ABSTRACT
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.
Subject(s)
Cranial Nerve Injuries , Hypoglossal Nerve Diseases , Hypoglossal Nerve , Laryngeal Masks , Patient SafetyABSTRACT
Neurologic complications after shoulder surgery may result from surgical procedures or anesthesia. Hypoglossal nerve is a pure motor nerve that supplies mylohyoid and hyoglossus muscles. Isolated hypoglossal nerve injury may be caused by direct trauma, head malposition (hyperextension or hyperflexion), and indirect compression or traction during intubation. We report a case of left hypoglossal nerve palsy after arthroscopic left shoulder surgery in the beach chair position under general anesthesia combined with brachial plexus block.
Subject(s)
Anesthesia , Anesthesia, General , Brachial Plexus Block , Brachial Plexus , Cranial Nerves , Craniocerebral Trauma , Equipment and Supplies , Hypoglossal Nerve Diseases , Hypoglossal Nerve Injuries , Hypoglossal Nerve , Intubation , Muscles , Paralysis , Shoulder , TractionABSTRACT
No abstract available.
Subject(s)
Hypoglossal Nerve Diseases , Hypoglossal Nerve , Submandibular GlandABSTRACT
No abstract available.
Subject(s)
Arachnoid , Hypoglossal Nerve Diseases , Hypoglossal NerveABSTRACT
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.
Subject(s)
Adult , Female , Humans , Autoimmune Diseases , Cranial Nerve Diseases , Head , Hypoglossal Nerve Diseases , Hypoglossal Nerve , Neck Injuries , ParalysisABSTRACT
PURPOSE: Hyoid bone is a U-shaped bone in the anterior of the neck. Hyoid bone fractures are exceedingly rare and represent only 0.002% of all fractures because of its protective position relative to the mandible and its suspension by elastic musculature. We report a patient who presented hyoid bone fracture associated with hypoglossal nerve palsy. We also discuss the possible complication and treatment. METHODS: A 69-year-old man was transferred from another institution because of persistent purulent discharge from the left chin. He had a history of trauma in which a knuckle crane grabbed his face and neck in the construction site. A CT scan at the time of the accident demonstrated a comminuted fracture of the right side of the mandible and hyoid bone fracture at the junction between body and right greater cornua. The displaced fracture of hyoid bone and fullness in the pre-epiglottic space were noted, probably indicating some edema. The patient was transferred into ICU after treatment of emergency tracheostomy because the patient showed respiratory distress rapidly. When the patient was hospitalized in our emergency room, he complained of dysphagia and pain when swallowing. On examination of oral cavity, the presence of muscle wasting with fasciculation of the tongue was noted and the tongue deviates to the left side on protruding from the mouth. Pharyngolarygoscopy was performed to make sure that there was no evidence of progressive swelling and pharyngeal laceration. RESULTS: The patient underwent surgical removal of dead and infected tissue from the wound and reconstruction of mandibular bony defect by iliac bone grafting. Hyoid bone fracture was managed conservatively with oral analgesics, soft diet and restricted movement. Hypoglossal nerve palsy was resolved within 7 weeks after trauma without complications. CONCLUSION: Closed hyoid bone fracture is usually uncomplicated and thus it can be treated conservatively. Surgical intervention for hyoid bone fracture is recommended for patient with airway compromise, pharyngeal perforation and painful symptoms which show no response to conservative care. Furthermore, since respiratory distress syndrome may develop quickly, close observation is required. Besides, hypoglossal nerve palsy is a rarely recognized complication of hyoid bone fracture.
Subject(s)
Aged , Humans , Analgesics , Bone Transplantation , Chin , Deglutition , Deglutition Disorders , Diet , Edema , Emergencies , Fasciculation , Fractures, Comminuted , Hyoid Bone , Hypoglossal Nerve , Hypoglossal Nerve Diseases , Mandible , Mouth , Muscles , Neck , Tongue , TracheostomyABSTRACT
Bilateral hypoglossal nerve palsy is a rare clinical presentation. We report a case of central skull base osteomyelitis (SBO) presenting with complete tongue paralysis in a 53-year-old man who was not diabetic or immunocompromised. Magnetic resonance imaging demonstrated characteristic features including abnormal contrast enhancement in the clivus (T1-weighted images). Blood tests revealed elevated acute-phase reactants and leukocytosis, which prompted prolonged antibiotic treatment. He responded well to the antibiotics, which together with typical clinical and imaging findings led to the diagnosis of bacterial SBO.
