Tongue Bite Injury Resulting from Intra-operative Neuromonitoring during Posterior Scoliosis Corrective Surgery Not an Uncommon Complication: Case Report and Literature Review

Abstract

Tongue bite injuries (TBI) resulting from the use of intra-operative neuromonitoring (IONM) during spinal surgeries are not as uncommon a complication as previously thought, especially when using transcranial motor evoked potential (TcMEP). The incidence of bite injuries ranged from 0.14% to 0.63%, with TBI occurring four times more frequently than lip injuries, and of these, 0.15% of tongue lacerations required surgical repair. Through our literature search, we discovered that these injuries have never been reported in Malaysia; additionally, this is the first incidence encountered by our team. We are reporting a 20-year-old male who sustained a TBI during posterior scoliosis corrective surgery while using TcMEP. We report on its management and reviewed literatures to explain the causes and the recommendations for the prevention of this injury. In conclusion, TBI is an unpleasant complication in spinal surgery related to the use of IONM. Safety precautions need to be taken during surgical preparation, and we propose using two to three soft bite blocks (SBB) to aid in reducing the rate of this complication.