- sical stalk that may appear similar to an abscess. The need for surgery depends an how well the infection responds to mecical treatment and the cosmetic appearance required. IF the abscess recurs, the possibility of the infection extending into the umbilical cord remnants must be considered, and Figure 19-11 Schematic illustration of a localized infection within the umbilical vein, This abscese could be completely resected at surgery Figure 19-12 A, Marsupialization of a large, infected umbili- cal tract ascending to the liver and arborizing into the parenchyma. 8, A schematic diagram of the marsupializa- ‘Yon technique.CHAPTER 19) Miscellaneous Abnormalities of the Calf 545, Figure 19-13 A, Large umbilical abscess that was nonreducible, warm, and painful. 8-0, Draining the umbilical abscess after aspiration and confirming the presence of purulent material. ssargical removal is indicated. However, initial drainage of purulent material is essential, ‘An open herniorrhaphy with complete removal of the abscess is recommended. A fusiform incision is made sround the border of the abscess, and the subcutaneous tissue is sharply dissected to expose the lines alba. The abscess cavity should not be entered. A small incision is made into the aldomen either cranial or caudal to the base of the abscess to permit digital palpation of the umbilical cord remnants If the infection extends intraabdominally, the abdomen is ‘opened further, and the involved umbilical remnants are removed along with the abscess. If the abscess is localized, the capsule and all adherent tissue are extirpated. The inct- sion is closed as described for a routine herniorshaphy Urachal Cysts/Ruptures Several anatomic abnormalities of the wrachys may ocesr in all species and have been reported in cattle. Urachal eyste have been found in calves with umbilical masses/hernias and should be included as a differential diagnosis in calves with ‘nonreducible umbilical masses. Urachal eysts can be imaged with ultrasound and the diagnosis confirmed at surgery. In fone calf, the urachal cyste ruptured into the subeutancous issues around the umbilicus subsequent to attempts to reduce the umbilical swelling The subcutaneous urine caused severe tissue inflammation around the umbilicus with necrasis ofa small area of skin, Rupture of the urachus into the subcutaneous space occurs in foals but is uswally not associated with a urachal eyst, Itis thought to be a result of traumatic fosling, with evidence of umbilical swelling and subcutaneous seine accumulation very soon after birth ‘The other main urachal anatomic defect is failure to invalute or disappear after birth. The typical noninfected patent or persistent urachus with dibbling of urine seen sn neonatal foals is very uncommon in neonatal calves. A persistent ‘urachus consisting ofa thin band of tissue has been reported ‘to cause small-intestinal strangulation in an adult cow. Addi onal, rupture of a persistent urachus that communicated swith the lumen of the bladder resulted in uroperitoneum in 8 yearling bull. Similar anatomic or congenital abnormalties of the umbilical vein and arteries in ealver have not been reported.346 PARTIM © Calf DIAGNOSIS most calves ean be determined from physical examination of the animal end close inspection of the umbilical region. Calves placed in lateral recumbency relax their abdomen, which permits deep palpation of intraabdominal lowever, ultrasonography of the umbilicus is recommended ‘in most cases to document the diagnosis and determine the site(s) and severity of the infection preoperatively in cases of concurrent infection, Enlargement of the internal umbilical structures and the presence of echogenic material (fluid and fr gas) usually confirms the diagnosis of infection within the ‘umbilical remnants, However, normal ultrasonographic nd: ings do not always indicate the absence of infection, and ultrasound cannot be relied on to always accurately assess the presence of intraabdominal adhesions. SURGICAL MANAGEMENT ‘The appropriste management of patients with umbilical -asses/hernias depends on accurate preoperative diagnosis, As previously stated, small, uncomplicated umbilical hernias and many umbilical abscesses may ot require. surgery ‘Uncomplicated umbilical herniss requiring surgery can be repaired with the calf in dorsal recumbency using se Uuoa {xylazine hydrochloride) and a local anesthetic. If infec tion oF some other problem associated with the umbilical ras is identified or likely, surgery shosild be performed with the animal under general anesthesia because of the increased sargery’ time and potential for complications, Inhalation general anesthesia is preferred, but intravenous combinations Fach as xylazine hydrachloride-ketamine hydrochloride, valium ketamine hydrochloride, or xylazine hydrochloride ketamine hydrochloride-gusifenesin may be used to help reduce expense. Proper preoperative management of abscesses, omphali- tis, and