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

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

OBJECTIVETo investigate the optimal timing for the repair of persistent incomplete facial paralysis by hypoglossal-facial 'side'-to-side neurorrhaphy in rats.

METHODSA total of 30 adult rats with crushed and bulldog-clamped facial nerve injury were randomly divided into 5 groups (n = 6 each) that were subjected to injury without nerve repair or with immediate repair, 2-week-delayed repair, 4-week-delayed repair, or 8-week-delayed repair. Three months later, the effects of repair in each rat were evaluated by facial symmetry assessment, electrophysiological examination, retrograde labeling, and axon regeneration measurement.

RESULTSAt 3 months after injury, the alpha angle significantly increased in the group of rats with 4-week-delayed repair compared with the other four groups. Upon stimulation of the facial nerve or Pre degenerated nerve, the muscle action potentials MAPs were recorded in the whisker pad muscle, and the MAP amplitude and area under the curve in the 4-week-delayed repair group were significantly augmented at 3 months post-injury. Similarly, the number of retrograde-labeled motor neurons in the facial and hypoglossal nuclei was quantified to be significantly greater in the 4-week-delayed repair group than in the other groups, and a large number of regenerated axons was also observed.

CONCLUSIONThe results of this study demonstrated that hemiHN-FN neurorrhaphy performed 4 weeks after facial nerve injury was most effective in terms of the functional recovery of axonal regeneration and activation of facial muscles.

Animals ; Disease Models, Animal ; Facial Nerve ; surgery ; Facial Nerve Injuries ; complications ; surgery ; Facial Paralysis ; etiology ; surgery ; Hypoglossal Nerve ; surgery ; Nerve Regeneration ; Neurosurgical Procedures ; methods ; Rats, Sprague-Dawley ; Treatment Outcome

Multifocal acquired demyelinating sensory and motor neuropathy (MADSAM) is a peripheral neuropathy characterized by multifocal weakness and associated sensory impairment. MADSAM is associated with multifocal persistent conduction block and other signs of demyelination. The incidence of cranial nerve involvement in MADSAM was recently reported to be approximately 15%. However, reports of hypoglossal neuropathy occurring in MADSAM are rare. Unilateral hypoglossal neuropathy in MADSAM is usually misdiagnosed as motor neuron disease. We report a patient with MADSAM presenting with tongue hemiatrophy.
Cranial Nerves ; Demyelinating Diseases ; Diagnosis, Differential ; Humans ; Hypoglossal Nerve Diseases ; Incidence ; Motor Neuron Disease ; Motor Neurons ; Peripheral Nervous System Diseases ; Tongue

Collet-Sicard syndrome is a rare syndrome that involves paralysis of 9th to 12th cranial nerves. We report an uncommon case of schwannoma of the hypoglossal nerve in a 39-year-old woman presented with slurred speech, hoarse voice, and swallowing difficulty. Physical examination revealed decreased gag reflex on the right side, decreased laryngeal elevation, tongue deviation to the right side, and weakness of right trapezius muscle. MRI revealed a mass lesion in the right parapharyngeal space below the jugular foramen. The tumor was surgically removed. It was confirmed as hypoglossal nerve schwannoma via pathologic examination. Videofluoroscopic swallowing study revealed aspiration of liquid food and severe bolus retention in the vallecula and piriform sinus. Laryngoscopy revealed right vocal cord palsy. Electrodiagnostic study revealed paralysis of the right 11th cranial nerve. In summary, we report an uncommon case of schwannoma of the hypoglossal nerve with 9th to 12th cranial nerve palsy presenting as Collet-Sicard syndrome.
Adult ; Cranial Nerve Diseases ; Cranial Nerves ; Deglutition ; Female ; Humans ; Hypoglossal Nerve* ; Laryngoscopy ; Magnetic Resonance Imaging ; Neurilemmoma* ; Paralysis ; Physical Examination ; Pyriform Sinus ; Reflex ; Superficial Back Muscles ; Tongue ; Vocal Cord Paralysis ; Voice

