Stephen J. Birchard DVM, MS, Diplomate ACVS

Monday, September 4, 2023

Testicular Torsion of a Cryptorchid Testicle

Tank is a 5-month-old male intact boxer who presented to the Emergency Service for acute vomiting and abdominal pain. The vomiting began about 12 hours before presentation. The referring veterinarian had obtained abdominal radiographs and was suspicious of a gastric foreign body. There was no other history of medical problems with Tank.


On physical examination, Tank was quiet but responsive, ambulatory, and mildly dehydrated. He was painful on abdominal palpation, especially in the mid to caudal abdomen. Only one testicle was palpable in his scrotum, which was determined to be the right testicle. The left testicle was not palpable in the inguinal area.


A complete blood count and serum chemistry profile revealed no significant abnormalities. On review of the referring veterinarian's abdominal radiographs, we did not find evidence of a gastric foreign body or other abnormality. 


Abdominal ultrasound revealed a structure that appeared to be a testicle. (Fig 1)

Fig 1: Abdominal ultrasound showing a cryptorchid testicle (arrow)

Placement of the ultrasound probe on the structure elicited severe pain. We were concerned that Tank had torsion of the abdominal cryptorchid testicle. 


A left paramedian abdominal exploratory was performed. Torsion of the left retained testicle was confirmed, and the testicle was removed.

Fig. 2: Surgical removal of the abdominal testicle

The descended testicle was also removed. 

Fig. 3: Both testicles removed from Tank, normal on the right, testicular torsion on the left

Tank made an unremarkable recovery from anesthesia and surgery and was discharged from the hospital the following day. 


Cryptorchidism is a common congenital anomaly in male dogs. One or both testicles can be retained in the inguinal region, inguinal canal, or abdomen. For more details on surgery for this disorder, see, and scan the QR code for a complete discussion of cryptorchidism in dogs and cats.


Sunday, February 19, 2023

Adaptic Touch: The Ideal Dressing For Open Skin Wounds in Dogs and Cats

When managing open skin wounds in dogs and cats, bandaging materials and techniques are critical elements of the treatment strategy. The interior of the bandage in contact with the wound is called the primary layer and is the most important of the dressing for creating a suitable environment for healing. Many options for the primary bandage layer are available, including wet saline sponges, dry sponges, silicone dressings, medical-grade honey gauze, petroleum-impregnated gauze, and Telfa pads. The ideal first layer of the bandage should encourage granulation tissue formation. It should not inhibit healing cells and not promote infection. The primary layer should allow absorption of wound exudate into the second layer of the bandage to prevent accumulation at the wound surface.  


Telfa pads have historically been used for open wounds in animals, but newer materials that allow better absorption of exudate from the wound are available. Wet saline sponges are commonly used as the initial primary bandage layer in acute traumatic wounds because they are highly absorptive, allow gentle debridement of dead tissue, and are inexpensive. However, when saline sponges become dry, they are adherent, making bandage changes painful. Patient sedation is frequently necessary to prevent discomfort during removal. Lavage of the dried sponges with sterile saline during bandage change will allow them to be peeled off the wound more easily and with less pain. Although wet saline sponges are very effective in initially managing severe wounds, such as bite wounds in dogs and cats, a primary bandage layer is needed for the next healing phase. Ideally, this material should allow absorption of wound exudate and be non-adherent to reduce patient discomfort.

The Adaptic Touch is an excellent choice for the primary bandage layer on open wounds in dogs and cats. It is a soft and pliable silicone-coated mesh material that readily conforms to the wound surface. The pore size in the mesh is small enough to prevent the ingrowth of granulation tissue into the material. The Adaptic Touch mesh allows the passage of wound exudate into the secondary bandage layer and is non-adherent, minimizing patient discomfort during bandage changes. It has been used extensively for various human wounds and is gaining favor with veterinarians. Cotton is a good choice for the secondary layer of the Adaptic Touch bandage allowing for the transmission of fluid through the pores of the mesh. Use only one layer of the Adaptic to ensure adequate absorption into the cotton.


The original Adaptic mesh is a petroleum-impregnated gauze that allows absorption and is non-adherent. However, petroleum may have some detrimental effects on wound healing, and it is only partially non-adherent. These characteristics make them less ideal than their counterpart, the Adaptic Touch.


See the above video for a demonstration of the non-adherent nature of the Adaptic Touch dressing. 