infections of umbilical cord remnants may decrease the potential for contamination and the duration of surgery. Large abscesses should he drained or aspirated and treated medically with antimicrobials for several days before surgery to decrease their size and minimize the aumber of bacteria, Draining traets should be Tavaged and given time to heal before surgery, if possible. Otherwise, they should be over- sewn at the beginning of surgery to minimize contamination. Infected umbilical vemnants and abscesses should be resected en bloc if possible to prevent contamination of the abdomen and incision If infection is confirmed or possible, antimicro: bale should be given before surgery and continued after suargery if needed. Antimicrabials should be based on the results of a culture and sensitivity, but procaine penicillin and/or ceftiofur are effective against most bacteria assaci- sted with umbilical infections in calves Small, uncomplicated hernias in calves can be repaired with a closed herniorshaphy (peritoneum is not opened) similar to that performed in foals, However, compared with a closed herniorrhaphy, an open herniorthaphy often takes less time, is less traumatic, allows inspection of the abdomi- nal viscera, and permits removal of the smbilieal remnants if considered necessary. Before surgery, the external opening of the umbilicus and prepuce are oversewn to prevent con tamination of the surgery site. A fusiform incision is made around the umbilicus using a scalpel. A combination of blunt and sharp dissection with or without electrocautery to control bleeding is used to expose the hemnial ring. The abdomen is entered cranial or lateral to the umbilical stalk to permit digital palpation of intraabdominal structures. The scarred edge of the hernial ring is sharply incised together swith the peritoneum, In cases with umbilical remnant infec ‘tons, the umbilical vein and arteries are ligated above the site(s} of infection, and the urachus is excised along with the apex of the bladder. The bladder is closed routinely. Com- plete removal ofthe infected umbilical remnants in situ can Usually be performed except with severe infections of the umbilical vein. Simple apposition of the unscarred hernial ring with minimal tension is thought to lead to ideal healing. Several suture patterns may be used, but simple interrupted, interrupted cruciate, or simple continuous patterns are used most commonly. In most eases absorbable suture material sich as polyglactin 910, polydioxanone, or polyglycolic acid is recommended to close the body wal, In larger defects, tension-relieving sutures such ar near-far-far-near placed at regular intervals may help appose the two sides. In an older animal, withholding solid food for 36 to 48 hours reduces ‘the rumen volume and greatly facilitates body wall closure. Large hernias (greater than 15 em) and hernias unswceess- fully repaired previously are often candidates for mesh her- piorshaphy (Figure 19-14). Polypropylene (Marlex) or plastic (Proxplast) mesh products are the most commonly used, although plastic mesh is less expensive than polypropylene In addition, plastic mesh is less elastic and decreases the mount of sagging seen alter surgery. A fascial overlay te nique is recommended for placing the mesh (Metlwraith and Robertson, 1998), Briefly, a semielliptical incision is made slong one side of the hernial ring. The skin, subcutaneous lisse, and Bbrows hernial sac are reflected across the hernial defect to expose the opposite hernial ring. Usually the peri- toneum is adhered to the hernial sac and ss incised. A double layer of mesh is placed either retraperitoncal or between the incised edges of the hernial ring (Figure 19-15), The mesh is secured circumferentially around the hernial ring with inter- rupted horizontal mattress sutures, making certain the mesh is taut, The reflected hernial fascia, subeutaneows tissue, and skin are placed over the mesh and closed routinely. Antim crobial therapy should be used for mesh heriorrhaphies because of the increased risk of infection associated with mesh implantation, Figure 19-14 The umbilical hernia in this Holstein calf had been repaired two previous times without success. ThCHAPTER 19) Figure 19-15 Placement of the mesh within the hernial defect in the calf in Figure 19-14. The plastic mesh was doubled, placed retroperitoneal, and secured to the hernil ring ‘with nonabsorbable suture material. A fascial overlay technique ‘var ured for the mesh herniorshaphy in this calf COMPLICATIONS Postoperative complications of umbilical herniorrhaphy are ‘more numerous in calves than in foals, probably because concurrent infection is more common in calves with umbili- cal hernias Most complications are related to incisional problems such as suture abscesses, seromas, hematomas, and dehiscence. The majority of these problems usually do not sffect the success of the surgery unless the local infection is severe enovigh