Hypoglossal nerve palsy is a rare complication of endotracheal intubation. The mechanism of nerve palsy is mainly attributed to stretching or compression of the nerve during airway manipulation. The cuff pressure can also contribute to the occurrence of hypoglossal nerve palsy. Since it is often accompanied by other cranial nerve palsies, meticulous overall cranial nerve examination is necessary. The main treatment is supportive with respiratory monitoring. The prognosis is favorable. Majority of patients achieve nearly full recovery of nerve function. Here, we report a case of unilateral hypoglossal nerve palsy following usual, uneventful endotracheal intubation and review the literature.
Anesthesia ; Cranial Nerve Diseases ; Cranial Nerves ; Humans ; Hypoglossal Nerve Diseases* ; Hypoglossal Nerve* ; Intraoperative Complications ; Intubation ; Intubation, Intratracheal* ; Paralysis ; Prognosis

The prevalence of obstructive sleep apnea (OSA) is estimated to be 1–5% of the adult population world-wide, and in Korea, it is reported at 4.5% of men and 3.2% of women (Age 40 to 69 years old). Active treatment of OSA is associated with decrease in insulin resistance, cardiovascular disease, psychosocial problems, and mortality. Surgical treatment of OSA has evolved in the era of neuromodulation with the advent of hypoglossal nerve stimulation (HGNS). We share this review of HGNS with our maxillofacial surgical colleagues to expand the scope of surgical care for OSA.
Adult ; Cardiovascular Diseases ; Female ; Humans ; Hypoglossal Nerve* ; Insulin Resistance ; Korea ; Male ; Mortality ; Oral and Maxillofacial Surgeons* ; Prevalence ; Sleep Apnea, Obstructive* ; Snoring

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

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

BACKGROUND: Carotid endarterectomy (CEA) with selective shunting is the surgical method currently used to treat patients with carotid artery disease. We evaluated the incidence of major postoperative complications in patients who underwent CEA with selective shunting under transcranial Doppler (TCD) at our institution. METHODS: The records of 45 patients who underwent CEA with TCD-based selective shunting under general anesthesia from November 2009 to June 2015 were reviewed. The risk factors for postoperative complications were analyzed using univariate and multivariate analysis. RESULTS: Preoperative atrial fibrillation was observed in three patients. Plaque ulceration was detected in 10 patients (22.2%) by preoperative computed tomography imaging. High-level stenosis was observed in 16 patients (35.5%), and 18 patients had contralateral stenosis. Twenty patients (44.4%) required shunt placement due to reduced TCD flow or a poor temporal window. The 30-day mortality rate was 2.2%. No cases of major stroke were observed in the 30 days after surgery, but four cases of minor stroke were noted. Univariate analysis showed that preoperative atrial fibrillation (odds ratio [OR], 40; p=0.018) and ex-smoker status (OR, 17.5; p=0.021) were statistically significant risk factors for a minor stroke in the 30-day postoperative period. Analogously, multivariate analysis also found that atrial fibrillation (p<0.001) and ex-smoker status (p=0.002) were significant risk factors for a minor stroke in the 30-day postoperative period. No variables were identified as risk factors for 30-day major stroke or death. No wound complications were found, although one (2.2%) of the patients suffered from a hypoglossal nerve injury. CONCLUSION: TCD-based CEA is a safe and reliable method to treat patients with carotid artery disease. Preoperative atrial fibrillation and ex-smoker status were found to increase the postoperative risk of a small embolism leading to a minor neurologic deficit.
Anesthesia, General ; Atrial Fibrillation ; Carotid Artery Diseases ; Constriction, Pathologic ; Embolism ; Endarterectomy, Carotid* ; Humans ; Hypoglossal Nerve Injuries ; Incidence ; Mortality ; Multivariate Analysis ; Neurologic Manifestations ; Postoperative Complications ; Postoperative Period ; Retrospective Studies* ; Risk Factors ; Stroke ; Ulcer ; Ultrasonography, Doppler, Transcranial ; Wounds and Injuries