Subject(s)
Humans , Middle Aged , Acute-Phase Proteins , Anti-Bacterial Agents , Cranial Fossa, Posterior , Hematologic Tests , Hypoglossal Nerve , Hypoglossal Nerve Diseases , Leukocytosis , Magnetic Resonance Imaging , Osteomyelitis , Paralysis , Skull , Skull Base , TongueABSTRACT
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.
Subject(s)
Adult , Female , Humans , Counseling , Dysarthria , Hypoglossal Nerve , Hypoglossal Nerve Diseases , Hypoglossal Nerve Injuries , Mouth , Neck , Neurologic Examination , Tongue , TonsillectomyABSTRACT
Isolated hypoglossal nerve palsy is a rare clinical condition and it causes deviation of the tongue and dysarthria. A 50-year-old female presented with tongue deviation to the left and mild dysarthria. She had no remarkable past medical history except several recent upper respiratory infections. On examination, the other cranial nerves were intact and she had no focal neurological signs. The findings of MRI and MR angiography were normal. Cerebrospinal fluid analysis revealed only mild elevation of protein. We diagnosed her as suffering with idiopathic isolated hypoglossal nerver palsy and we administered steroid therapy. The dysarthria was improved, but the tongue deviation still remained at 50 days after onset. We report here on a rare case of idiopathic isolated hypoglossal nerve palsy.
Subject(s)
Female , Humans , Middle Aged , Angiography , Cranial Nerves , Dysarthria , Hypoglossal Nerve , Hypoglossal Nerve Diseases , Paralysis , Respiratory Tract Infections , Stress, Psychological , TongueABSTRACT
PURPOSE: Isolated hypoglossal nerve palsy is a rare manifestation of various underlying disease. This article presents a rare complication of general anesthesia associated with an surgical procedure on a case of zygomatic fracture. METHODS: An 18-year-old female patient was referred to our department by painful swelling on her left zygomatic area after the traffic accident. Left zygomatic complex fracture was identified on the simple x-ray and facial bone CT scan, and the fracture was treated with open reduction and internal fixation under general anesthesia. On the first postoperative day, she complained of difficulty in swallowing solid food, dysarthria and deviated tongue to her right side. There was no abnormal findings on the neurological examination, brain MRI and routine chemistry. She was diagnosed with transient hypoglossal nerve palsy and dexamethasone with multi-vitamins was administrated intravenously for 5 days. RESULTS: The symptoms were completely resolved by the ninth postoperative day and the patient was discharged without any other complications. CONCLUSION: The hypoglossal(cranial nerve XII)nerve supplies motor innervation to all of the ipsilateral extrinsic and intrinsic tongue muscles. The hypoglossal nerve damage may caused by the compression between the airway and the hyoid bone during the endotracheal intubation, and direct trauma due to excessive pressure or neck extension. We described a rare case of unintended injury to hypoglossal nerve and care must be taken not to cause the hypoglossal nerve damage especially in facial plastic surgery with excessive neck extension under general anesthesia.
Subject(s)
Adolescent , Female , Humans , Accidents, Traffic , Anesthesia, General , Brain , Deglutition , Dexamethasone , Dysarthria , Equipment and Supplies , Facial Bones , Hyoid Bone , Hypoglossal Nerve , Hypoglossal Nerve Diseases , Intubation, Intratracheal , Muscles , Neck , Neurologic Examination , Surgery, Plastic , Tongue , Zygomatic FracturesABSTRACT
Although the incidence of unilateral abducens nerve palsy has been reported to be as high as 1% to 2.7% of head trauma cases, bilateral abducens nerve palsy following trauma is extremely rare. In this report, we present the case of a patient who developed a bilateral abducens nerve palsy and hypoglossal nerve palsy 3 days after suffering head trauma. He had a Glasgow Coma Score (GCS) of 15 points. Computed tomography (CT) images demonstrated clivus epidural hematoma and subarachnoid hemorrhage on the basal cistern. Herein, we discuss the possible mechanisms of these nerve palsies and its management.
Subject(s)
Humans , Abducens Nerve , Abducens Nerve Diseases , Coma , Cranial Fossa, Posterior , Craniocerebral Trauma , Head , Hematoma , Hypoglossal Nerve Diseases , Incidence , Paralysis , Stress, Psychological , Subarachnoid HemorrhageABSTRACT
Occipital condyle syndrome, which consists of unilateral occipital region pain associated with ipsilateral 12th cranial nerve paresis, is a rare, but stereotypic syndrome. Herein, we report a patient with occipital condyle syndrome associated with metastasis at the skull base from the hepatocellular carcinoma.