to cause fare of the bady wall closure and recurrence of the hernia, The more ventral location of the suture line and the greater weight distributed across it in calves compared with foals may lead to a higher risk of inci- sional dehiscence in calves. Abdominal support bandages ‘may help prevent reherniation if the abdominal wall appears weak at surgery; however, good surgical technique and limited postoperative activity ate the most important factors in preventing body wall dehiscence. Peritonitis is more serious potential complication and is usually associated with, severe contamination of the abdomen during surgery or with foci of intraabdominal infection that were incompletely removed at surgery. This complication is most likely in calves swith umbilical vein infections invelving the liver, Although these postoperative problems are possible, most calves do very well after umbilical herniorshaphy with a favorable prognasis for a productive life RECOMMENDED READINGS Baxter GM: Umbilical masses i ‘and complications, Compen 505-513, 1989, Boure L, Marcoux M, Laverty S: Laparoscopic abdominal anatomy of foals positioned in dorsal eecumbency,, Vet Surg 25:1-6, 1997 Edwards RB, ‘Fubini SL: A one-stage marsupialization procedure for management of infected umbilical vein remnants in calves and foals, Vet Surg 24:32-35, 1995. Fischer AT Jr: Laparoscopically assisted resection of umbili- ‘eal structures in foals, J Am Vet Med Assoc 214:1813— 1816, 1999) salves: diagnosis, treatment, ‘Contin Educ Pract Vet 11 Miscellaneous Abnormalities of the Calf 347 Hayes HM: Congenital umbilical and inguinal hernias in cattle, horses, swine, dogs and cats isk by breed and sex smong hospital patients, Am J Vet Res 35:839-842, 1974, ischer CJ, Iselin U, Steiner A: Ultrasonographic diagnosis of urachal eyst in three calves, J Am Vet Med Assoc 204:1801-1804, 1994 Mellwraith CW, Robertson JT: Herniorthaphy using sy thetic mesh ‘and a fascial overlay. In. Equine surgery advanced techniques, ed 2, Philadelphia, 1988, Williams & Wilkins, pp 365370. Staller GS, Tulleners EP, Reef VB, Spencer PA: Concordance of ultrasonographic and physical ndings in cattle with an tumbilical mass or suspected to have infection of the ‘umbilical cord remnants: 32 cases (1987-1989), J Am Vet Med Assoc 205:77-81, 1995, Steiner A, Lischer CJ, Oertle C: Marsupialization of umbil cal vein abscesses with involvement of the liver in 13 calves, Ver Surg 22:184-189, 1993 ‘Trent AM, Smith DE: Surgical management of umbilical Imasses with associated umbilical remnant infections in calves, J Aim Vet Med Assoc 185:1531-1534, 1984, Watson E, Mahaffey MB, Crowell W, et al: Ultrasonography ‘of the smbilieal steuctures in clinically normal calves, Ae J Vet Res 35:773-780, 1994 OTITIS MEDIA/INTERNA: CALVES ‘Thomas J Divers and Norm 6. Ducharme (he editers would keto express their thanks to Dr. Brett Wood co-author of the previous elton) (Otitis media interna (M/1) is a very common disorder of ‘young dairy replacement calves and veal calves. The majority of eases seen are in calves 3 to 8 weeks of age. It can be a farm problem and may commonly oecur concurrently with respiratory disease and occasionally with septic arthritis Mycoplasma bovis is the organism most often implicated in the disease process, and the disorder is particularly common in veal calf operations and in dairy herds with Mycoplasma bovis positive bull milk cultures. Anatomical and Pathophysi Considerations ‘The middle ear is comprised of the tympanic cavity and suditory tubes lined by mucous membrane. The tympanic cavity, located between the tympanic membrane and inter- nal ear, consists of three parts: the atrium, the epitympanic recess (which contains most of the auditory ossicles}, and the large tympanic bulla (Figure 1-164 and B). The fimetion of the middle car i to transmit sound waves that reach the tympanic membrane through the auditory ossicles to the internal ear, The internal ear consists of two cavities (mem- Dranous and osseous labyrinth) in the petrous part of the temporal bone that encloses a complex membranous mem brane containing the auditory cells and distal ramification of | the auditory nerve. The osseous labyrinth, immediately medial to the tympanic cavity, has three parts: the cochles, vestibule, and semicircular canals. The membranous laby- sinth lies within the osseous labyrinth; st contains supporting cells and hair cells, The distal extremities of the cochlear nerves are located at the base of the hair celle Dissemination of M. bovis to the middle ear is thought to mostly occur from the colonization of the oropharynx and extension into the tympanic bulla through the eustachian quditory) tube. Chronic suppurative otitis media results from the bacterial infection, This causes inflammation, ulceration, and production of granulation tissue within the middle ear. This eycle of inflammation leads to destruction of the bony margins of the middle ear and damage to