In summary, the ideal bandages for open skin wounds in dogs and cats have primary layers that allow absorption of wound exudate, are non-adherent, and do not inhibit wound healing. For wounds that are highly contaminated and filled with dirt and debris that cannot be entirely removed by surgical debridement and flushing, moist saline sponges are indicated as the initial bandage. Since these bandages are adherent and painful to remove, transition to non-adherent dressings such as the Adaptic Touch is recommended for the next phase of wound treatment.



International case series: Using ADAPTIC TOUCH® Non-Adhering Silicone Dressing: Case Studies. London: Wounds International, 2013. 

Wounds International case studies evaluation. ADAPTIC TOUCHTM Non-Adhering Silicone Dressing in skin tear management. Wounds International, 2018 (Suppl). Cooper 

Janice Bianchi*, Simon Barrett, Fania Pagnamenta, Fiona Russell, Sandra Stringfellow, Pam
Cooper. Consensus guidance for the use of Adaptic Touch non-adherent dressing. Wounds UK, 2011, Vol 7, No 3 

When surrounded with love, seriously ill pets are more likely to survive. Read about this in Dr. Birchard's new book. Click here for more information.




Tuesday, November 29, 2022

Dr. Homer Dale: Arbitrary, Strict, Stubborn, and the Best Teacher I've Ever Had

It was a dull and lifeless classroom. Cinderblock walls were painted pale yellow, the floor was faded linoleum. There was a small wooden lectern in the front of the room, and a large blackboard with a shelf for chalk and erasers. Wooden seats with metal legs and attached desks were arranged in neat rows with an aisle down the middle. All seats faced the blackboard. Cold, bluish fluorescent lights illuminated everything. The classroom was in a small, one story building that originally was an airplane hangar, later converted to teaching and research space. Clearly the re-purposing budget was slim. 


 I walked into the classroom and sat down in my usual spot. Funny how, even when seats are not assigned, we still sit in the same one every time. The room could barely hold the 72 members of my class. There was a murmur of quiet conversation between early arriving students, and some of them kept nervously looking back to the room’s entrance to see if the professor was coming.  “Who is today’s scout?” I asked Jim my classmate sitting next to me. “Don”, he said. “He’s standing in the hall by the classroom door now.” Don was today’s “sentry”, who would watch for the professor walking down the hall toward the classroom to begin the session. If he appeared to be holding a stack of papers, Don’s job was to run into the room and sound the alarm “He has a quiz!”


I pulled my spiral notebook and pen out of my backpack in preparation for the possible quiz and then the frenetic notetaking that would occupy the next 50 minutes. No handouts were supplied in this class. One was to obey the old-school preferences of the professor: attend the class and experience his lecture in person where he taught with all he needed: a stick of chalk, and a blackboard. 


This was Veterinary Physiology 101. Part of the so-called Core Curriculum, it was a required course offered in the second year of veterinary school. The professor was Dr. Homer E. Dale. An imposing man, he was tall, slim, middle-aged, and had closely cropped gray hair. He wore an impeccably clean, wrinkle-free, white lab coat with his full name embroidered over the top pocket. His posture was erect, his head held high. His appearance and demeanor were almost military in nature. He spoke clearly, deliberately. There was an air of confidence about him. When asked a difficult question, he would respond: “Nobody knows the answer, even I don’t know.”


Dr. Dale was the most organized lecturer I had ever seen. He delivered his facts from memory, without notes. The principles of physiology flowed from him to the chalk, then to the blackboard, and then to our notebooks by hastily scribbled notes. Every statement was important. He was teaching us how the body works. 


In most college courses, one’s grade is determined by the time-honored tradition of two tests, a midterm exam, and a final exam. Your scores on the two tests are combined to determine your final grade. Dr. Dale did not conform to this standard evaluation protocol. He had a unique system that he liked, but we hated. 


The grade in Professor Dale’s class was determined entirely by surprise quizzes – no midterm or final exam, just numerous short unannounced tests administered during the first 10 minutes of class. We didn’t know until he walked into the classroom if there was a quiz, so we had to be ready for an exam every day. Each quiz was comprehensive, it covered all material that had been taught up to that day. At first glance, this appeared to be a cruel and unusual punishment for students, but it was pure genius. It forced us to come to class every day and study our notes every night. As a result, his class had priority over all our other courses. I was one of the few who didn’t despise him for these methods. In fact, I liked it. After all, we are in training to be doctors, and knowledge of physiology was essential.


