Tonsillectomy is a common procedure in the ENT department but unusual complications related to nerve injury might be associated with the surgery. We report a case of permanent hypoglossal nerve palsy following tonsillectomy in a 33-year-old female patient. The findings from the neurologic examination were unremarkable except for tongue deviation to the left, hemiatrophy of the tongue and associated dysarthria. Forceful pressure and stretch of hypoglossal nerve during surgery can explain the cause of injury. To avoid nerve compression, intermittent release of the mouth gag and avoidance of neck hyperextension are suggested especially when long operation time would be expected. Although rare, having knowledge of the existence of hypoglossal nerve injury complicating tonsillectomy is important when counseling patients.
Adult ; Counseling ; Dysarthria ; Female ; Humans ; Hypoglossal Nerve ; Hypoglossal Nerve Diseases ; Hypoglossal Nerve Injuries ; Mouth ; Neck ; Neurologic Examination ; Tongue ; Tonsillectomy

Hypoglossal nerve injury is an uncommon complication following endotracheal intubation. A transoral procedure including endotracheal intubation may result in hypoglossal nerve compression at the lateral margin on the hyoid bone and inner mandibular margin at the tongue base. A 50-year-old patient undergoing rotator cuff repair developed a transient unilateral postoperative hypoglossal nerve injury following uncomplicated endotracheal intubation for general anesthesia. The following day the patient complained of difficulty with tongue movement and buccal manipulation of food, and had slurred speech. An electrophysiologic assessment confirmed a diagnosis of unilateral hypoglossal nerve palsy. The symptoms resolved spontaneously and completely by 6 weeks. The possible etiology of the injury is discussed, and related literatures are reviewed.
Anesthesia, General ; Humans ; Hyoid Bone ; Hypoglossal Nerve ; Hypoglossal Nerve Diseases ; Hypoglossal Nerve Injuries ; Intubation, Intratracheal ; Middle Aged ; Rotator Cuff ; Tongue

BACKGROUND: The laryngeal mask airway (LMAⓇ) Protector™ (Teleflex Medical Co., Ireland) is the latest innovation in the second generation of LMA devices. One distinguishing feature of this device is its integrated, color-coded cuff pressure indicator (Cuff ™ technology) which enables continuous cuff pressure monitoring and allows adjustments when necessary; this ensures patient safety due to better monitoring.CASE: We report a case of postoperative unilateral hypoglossal nerve palsy after uncomplicated use of the LMA Protector. To the best of our knowledge, this could be the second reported case.CONCLUSIONS: This case demonstrates that anesthetists need to routinely measure cuff pressure and that the Cuff Pilot™ technology is not a panacea for potential cranial nerve injury after airway manipulation.
Cranial Nerve Injuries ; Hypoglossal Nerve Diseases ; Hypoglossal Nerve ; Laryngeal Masks ; Patient Safety

We examined 16 patients with unilateral tongue deviation using magnetic stimulator in order to evaluate central hypoglossal nerve palsy following brain injury. Surface recording electrodes were placed at the apex and anterolateral one thirds of tongue. Magnetic stimulation was performed at vertex and occiput. On occiput stimulation, the mean latency was 3.77+/-0.36 msec in affected side and 3.89+/-0.47 msec in sound side for male patients, and 3.9+/-0.61 msec, 3.90+/-0.55 msec respectively for female patients. The mean amplitude was 0.85+/-0.63 mV in affected side and 2.64+/-2.32 mV in sound side for male patients and 1.00. 8273;0.23 mV, 3.56+/-0.40 mV respectively for female patients. There was significant difference between affected side and sound side for amplitude. On vertex stimulation, the mean latency was 8.61+/-0.83 msec in affected side and 7.50+/-0.80 msec in sound side for male patients, and 9.66+/-1.14 msec, 6.48+/-0.44 msec respectively for female patients. The mean amplitude was 0.77+/-0.59 mV in affected side and 1.23?1.08 mV in sound side for male patients and 0.52+/-0.23 mV, 1.15+/-0.64 mV respectively for female patients. There was significant difference between affected side and sound side for latency and amplitude.
Brain Injuries ; Brain* ; Electrodes ; Female ; Humans ; Hypoglossal Nerve Diseases ; Hypoglossal Nerve* ; Male ; Tongue

