Felis ISSN 2398-2950

Bulla osteotomy

Contributor(s): Jan Bellows, Andrew Gardiner, Laura Owen, Daniel Smeak

Introduction

  • Surgical access to the tympanic bulla by means of a lateral or ventral osteotomy.
  • The middle ear is a pear-shaped cavity within the petrous temporal bone. The tympanic membrane, auditory ossicles, eustachian tube, and inner ear lie within the neck of this bone while the tympanic bulla is at its base.
  • The feline tympanic bulla is divided into a small dorsolateral compartment and a large ventromedial compartment by an incomplete bony septum.
  • In the cat, sympathetic nerve fibers within the bulla are exposed along the promontory in the dorsomedial aspect of the bulla and are more readily damaged than in their canine counterparts.

Uses

  • Most often performed for removal of nasopharyngeal polyps Nasopharyngeal polyp.
  • Used in the treatment of otitis media Otitis media arising from inflammatory/infective processes, and in neoplasia affecting the middle ear.
  • Exploration of the middle ear to determine cause of middle ear disease.

Advantages

  • Lateral osteotomy: conveniently performed at the same time as total ear canal ablation Ear: total ear canal ablation; intra-operative repositioning is not required.
  • Ventral osteotomy: offers maximal exposure of the tympanic cavity and both bullae are easily accessed without repositioning patient. Reduced risk of facial nerve damage.

Disadvantages

  • Lateral osteotomy: does not provide as good access to the tympanic cavity as the ventral technique. Increased risk of facial nerve damage during the approach.
  • Ventral osteotomy: inconvenient when total ear canal ablation is being carried out, as patient repositioning is required.

Requirements

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Preparation

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Procedure

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Aftercare

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Outcomes

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Prognosis

  • Good: if condition is not malignant. Complete evacuation of epilthelium, debris, foreign bodies is paramount to success of surgery. Consider ancillary therapies (radiation, chemotherapy) if neoplasia is found in middle ear.

Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Donnelly K E & Tillson D M (2004) Feline inflammatory polyps and ventral bulla osteotomy. Compend Contin Educ Pract Vet 26 (6), 446-448, 450-454 VetMedResource.
  • Lanz O I & Wood B C (2004) Surgery of the ear and pinna. Vet Clin North Am Small Anim Pract 34 (2), 567-599 PubMed.
  • Muilenburg R K & Fry T R (2002) Feline nasopharyngeal polyps. Vet Clin North Am Small Anim Prac32 (4), 839-849 PubMed.
  • Smeak D D, Crocker C B & Birchard S J (1996) Treatments of recurrent otitis media after total ear canal ablation and lateral bulla osteotomy in dogs - nine cases (1986-1994). JAVMA 209 (5), 937-942 PubMed.
  • Smeak D D, Kerpsack S J (1993) Total ear canal ablation and lateral bulla osteotomy for management of end stage otitis externa. Semin Vet Med (1), 30-41 PubMed.
  • Williams J M & White R A S (1992) Total ear canal ablation combined with lateral bulla osteotomy in the cat. JSAP 33 (5), 225-227 VetMedResource.

Other sources of information

  • White R A S (2003) Middle ear. In: Textbook of Small Animal Surgery. Ed Slatter 3rd edn. W B Saunders, Philadelphia. pp 1757-1767.


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