Dr. Dale’s system also guaranteed that we came to class early, to be sure we started the dreaded quizzes on time. After he quickly handed out the 1-page tests at the beginning of class, we had precisely 10 minutes to answer the questions. If anyone took too long, there were repercussions. When he said, “Times up!” everyone had to drop their pencil and immediately pass their test down the row to be collected by the person sitting adjacent to the aisle. If anyone continued writing past the deadline, the entire row of students failed the test. 


If you think Dr. Dale’s methods were unfair, well, it gets worse. The physiology class consisted of two semesters, the first in Spring and the second in the Fall with summer break between the two. Remember that each quiz covered all the material that came before it. On the first day of the Fall semester, Dr. Dale gave us a quiz on the information from the entire Spring Semester. Many of us were not surprised by this perverse action. 


Despite his authoritarian style and unorthodox methods, I admired Dr. Dale. He was passionate about teaching and understood how important it was for us to learn the material. Yes, he was intimidating and strict, but he was brilliant, articulate, and methodical. He recognized how draconian his policies were but had no intention of changing them. After years of experience, he knew what worked.


The class met three times a week, and we all quickly became accustomed to Dr. Dale’s lecturing style and mannerisms. He spoke slowly, emphasizing key points and explaining the relevance of the subject matter. He had a habit of swiping one side of his face with his index figure in between sentences, and he would clear his throat in an odd way. It was more of a forced expiration than a cough, and he did it a lot. He also had a characteristic body posture while talking; hands on hips, head cocked to one side, sweeping motions with his arms, and animated facial expressions. 


I started to imitate him, the arm motions, the throat sounds, and his voice inflections, first to myself and then to my classmates while we were chatting between classes. They loved watching me pretend to be Dr. Dale and kept encouraging me to do it more. I also learned how to write on the blackboard like him, to shape the letters exactly the way he did. It’s easy to learn the idiosyncrasies of someone you want to emulate. 


As the second semester of the course ended, several members of the class wanted to organize an event to celebrate our “survival” of Dr. Dale’s physiology course. After some discussion, we decided to do a skit that depicted a typical class session. I was chosen to play the role of the esteemed Professor. It was a chance to display my admiration of this amazing man through imitation of his teaching style. But I didn’t know how he would feel about it. We approached him about the idea, and he liked it. He even asked if he could bring his teenage daughter to the event. I breathed a sign of relief. Now I could focus on how to capture his essence in an entertaining but respectful manner. 


We reserved a room on campus and scheduled it as an evening session. The room was arranged just like his classroom, rows of seats for the students facing front at a blackboard, with an aisle in the center. We placed 2 seats and a small table in the front of the room, to one side, for Dr. Dale and his daughter to sit and watch the proceedings. The scene was set, and it was perfect.


I wore a clean, white, long lab coat just like his, and wrote his name on the front. I dusted my hair with baby powder to make it look gray and donned black horned rimmed glasses like the ones he used. Once everyone was settled in the room, I made my entrance from the back of the room as he would, and . . . I had a quiz.


I passed out the quizes to the students and gave one to Dr. Dale and his daughter. I don’t remember what questions I asked but they were intended to be like his, only funny. As I handed Dr. Dale the quiz he facetiously picked up his grade book and shook it in my face to warn me that my behavior this evening could affect my grade. He was being a good sport which helped me relax and enjoy the moment. I couldn’t wait to start the lecture. 


I stood by the blackboard, picked up the chalk, and launched my best Homer Dale impersonation. As I started one of my classmates in the front row whispered, “This is excellent!” I did the voice, the mannerisms, the hands on the hips, and even the frequent swipe of the cheek and throat clearing cough. In the corner of my eye, I could see him and his daughter smiling. 


A few of my classmates assisted with some other elements of the skit that depicted typical class activities, and then the festivities drew to a close. The audience, and the professor and his daughter, enjoyed the show. I was so grateful that Dr. Dale allowed us to have a little fun at his expense. I think he understood that underneath all the jokes and imitations, we had tremendous respect for him and his commitment to our education. The best part of the evening for me was to see the professor reveal a little of what lies beneath that crusty exterior. We saw a tiny bit of his soul, and it was beautiful.


