Hypoglossal nerve (XII), maxillary nerve (V2) and lingual nerve (V3) palsy after laryngeal surgery. A case report.
Abstract Introduction/ Laryngeal surgery requires an orotracheal intubation and sometimes a Kleinsasser suspensor which allows access to the surgical material and manipulation of the area to be operated. These devices can compress different cranial nerves, causing sensory alterations, dysphonia, dysphagia, and dysglosia.Description / A 34-year-old female, required laryngeal microsurgery to resect vocal cord polyps using a Kleinsasser suspensor. Two weeks after, the patient reported pain in the right temporomandibular joint, choking with fluids and had vocal fatigue. After 4 weeks previous symptoms subsided, but in the physical examination a right deviation of the tongue was observed with an atrophy of the right half tongue and hypoesthesia of its anterior two thirds and of the nasal wing, superior lip and right inferior orbital rim. She still presents vocal fatigue. The fibrolaryngoscopy was normal. Diagnosis: functional dysphonia and a hypoglossal nerve and trigeminal nerve palsy: the maxillary branch and the the lingual nerve of the mandibular branch. Treatment: Vocal training and exercises to improve lingual dexterity. After 3 months she recovered normal phonation and sensibility. A slight lingual deviation persists, but with no interference in functionality.Discussion / Neuroapraxias lasts days or 3-6 months. The diagnosis is clinical. Fibrolaryngoscopy can help detect severe functional cases. In those cases, it is advisable to request a neurophysiology study to help establish a prognosis. Rehabilitation intervention participates in the management of symptoms or possible sequelae.Conclusions/These complications influence in the duration and severity of postsurgery symptoms, so they must be ruled out.
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Gevorgyan A, Nedzelski JM. A late recognition of Tapia syndrome: a case report and literature review. Laryngoscope. 2013 Oct;123(10):2423-7.
Cariati P, et al. Tapia's syndrome: pathogenetic mechanisms, diagnostic management, and proper treatment: a case series. J Med Case Rep. 2016 Jan 25;10: 23.
Thiruvenkatarajan V, et al. Cranial nerve injuries with supraglottic airway devices: a systematic review of published case reports and series. Anaesthesia. 2015 Mar;70(3):344-59.
Shah AC, et al. Hypoglossal nerve palsy after airway management for general anesthesia: an analysis of 69 patients. Anesth Analg. 2015 Jan;120(1):105-20.
Hickman N, Mathews A. Cranial nerve injuries with supraglottic airway devices--more common than we think? Anaesthesia. 2015 Sep;70(9):1095-6.
Mumtaz S, Henry A, Singh M. Tapia's Syndrome. Anesth Prog. 2018 Summer;65(2):129-130.
Melián-Cruz, N. E., Madroñero-Mariscal, R., & Nasarre-álvaro-gracia, A. (2018). Hypoglossal nerve (XII), maxillary nerve (V2) and lingual nerve (V3) palsy after laryngeal surgery. A case report. Revista ORL, 9(7), 2.6. https://doi.org/10.14201/orl.19349
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