Unilateral Hypoglossal Nerve Palsy After Lumbar Disk Herniation Surgery

Abstract

The intrinsic muscles of the tongue are innervated by the 12th cranial nerve, the Nervus Hypoglossus (NH), a pure motor nerve. Following airway management, a complication that can occur is isolated NH paralysis. The patient’s hypoglossal nerve palsy was discussed in this case report. A 50-year-old male patient was scheduled for lumbar disc herniation surgery. Following routine monitoring, the patient underwent induction, and an 8.5-mm spiral endotracheal tube was used for endotracheal intubation. Following the surgery, the patient was transferred to the ward, and after two hours complaints of numbness in the tongue, movement restriction, and speech difficulty began. When he removed his tongue from his mouth, it was deviated to the right. Airway management or prone positioning was suspected as the cause of this condition, and right isolated NH palsy was diagnosed. The methylprednisolone therapy was applied to the patient for one week. After one month, the patient recovered completely without any sequelae. A rare side effect of neuropraxia caused by endotracheal intubation, mask ventilation, bronchoscopy, placement of laryngeal mask airway or prone positioning is isolated NH paralysis. Steroid medication for a short period of time is often effective and curative. Patients undergoing any type of airway manipulation should be aware of the risk of isolated NH palsy. Keywords: Airway management, hypoglossal nerve palsy, methylprednisolone, nervus hypoglossus