The following summer I worked for Dr. Dale as an assistant in his research laboratory and helped reorganize some of his teaching materials. I felt honored to work for him. During my breaks from work, I would sometimes sit in his office and just chat with him about vet school and other subjects. We shared a love of the outdoors and exchanged stories about some of our canoeing and camping exploits. I got to know him as a person, and my admiration of him grew. One day I mustered enough courage to tell him he was the best teacher I’d ever had. His usual stern face softened, he looked at me with kind eyes and said a simple thank you, and we went back to work. It was a moment of intimacy that I will never forget.


Homer Dale passed away several years ago. He was 95 years old. I regret that I didn’t keep in touch with him after graduation from veterinary school. I would have told him how much he influenced me, how much I valued his advice, mentorship, and friendship. I would have told him that he had a profound effect on my career, and that I still think about him 50 years after taking his class in that old airplane hangar. I would have told him that I still have my notes from his class, and when I read them I can hear his voice delivering each sentence.


Tuesday, June 28, 2022

Medical and Surgical Treatment of Severe Thermal Burns in a Cat

Signalment and Presentation

Maximus, a healthy 6-month-old mixed breed neutered male cat, was presented for severe thermal burns over large areas of his body after jumping into a bathtub filled with scalding hot water.  The injury occurred just a few hours before presentation.


On admission, Maximus was tachycardic and severely painful. All four paws were red, swollen, and bleeding. The skin on his ventral abdomen and thorax was bright red and bruised. It appeared that the injury affected about 50% of his body. There was no other previous history of medical problems.


Initial Treatment

Maximus was initially administered intravenous fluids, antibiotics, and buprenorphine for pain. Continuous intravenous infusion of fentanyl was added to the treatment regimen soon after admission. Blood tests showed evidence of dehydration and elevated serum potassium. Silver sulfadiazine was used as the topical cream medication on the burned areas.


Maximus was non-ambulatory because the skin of his footpads was peeling off, leaving subcutaneous tissue exposed. Over the next several hours, the burned areas on his legs, chest, and belly gradually became purple in color. Some of the burned skin on his chest was becoming hard and leathery. (Fig. 1a,b) On a pain scale from 1-24 (1 being little or no pain, 24 being the worst pain possible), the attending clinician listed Maximus as 24. Intravenous lidocaine and ketamine were added to the fentanyl infusion to provide more analgesia. The dosage of fentanyl was also increased.

Fig. 1a: Maximus several hours after admission to the hospital

Fig. 1b

After sedating him with intravenous propofol, all of Maximus’ burned areas were carefully clipped and cleaned. With the hair removed, the burned regions were more clearly visible; the total surface area of his burned body appeared to be closer to 60%. 


More blood tests showed that Maximus’ albumin was already below normal. Albumin was being depleted because of the severe inflammation of the damaged skin and loss of albumin-rich fluid that oozed from his wounds. A nasogastric tube was placed to augment his dietary intake. 


Wound Management

On day two after admission, Manuka honey (Medihoney) was begun as the topical medication on the wounds, and standard bandaging was continued. The burned areas were gradually declaring themselves, and on day 4, some were starting to turn yellowish-brown and becoming hard and crusty. Escars were developing, indicating full-thickness skin injury. (Fig. 2)

Fig. 2: Escar development over mid abdomen and rear legs

To simplify the bandage changes that were time-consuming and painful, the attending clinician Dr. Becky Ball began covering Maximus with infant onesies, little pajama outfits that completely covered the entire body, legs, and feet. (Fig. 3) Each day the onesie was removed, the wounds gently cleaned, Medihoney ointment applied, and a clean onesie replaced. 

Fig. 3: Onesie pajama bandage applied.

Maximus was discharged 12 days after admission. The owner, a physician, assumed the nursing care at home. Rechecks with Dr. Ball were scheduled every 4-5 days for wound assessment. The escars gradually peeled away from the healthy skin, exposing new granulation tissue underneath. No evidence of infection was seen, and Maximus' appetite was good. 


Maximus continued to be re-examined about every two weeks. The eschars completely sloughed off, and the skin defects were contracting and closing well. But, as the skin tightened in his inguinal region, scar tissue pulled his rear legs medially, severely restricting his mobility. (Fig. 4) Surgery would be necessary to alleviate the contracture and allow Maximus to use the hind legs better. 

