Fluoroscopic guidance for bulla identification during ventral bulla osteotomy in eight French bulldogs

Abstract

Objective: To describe the technique and outcome of fluoroscopy to guide bulla identification in French bulldogs during ventral bulla osteotomy.

Materials and methods: Medical records of eight French bulldogs with otitis media that underwent a fluoroscopic-guided ventral bulla osteotomy between January 2020 and June 2023 were reviewed. Demographics, preoperative diagnostic findings, advanced imaging findings, surgical times, histopathology and culture results, as well as postoperative outcomes, were recorded.

Results: Following routine dissection of the bulla, fluoroscopic imaging was used to confirm the placement of a Steinmann pin before bulla penetration. The median surgical time was 152 minutes (range: 80-210 minutes). All dogs survived to discharge. Six out of eight dogs retained an ipsilateral head tilt postoperatively. Two dogs exhibited residual vestibular ataxia at 14 days postoperatively, which improved and resolved 7 months and 2 years postoperatively respectively. One dog developed recurring otitis media, and a total ear canal ablation and lateral bulla osteotomy were recommended.

Clinical significance: Intraoperative fluoroscopy can be used successfully to guide the identification of the bulla in ventral bulla osteotomies in brachycephalic breeds.

Keywords: canine; fluoroscopic‐guided; french bulldogs; otitis media; ventral bulla osteotomy.

FIGURE 1

Ventrodorsal fluoroscopic image of French bulldog #8 undergoing fluoroscopic guided ventral bulla osteotomy. Following soft tissue dissection and using fluoroscopic guidance, a Freer periosteal elevator was positioned over the ventral bulla (yellow asterisk) once identified. The zygomatic arch (red X) and vertical ramus of the mandible (green arrow) are as labelled.

FIGURE 2

Ventrodorsal fluoroscopic image of French bulldog #8 undergoing fluoroscopic guided ventral bulla osteotomy. Following soft tissue dissection and using fluoroscopic guidance, a 3/32” Steinmann pin was advanced in the ventral bulla (yellow asterisk). The zygomatic arch (red X) and vertical ramus of the mandible (green arrow) are as labelled.

FIGURE 3

A second intraoperative ventrodorsal fluoroscopic image of French bulldog #8 undergoing fluoroscopic guided ventral bulla osteotomy. The ventral bulla (yellow asterisk), zygomatic arch (red X) and vertical ramus of the mandible (green arrow) are as labelled.

FIGURE 4

Axial preoperative computed tomography image of a brachycephalic dog (French bulldog #8) skull with the distance from the ventral bulla to skin measured at 70.4 mm, respectively, using the Keystone Omni software (asterisk).