Iatrogenic bilateral hypoglossal palsy following spinal surgery

Case Report

Abstract

Introduction

Bilateral hypoglossal palsy is a rare complication during airway management in surgery.

Case presentation

Isolated bilateral hypoglossal palsy was noted post-operatively in a patient who underwent multiple spinal surgeries associated with prone anaesthesia.

Discussion

Risk factors include difficult, multiple intubations, prolonged surgical time, throat pack, and hyperextension of the neck during intubation.

Conclusion

We aim to create awareness about this complication which has a significant morbidity and negative effect on patient outcomes.

Keywords

Bilateral hypoglossal Palsy Spinal surgery Prone 

Notes

Compliance with ethical standards

Conflict of interest

None of the authors has any potential conflict of interest.

Informed consent

Informed consent has been obtained from all individuals included in the study.

References

  1. 1.
    Sommer M, Schuldt M, Runge U, Gielen-Wijffels S, Marcus M (2004) Bilateral hypoglossal nerve injury following the use of the laryngeal mask without the use of nitrous oxide. Acta Anaesthesiol Scand 48(3):377–378CrossRefPubMedGoogle Scholar
  2. 2.
    Shah A, Barnes C, Spiekerman C, Bollag L (2015) Hypoglossal nerve palsy after airway management for general anesthesia. Anesth Analg 120(1):105–120CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Fritz M, Kang B, Fox T (2017) Practical neurology—iatrogenic hypoglossal nerve palsy (Internet). Practical Neurology. http://practicalneurology.com/2014/02/iatrogenic-hypoglossal-nerve-palsy/. Cited 14 March 2017
  4. 4.
    Evers K, Eindhoven G, Wierda J (1999) Transient nerve damage following intubation for trans-sphenoidal hypophysectomy. Can J Anesth 46(12):1143–1145CrossRefPubMedGoogle Scholar
  5. 5.
    Streppel M, Bachmann G, Stennert E (1997) Hypoglossal nerve palsy as a complication of transoral intubation for general anesthesia. Anesthesiology 86(4):1007CrossRefPubMedGoogle Scholar
  6. 6.
    Lin H, Barkhaus P (2009) Cranial nerve XII: the hypoglossal nerve. Semin Neurol 29(01):045–052CrossRefGoogle Scholar
  7. 7.
    Alves P (2010) Imaging the hypoglossal nerve. Eur J Radiol 74(2):368–377CrossRefPubMedGoogle Scholar
  8. 8.
    Laskawi R, Rohrbach S (2005) Impaired motor functions. Surgical and conservative procedures for restoring motor functions of the facial nerve, accessory nerve, hypoglossal nerve. Laryngorhinootologie 84(Suppl 1):S142–S155CrossRefPubMedGoogle Scholar
  9. 9.
    Lopes G, Denoel C, Desuter G, Docquier MA (2009) Two cases of isolated unilateral paralysis of hypoglossal nerve after uncomplicated orotracheal intubation. Acta Anaesthesiol Belg 60:191–193PubMedGoogle Scholar
  10. 10.
    Tesei F, Poveda L, Strali W, Tosi L, Magnani G (2006) Unilateral laryngeal and hypoglossal paralysis following rhinoplasty in general anaesthetic. Acta Otorhinolaryngol Ital 26(4):219–221PubMedPubMedCentralGoogle Scholar
  11. 11.
    Dziewas R, Ludemann P (2002) Hypoglossal nerve palsy as complication of oral intubation, bronchoscopy and use of the laryngeal mask airway. Eur Neurol 47:239–243CrossRefPubMedGoogle Scholar
  12. 12.
    Mullins RC, Drez D Jr, Cooper J (1992) Hypoglossal nerve palsy after arthroscopy of the shoulder and open operation with the patient in the beach-chair position. A case report. J Bone Joint Surg Am 74:137–139CrossRefPubMedGoogle Scholar
  13. 13.
    Haslam B, Collins S (2013) Unilateral hypoglossal neurapraxia following endotracheal intubation for total shoulder arthroplasty. AANA 81:233–236Google Scholar
  14. 14.
    Nagai K, Sakuramoto C, Goto F (1994) Unilateral hypoglossal nerve paralysis following the use of the laryngeal mask airway. Anaesthesia 49:603–604CrossRefPubMedGoogle Scholar
  15. 15.
    Ratnaraj J, Todorov A, McHugh T, Cheng MA, Lauryssen C (2002) Effects of decreasing endotracheal tube cuff pressures during neck retraction for anterior cervical spine surgery. J Neurosurg 97:176–179PubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany 2017

Authors and Affiliations

  1. 1.Department of Spinal SurgerySalford Royal NHS Foundation TrustSalfordUK
  2. 2.Department of AnaesthesiaSalford Royal NHS Foundation TrustSalfordUK

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