Fig. 4: Wound contraction of inguinal skin.

Skin Reconstruction


Seven months after Maximus’ injury, a caudal superficial epigastric axial pattern skin flap was performed to alleviate the inguinal wound contracture. (Fig. 5a-b) Click here for a detailed description of the skin flap procedure. The surgery went well, and he was discharged from the hospital the following day.

Fig. 5a: Axial pattern skin flap design. Arrow indicates the direction of rotation of the flap after it is dissected out.

Fig. 5b: Completed skin flap procedure.

Seven days postoperatively, suture removal was performed. The skin flap was viable and had healed well to adjacent skin. Maximus was much more mobile and less painful. Seven months postoperatively, he was examined again and was doing well with all wounds healed and his function back to normal. (Fig. 6, 7)

Fig. 6: Appearance of inguinal area seven months after skin flap reconstruction.

Fig. 7: Maximus and his owner 15 months after his injury.



Maximus overcame a severe injury with burns over a large portion of his body. He exemplifies the remarkable wound healing process, particularly when supported with good nursing care. Manuka honey was effective in preventing infection and encouraging wound healing. Dietary support was instrumental in avoiding hypoproteinemia and malnutrition. Excessive wound contracture necessitated skin flap reconstruction, improving mobility and relieving chronic pain. 

Maximus' owner, a neonatologist, was instrumental in his recovery. She assumed the challenging nursing care at home and was diligent in the tedious work of medicating, bandaging, and maintaining good hygiene.


Maximus’ complete story is told in Dr. Birchard’s book: Their Tails Kept Wagging: Pets Show Us How Hope, Forgiveness, and Love Prevail, a collection of inspirational stories of severely ill pets who survived due to modern medicine and compassionate caregivers. For more information, click here.


Thursday, March 31, 2022

How Pets Can Help Heal the Trauma of Parental Estrangement

Their Tails Kept Wagging: Pets Show How Hope, Forgiveness, and Love Prevail
by Stephen J. Birchard
and Fe Anam Avis

Available on and other major booksellers' websites.

Tuesday, March 8, 2022

Their Tails Kept Wagging: Pets Show Us How Hope, Forgiveness, and Love Prevail


When seriously ill pets are surrounded with love, they are more likely to survive. 

In my book: Their Tails Kept Wagging: Pets Show Us How Hope, Forgiveness, and Love Prevail, we tell the stories of critically ill dogs and cats who 
refused to give up despite poor odds of survival. They lived because of modern medicine and the love and compassion of their caregivers and owners. 

For more information about the book, go to: Their Tails Kept Wagging

Stephen’s quotes

"For life is a seamless web. It connects us not merely with one another, but with all that is sentient; with all that shares its miracle of birth and feeling and death."— Abe Fortas

Tuesday, March 1, 2022

Reconstruction of Bilateral Caudal Maxillectomy Using an Autogenous Auricular Cartilage Graft

Stephen J. Birchard

Rebecca L. Ball

History and Physical Examination

Jack was a 4-year-old neutered male golden retriever that presented for inspiratory stertor for several weeks. (Fig. 1)

Fig. 1: Jack

There was no other history of illness. On routine physical examination, no abnormalities were identified, but oral examination under sedation revealed a 4cm diameter firm circular mass in the caudal hard palate. (Fig. 2) The mass was not movable and extended the entire width of the hard palate between the molar teeth. 

Fig. 2: Caudal hard palate mass

Diagnostic Tests

Plain film radiographs of the thorax revealed no evidence of metastasis. CT imaging of the oral cavity showed invasion of the bone of the hard palate and extension of the mass into the nasal cavity. A punch biopsy of the mass was obtained, and histopathology revealed multilobular osteochondrosarcoma.


Surgical Treatment

Under general anesthesia, the mass was excised by bilateral caudal segmental maxillectomy, including excision of the molar teeth on each side. After incising the mucosa around the mass and dorsal to the teeth, the maxillary bones and hard palate were incised with a bone burr and osteotome. The mass penetrated the hard palate but was not invasive into the nasal turbinates. The mass was excised, and bleeding was controlled with electrocautery and Vetspon in the nasal cavity. (Fig. 3)

Fig. 3: Appearance of surgical site after resection of the mass.

