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13 - An uncommon complication: Isolated unilateral hypoglossal nerve palsy after septorhinoplasty
Demet Yazici, Ayse Karaogullarindan, Gokhan Kuran, Ayse Karakaya
Objective: Isolated hypoglossal nerve palsy is a rare complication of long lasting operations under general anesthesia like cosmetic surgeries and orthopedic operations, caused by the use of laryngeal mask or intubation tube. In this case report, we discuss the probable causes and treatment methods of this complication in the light of the current literature.
Case: In this study, we present a 35-year old patient who developed isolated left hypoglossal nerve palsy right after septorhinoplasty. The patient received B vitamin complex and a gradual tapering dose of oral methylprednisolone treatment of 1mg/kg and his tongue movements completely recovered after three months.
Conclusion: Hypoglossal nerve palsy is the consequence of neuropraxia caused by compression of the nerve in between the intubation tube or its cuff and the hyoid bone or cervical vertebra. In this case report, we evaluated factors that increase the complication rate, such as the use of nitrous oxide during the surgery, the malposition of the intubation tube or the laryngeal mask. Precautions such as using adequate size intubation tubes, gentle intubation of the patient without trauma, proper positioning of the intubation tube, avoiding long-time hyperextension of the position of the head of the patient and checking intracuff pressure continuously with a manometer would help to prevent these kind of complications.
Keywords: Hypoglossal nerve, palsy, rhinoplasty
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