Abstract
A nine-year-old male European shorthair cat was referred to our practice with severe head trauma after suffering a road traffic accident (RTA). The patient presented marked facial swelling and multiple skin wounds and bruising, inspiratory dyspnea, palpable mandibular and maxillary fractures, serosanguinolent oronasal discharge and right eye exophthalmos and buphthalmos with loss of menace and pupillary reflex. After stabilizing the patient, a CT scan was performed under general anesthesia and an oesophagostomy tube was placed. The scan revealed the presence of multiple right tympanic bulla fractures. Multiple mandibular, maxillary, and palatine fractures were also present. The cat underwent surgery. Mandibular symphyseal separation and maxillary fractures were stabilized using intraoral cerclage wire fixation reinforced with composite and the right eye was enucleated. The rest of the fractures were treated conservatively. A CT scan 4 months after the trauma was also performed. At this point, the maxillofacial fractures were healing properly, and a bone callus demonstrating fusion of fragments of the right tympanic bulla was evident. There was absence of abnormal content inside the right tympanic bulla. The patient recovered uneventfully with no neurological deficits. To the author's knowledge this is the first case reporting a traumatic tympanic bulla fracture in the cat with case follow up, and the first case reported using CT as diagnostic imaging test.
Highlights
Tympanic bulla injuries in small animals are commonly associated with neoplastic or infectious causes, or secondary to known surgical intervention such as ventral bulla osteotomy, or lateral bulla osteotomy [1,2,3]
Long-term close follow-up is mandatory because the late occurrence of potentially life-threatening complications, including meningitis [10]. It is unknown whether the risk of concurrent intracranial injury and management strategies for tympanic bulla fracture in small animals can be appropriately derived from the approach to equivalent injuries in humans [4]
To the author’s knowledge, there is only one case reported of traumatic tympanic bulla fracture in the cat [5], which lacks the case follow up and only use plain x-rays as diagnostic imaging test
Summary
Tympanic bulla injuries in small animals are commonly associated with neoplastic or infectious causes, or secondary to known surgical intervention such as ventral bulla osteotomy, or lateral bulla osteotomy [1,2,3]. Long-term close follow-up is mandatory because the late occurrence of potentially life-threatening complications, including meningitis [10] It is unknown whether the risk of concurrent intracranial injury and management strategies for tympanic bulla fracture in small animals can be appropriately derived from the approach to equivalent injuries in humans [4]. The patient was sedated again with the same protocol and x-ray images were performed demonstrating continued bone healing with callus formation of maxillary and mandibular fractures were observed, so cerclage wires and composite were removed (Figures 4E,F). Four months after the trauma a control CT scan was performed using the same CT anesthetic and image acquisition protocol At this recheck, the maxillofacial fractures were noted to have healed properly, and the bony callus was present demonstrating fusion of the right tympanic bulla fragments (Figure 3b).
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