Most cats recover rapidly from the surgery and need no special care.
Postoperative complications are common with ventral bulla osteotomy, but are usually temporary:
- Horners’s syndrome (see figure 8)
- Head tilt
- Balance problems
- Recurrence of the polyp (rare after ventral bulla osteotomy)
Several critical structures are found along the outside of, or within, the bony sac (“bulla”) that forms the middle ear (Figures 7 and 8).
The temporomandibular joint (TMJ), which is the hinge of the lower jaw, and the muscles of the base of the tongue, located near the bulla, can become swollen after the surgery, so cats may be reluctant to eat or swallow. The nerve to each side of the tongue also runs along the bulla. Within the bulla, some of the nerves to the eye cross along the inner wall. These nerves are often damaged when the polyp is pulled by traction or when a ventral bulla osteotomy is performed.
About 80% of cats develop Horner’s syndrome after the procedure because of nerve damage (Figure 8). In these cats, the third eyelid is elevated, covering the bottom half of the eye, and the pupils are different sizes. Horner’s syndrome is usually temporary and does not affect the cat’s behavior or function.
Since the opening to the inner ear is also found in the bulla, about 40% of cats will show some balance problems, particularly a head tilt, and they may be wobbly and have rapid uncontrolled movements of their eyes. This condition is also usually temporary, but can affect the cat’s well-being while it lasts. The lining of the bulla, which is the source of the polyp, must be removed to prevent the polyp from re-growing. Therefore, the veterinary surgeon has to find a balance between too much cleaning, which can result in the above complications, and not enough, which can result in recurrence of the original signs.
Patients who have had a ventral bulla osteotomy will be given pain medication at home after surgery. Antibiotic therapy after surgery may be recommended if concurrent infection is suspected.
Anti-inflammatory therapy is given in some patients topically (in the ear canal) or systemically with inflammatory polyps, especially if ventral bulla osteotomy is not pursued.
An Elizabethan collar (aka “the cone” or e-collar) may be recommended to protect the incision from scratching.
Soft food or syringe feeding may be needed for those with TMJ issues. Feeding tubes are rarely needed. If your cat is not eating at home after surgery, contact your surgeon or primary care veterinarian immediately for advice.
Recurrence is common after simple extraction of the polyp. Recurrence of the polyp is uncommon after ventral bulla osteotomy. Prognosis for recovery is excellent after ventral bulla osteotomy, even in cats that develop Horner’s syndrome or balance problems after surgery, since these signs usually resolve within a month.