The hypoglossal nerve palsy receives only brief mention in most textbooks and compared with other cranial nerve palsies, 12th nerve palsy is much less common. A literature review revealed that in most cases, isolated hypoglossal nerve palsy indicates the presence of an intracranial or extracranial space occupying lesion, head and neck injury, vascular abnormality, infection, autoimmune disease or neuropathy. Reports of idiopathic cases are rare and treated with steroid therapy. We report a 38-year-old woman with isolated hypoglossal nerve palsy improved spontaneously without steroid use. Considering our experience with isolated hypoglossal nerve palsy, we believe that no therapy is required in the patients with hypoglossal nerve palsy of probably idiopathic causes.
Adult ; Autoimmune Diseases ; Cranial Nerve Diseases ; Female ; Head ; Humans ; Hypoglossal Nerve Diseases* ; Hypoglossal Nerve* ; Neck Injuries ; Paralysis

No abstract available.
Hypoglossal Nerve ; Hypoglossal Nerve Diseases

No abstract available.
Hypoglossal Nerve Diseases* ; Hypoglossal Nerve*

A recurrent laryngeal nerve injury is known as a complication referring to an anterior cervical spine surgery. However, hypoglossal nerve injury is not well known yet. Herein we report a rare case of a 39-years-old male with a hypoglossal nerve injury after C3/4 osteophyte resection with Smith-Robinson approach. In this case there appeared difficulties of articulation and tongue movement with deviation of the tongue to the left side after the surgery and we diagnosed a hypoglossal nerve injury due to retraction against the nerve during the operation. During the operative approach to the upper cervical spine we had to retract the internal carotid artery and the soft tissue to reach the vertebrae. This retract was the cause of the hypoglossal nerve injury. A gently traction and intermittent release is important to avoid a hypoglossal nerve damage.
Carotid Artery, Internal ; Cervical Vertebrae ; Female ; Humans ; Hypoglossal Nerve ; Hypoglossal Nerve Diseases* ; Hypoglossal Nerve Injuries ; Male ; Osteophyte ; Recurrent Laryngeal Nerve Injuries ; Spine* ; Tongue ; Traction

Hypoglossal nerve palsy after general anesthesia is an exceptionally rare complication, which has varied etiology. We present a case of unilateral hypoglossal nerve palsy resulting from repeated airway intervention for general anesthesia. A 57-year-old woman was scheduled to undergo modified radical mastectomy. During endotracheal intubation, the patient had Cormack's grade III-a severe airway condition. After the first intubation attempt failed, the intubation was attempted a second time using a stylet inside the endotracheal tube with cricoid pressure; this attempt was successful. In the evening of the operation day, the patient complained of dysarthria and dysphagia. Physical examination revealed deviation of the tongue to the right, which may have been caused by traumatic hypoglossal nerve injury. This case reviews the pathophysiology, prevention, and management of hypoglossal nerve palsy.
Anesthesia, General* ; Deglutition Disorders ; Dysarthria ; Female ; Humans ; Hypoglossal Nerve Diseases* ; Hypoglossal Nerve Injuries ; Hypoglossal Nerve* ; Intubation ; Intubation, Intratracheal* ; Mastectomy, Modified Radical ; Middle Aged ; Paralysis ; Physical Examination ; Tongue

We report a case of pulmonary edema developed in a 33-year-old female who underwent two-stage bilateral carotid body tumor excision. About 1 month ago, she had undergone a left carotid body tumor excision. After the operation, her tongue was deviated to left side. Bilateral hypoglossal nerve injury was suspected. These injuries should be carefully monitored in patients who will undergo a similar procedure on both sides because a bilateral deficit of the hypoglossal nerve is poorly tolerated, resulting potentially serious pulmonary edema. In recovery room, she became pale and SpO2 was fall down. We reintubated her immediately and the pulmonary edema was treated using a supportive management. She was discharged without any signs of dyspnea or airway obstruction, but hypoglossal nerve injury remained. We discuss the possible etiology of the upper airway obstruction after the neck surgery and review the literatures associated with the pulmonary edema following upper airway obstruction.
Adult ; Airway Obstruction ; Carotid Body Tumor* ; Carotid Body* ; Dyspnea ; Female ; Humans ; Hypoglossal Nerve ; Hypoglossal Nerve Diseases ; Hypoglossal Nerve Injuries ; Neck ; Pulmonary Edema* ; Recovery Room ; Tongue