Unilateral Hypoglossal Nerve Palsy Following the Use of the Laryngeal Mask Airway

Extract

Hypoglossal nerve injury is a rare complication of anesthetic airway management. We report a case of unilateral hypoglossal nerve injury following the use of the laryngeal mask airway (LMA). A 48-year-old man with no past medical history sustained a proximal humerus fracture. His pre-operative examination was normal except for a humerus fracture. Anesthesia was induced and a size-3 LMA was inserted successfully on first attempt without difficulty. The cuff was inflated with the recommended 20 ml of air until there was no leak and maintained at a pressure of 10-15 cm H₂0. The surgery was uneventful and the duration of anesthesia was two hours. Peri-operatively the patient was hemodynamically stable without episodes of hypotension. The recovery staff noted approximately three hours after the surgery that his tongue was deviated to the left. The patient complained of difficulty swallowing and slurred speech. He had normal sensation of his tongue, taste was unchanged, and the gag reflex was intact. No other cranial nerves were involved and no other neurological deficiency was found. The following day, there was significantly less dysarthria and slight improvement in tongue movement. Conservative management included speech therapy and regular assessment. He continued to improve and complete recovery took place within two weeks.