The large oronasal defect was closed by constructing bilateral mucosal flaps using buccal mucosa on each side of the defect and then sliding them to the midline. The flaps were closed on the midline in 2 layers: 4-0 PDS simple interrupted in the submucosa, and 4-0 PDS simple interrupted in the mucosa and sutured to the mucosa of the hard palate and soft palate in a similar manner. (Fig. 4)


Fig. 4: Oronasal defect closed by bilateral buccal mucosal flaps.

The mass was submitted for histopathology. (Fig. 5) Multilobular osteosarcoma (MLO) was confirmed, and complete resection with clean margins was reported.


Fig. 5: Tissue specimen submitted for histopathology.

Postoperative Care and Complications

Five days postoperatively, Jack presented for anorexia and a foul odor from the mouth. Oral examination revealed partial dehiscence of the rostral and caudal aspects of the buccal mucosal flaps, creating oronasal fistulae at both sites. Conservative management was initially recommended to feed soft food meatballs followed by mouth flushing with clean water. 


Surgical Revision

The rostral oronasal fistula was repaired two weeks postoperatively using an autogenous auricular cartilage graft. Under general anesthesia, a 2 cm by 3 cm rectangular section of auricular cartilage was harvested from the inner leaf of the base of the left pinna. (Fig. 6) 

Fig. 6: Red rectangle indicates the approximate size and location of the harvested auricular cartilage graft. (This is not Jack but is a dog with similar size and anatomy of the ear pinna.)

After lightly debriding and undermining the mucosa along the perimeter of the oronasal defect, the cartilage was placed in the defect with the edges inserted underneath the mucosa. The cartilage was sutured to the mucosa with 4-0 PDS simple interrupted pattern. (Fig. 7) 

Fig. 7: Closure of mucosa over cartilage graft (yellow arrow) and remaining oronasal defect (green arrow) to be repaired later.

An esophagostomy tube was placed in Jack to allow feeding while bypassing the oral cavity.


Three weeks postoperatively, Jack presented to repair the remaining defect in his palate. The cranial defect had healed well over the cartilage graft. He was doing well with only occasional difficulty drinking water. Under general anesthesia, a hinged buccal mucosal flap was performed to close the caudal oronasal fistula. (Figs. 8)


Fig. 8: Closure of hinged buccal/pharyngeal mucosal flap over remaining defect. (Arrow indicates the direction of the inverted flap.)


Two weeks after this final reconstruction, Jack returned for a recheck examination. On oral exam, the flap was intact and healing well. (Fig. 9)

Fig. 9: Healed defect after flap revision. 

Three months later, another recheck examination showed complete healing of all flaps and no persistent oronasal fistulae. Jack was doing well clinically with normal eating, drinking, and activity levels. 


Jack lived 6 more years after his surgery to remove the MLO. He did well during that time with no issues related to his surgery and no tumor regrowth. He eventually died of causes unrelated to the MLO. Even with a prolonged recovery and multiple revision surgeries, the owners were pleased that they had pursued the treatment of Jack’s oral tumor. 


Bilateral segmental maxillectomy is a surgical option for oral neoplasia of the hard palate, mainly when the tumor is on the midline. Reconstruction is by creating bilateral sliding buccal mucosal flaps that are sutured to each other on the midline over the hard palate defect.

Dehiscence is common due to the tension across the incisions and the lack of underlying bone. Reconstruction of the resultant defect is challenging due to the scarcity of available local tissue. Autogenous auricular cartilage grafts have been reported to augment the closure of oronasal defects in dogs and cats. (1,2). This technique was effective in Jack repairing one of the defects in his mucosal closure. It provided a surface for the oral mucosa to proliferate and fill the oronasal defect. The remaining defect was judged to be too large to do an additional cartilage graft but healed with a hinged buccal/pharyngeal mucosal flap. The long-term results of the reconstruction surgeries were excellent. Further clinical studies are warrented to evaluate the auricular cartilage graft technique for other oral cavity disorders such as cleft palate.  


Dr. Becky Ball was the primary surgeon in all procedures performed on Jack and directed his postoperative care. 


1. Soukup JW, Snyder Cj, Gengler WR. Free Auricular Autograft for Repair of an Oronasal Fistula in a Dog. J Vet Dent, Summer; 26(2): 86-95, 2009

2. Cox CL, Hunt GB, Cadier MM. Repair of Oronasal Fistulae Using Auricular Cartilage Grafts in Five Cats. Vet Surg 36:164-169, 2007.