ABSTRACT
El schwannoma es una patología rara del nervio facial. Su diagnóstico preoperatorio es dificultoso dado que no tiene síntomas ni signos patognomónico de la enfermedad. La disección del nervio facial en su tronco y sus ramas con electroestimulacion es la forma de quirúrgica de sospecharlo intraoperatoriamente. La descompresión parcial o exeresis completa deberá ser considerado de acuerdo a la experiencia del equipo quirúrgico en reconstrucción nerviosa. La reparación del nervio facial como primera opción debe el injerto inmediato o sutura termino terminal. La neurotización es un procedimiento quirúrgico que le provoca al paciente simetría facial con manejo de oclusión ocular y manejo de comisura bucal, debe ser realizado antes del año de la injuria nerviosa. La rehabilitación del nervio facial necesita de un equipo multidisciplinario y la colaboración permanente del paciente para conseguir los objetivos propuestos.
Schwannoma is a rare pathology of the facial nerve. Its preoperative diagnosis is difficult since it has no symptoms or pathognomonic signs of the disease. The dissection of the facial nerve in its trunk and its branches with electrostimulation is the surgical way to suspect it intraoperatively. Partial decompression or complete exeresis should be considered according to the experience of the surgical team in nerve reconstruction. The repair of the facial nerve as a first option should be the immediate graft or end-to-end suture. Neurotization is a surgical procedure that causes the patient facial symmetry with management of ocular occlusion and management of the corner of the mouth, it must be performed within a year of the nerve injury. The rehabilitation of the facial nerve requires a multidisciplinary team and the permanent collaboration of the patient to achieve the proposed objectives.
Subject(s)
Humans , Female , Adult , Anastomosis, Surgical/methods , Nerve Transfer/rehabilitation , Hypoglossal Nerve Diseases/surgery , Facial Nerve Diseases/pathology , Preoperative Period , Neurilemmoma/pathologyABSTRACT
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
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.
Subject(s)
Humans , Cranial Nerves , Demyelinating Diseases , Diagnosis, Differential , Hypoglossal Nerve Diseases , Incidence , Motor Neuron Disease , Motor Neurons , Peripheral Nervous System Diseases , TongueABSTRACT
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.
Subject(s)
Humans , Anesthesia , Cranial Nerve Diseases , Cranial Nerves , Hypoglossal Nerve Diseases , Hypoglossal Nerve , Intraoperative Complications , Intubation , Intubation, Intratracheal , Paralysis , PrognosisABSTRACT
No abstract available.
Subject(s)
Hypoglossal Nerve Diseases , Hypoglossal Nerve , Submandibular GlandABSTRACT
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)
Central Nervous System Vascular Malformations , Hypoglossal Nerve Diseases , Hypoglossal NerveABSTRACT
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.
Subject(s)
Female , Humans , Middle Aged , Anesthesia, General , Deglutition Disorders , Dysarthria , Hypoglossal Nerve Diseases , Hypoglossal Nerve Injuries , Hypoglossal Nerve , Intubation , Intubation, Intratracheal , Mastectomy, Modified Radical , Paralysis , Physical Examination , TongueABSTRACT
No abstract available.
Subject(s)
Hypoglossal Nerve Diseases , Hypoglossal Nerve , Paralysis , PrognosisABSTRACT
La parálisis aislada del nervio hipogloso es un signo infrecuentemente observado en la práctica neurológica diaria. Se presenta el caso de un hombre de 74 años, sin antecedentes clínicos de importancia, que consultó por comenzar en forma aguda con dolor retroauricular y dificultad en la deglución. En el examen neurológico se constató paresia del nervio hipogloso izquierdo como único dato positivo, sin evidencia de atrofia o fasciculaciones. Los estudios de neuroimágenes no mostraron hallazgos patológicos. El paciente evolucionó favorablemente en forma espontánea. La parálisis aislada e idiopática del nervio hipogloso requiere una exhaustiva evaluación con neuroimágenes y exámenes complementarios. Habitualmente presenta remisión parcial o total espontánea.
The isolated unilateral palsy of the hypoglossal nerve is an unusual sign in daily medical practice. We present the case of a74 year old man, without relevant medical history, who started with headache and difficulty to swallow. On the physical examination, he had isolated hypoglossal nerve palsy without evidence of tongue atrophy or fasciculation. The patient had a good spontaneous evolution. Idiopathic isolated hypoglossal nerve palsy requires an exhaustive evaluation with neuroimages and complementary exams. It usually presents partial or total spontaneous remission.