Subject(s)
Humans , Carcinoma, Hepatocellular , Cranial Nerves , Hypoglossal Nerve Diseases , Neoplasm Metastasis , Paresis , Skull BaseABSTRACT
Hypoglossal nerve palsy is a rare complication after general anesthesia with orotracheal intubation. It can present with symptoms of tongue deviation, dysarthria and swallowing difficulties. We report 33-year-old female who was scheduled to undergo surgery for a nasal bone fracture under general anesthesia, using orotracheal intubation. After surgery, she complained right side tongue deviation and, dysarthria, and was diagnosed with right hypoglossal nerve palsy. The cause of the hypoglossal nerve palsy was assumed to be a complication of the orotracheal intubation. Fortunately, the patient fully recovered 2 weeks after surgery.
Subject(s)
Adult , Female , Humans , Anesthesia, General , Deglutition , Dysarthria , Hypoglossal Nerve Diseases , Hypoglossal Nerve , Intubation , Nasal Bone , TongueABSTRACT
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.
Subject(s)
Adult , Female , Humans , Airway Obstruction , Carotid Body Tumor , Carotid Body , Dyspnea , Hypoglossal Nerve , Hypoglossal Nerve Diseases , Hypoglossal Nerve Injuries , Neck , Pulmonary Edema , Recovery Room , TongueABSTRACT
The hypoglossal nerve is a motor supply of the tongue. Hypoglossal nerve palsy after general anesthesia is rare but there have been several reports showing an association with oropharyngeal manipulation such as intubation, bronchoscopy, and laryngeal mask airway. The main mechanism considered has been a temporary compression of the nerve along its superficial course at the lateral root of the tongue during oropharyngeal manipulation. We encountered a patient who complained speaking and swallowing difficulties after general surgery. A deviation to the affected side, atrophy, and fasciculation of tongue were observed. Almost all palsies recovered spontaneously. We present a patient with a transient unilateral hypoglossal nerve palsy after an uncomplicated intubation and anesthesia for surgery for humerus fracture in the beach-chair position.
Subject(s)
Humans , Anesthesia , Anesthesia, General , Atrophy , Bronchoscopy , Deglutition , Fasciculation , Humerus , Hypoglossal Nerve Diseases , Hypoglossal Nerve , Intubation , Laryngeal Masks , Paralysis , TongueABSTRACT
The isolated hypoglossal nerve palsy is less frequently seen, but occasionally it appears as the initial or solitary sign of an intracranial or extracranial space-occupying lesion or a vascular abnormality of the internal carotid artery. We present a 55-year-old woman with isolated hypoglossal nerve palsy due to an oropharyngeal carotid space mass.
Subject(s)
Female , Humans , Middle Aged , Carotid Artery, Internal , Hypoglossal Nerve Diseases , Hypoglossal NerveABSTRACT
Hypoglossal nerve palsy is a rare and also a multietiological disease. Nearly half of the 12th nerve palsies were caused by tumors and only 5% followed by surgery, usually after head and neck surgery such as carotid endarterectomy. In the reported cases, complications of oral intubation, bronchoscopy and use of laryngeal mask airway can be the causes of hypoglossal nerve palsy and the positional change of neck can be the cause of nerve injury. Using the Beach chair position for arthroscopy of the shoulder has the advantages of reducing traction injuries to the brachial plexus but also the possibilities of complications such as air embolism, complete airway obstruction and nerve injury. We report a case of transient hypoglossal nerve palsy after general anesthesia, using orotracheal intubation, for shoulder arthroscopic surgery in beach chair position.
Subject(s)
Airway Obstruction , Anesthesia, General , Arthroscopy , Brachial Plexus , Bronchoscopy , Embolism, Air , Endarterectomy, Carotid , Head , Hypoglossal Nerve Diseases , Hypoglossal Nerve , Intubation , Laryngeal Masks , Neck , Paralysis , Shoulder , TractionABSTRACT
The peripheral hypoglossal nerve palsy is caused by carotid aneurysm, vascular entrapment, local infection, trauma, neck radiation, and tumors in the neck, retropharyngeal spaces, and basilar area of skull. A basilar skull lesion may rarely involve the hypoglossal nerve alone. We report a 58-year-old man with isolated hypoglossal nerve palsy due to metastasis of lung cancer at the skull base.
Subject(s)
Humans , Middle Aged , Aneurysm , Hypoglossal Nerve Diseases , Hypoglossal Nerve , Lung Neoplasms , Lung , Neck , Neoplasm Metastasis , Skull , Skull BaseABSTRACT
Laryngomicrosurgery is a common procedure in the otolaryngological fields. Transient glossopharyngeal and hypoglossal nerve palsy after laryngomicrosurgery are very rare. Recently, we experienced a palsy of glossopharyngeal and hypoglossal nerve which occurred after laryngomicrosurgery. We report this rare case with the review of literature.