Subject(s)
Aged , Humans , Male , Hypoglossal Nerve Diseases/diagnosis , Paralysis/diagnosis , Remission, SpontaneousABSTRACT
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.
Subject(s)
Female , Humans , Male , Carotid Artery, Internal , Cervical Vertebrae , Hypoglossal Nerve , Hypoglossal Nerve Diseases , Hypoglossal Nerve Injuries , Osteophyte , Recurrent Laryngeal Nerve Injuries , Spine , Tongue , TractionABSTRACT
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
No abstract available.
Subject(s)
Arachnoid , Hypoglossal Nerve Diseases , Hypoglossal NerveABSTRACT
Occipital condyle fractures (OCFs) with selective involvement of the hypoglossal canal are rare. OCFs usually occur after major trauma and combine multiple fractures. We describe a 38-year-old man who presented with neck pain and a tongue deviation to the right side after a traffic accident. Severe limitations were detected during active and passive range of neck motion in all directions. A physical examination revealed a normal gag reflex and normal mobility of the palate, larynx, and shoulder girdle. He had normal taste and general sensation in his tongue. However, he presented with a tongue deviation to the right side on protrusion. A videofluoroscopic swallowing study revealed piecemeal deglutition due to decreased tongue mobility but no aspiration of food. Plain X-ray film findings were negative, but a computed tomography study with coronal reconstruction demonstrated a right OCF involving the hypoglossal canal. An electrodiagnostic study revealed evidence of right hypoglossal nerve palsy. We report a rare case of isolated hypoglossal nerve palsy caused by an OCF.
Subject(s)
Adult , Humans , Accidents, Traffic , Deglutition , Electrodiagnosis , Hypoglossal Nerve , Hypoglossal Nerve Diseases , Larynx , Multidetector Computed Tomography , Neck , Neck Pain , Palate , Physical Examination , Reflex , Sensation , Shoulder , Tongue , X-Ray FilmABSTRACT
BACKGROUND: The purpose of this report is to describe the perioperative outcomes of standard carotid endarterectomy (CEA) with general anesthesia, routine shunting, and tissue patching in symptomatic carotid stenoses. MATERIALS AND METHODS: Between October 2007 and July 2011, 22 patients with symptomatic carotid stenosis (male/female, 19/3; mean age, 67.2+/-9.4 years) underwent a combined total of 23 CEAs using a standardized technique. The strict surgical protocol included general anesthesia and standard carotid bifurcation endarterectomy with routine shunting. The 8-French Pruitt-Inahara shunt was used in all the patients. RESULTS: During the ischemic time, the shunts were inserted within 2.5 minutes, and 5 patients (22.7%) revealed ischemic cerebral signals (flat wave) in electroencephalographic monitoring but recovered soon after insertion of the shunt. The mean shunting time for CEA was 59.1+/-10.3 minutes. There was no perioperative mortality or even minor stroke. All patients woke up in the operating room or the operative care room before being moved to the ward. One patient had difficulty swallowing due to hypoglossal nerve palsy, but had completely recovered by 1 month postsurgery. CONCLUSION: Routine shunting is suggested to be a safe and reliable method of brain perfusion and protection during CEA in symptomatic carotid stenoses.
Subject(s)
Humans , Anesthesia, General , Brain , Carotid Arteries , Carotid Stenosis , Deglutition , Endarterectomy , Endarterectomy, Carotid , Hypoglossal Nerve Diseases , Operating Rooms , Perfusion , Stroke , Surgical Procedures, OperativeABSTRACT
Schawannomas [neuromas, neurilemmomas] are benign tumors originating from showann cells or nerve fiber sheet cells. They are solitary, encapsulated tumors usually attached to, or surrounded by a nerve. We present a case of left hypoglossal nerve schwannoma in a 19 year old man who was admitted with progressive left tongue atrophy. Schwannoma of the hypoglossal nerve usually develops in the intracranial and extracranial portion or both in the intracranial and extracranial components forming a dumbbell shape tumor .The peripheral hypoglossal schwannomas are extremely rare