Tongue Laceration during Neurophysiologic Monitoring with Motor Evoked Potentials

DOI: 10.4236/ojanes.2012.25052   PDF   HTML   XML   3,923 Downloads   6,454 Views   Citations

Abstract

Although considered a safe modality for monitoring spinal cord function, motor evoked potentials (MEP) may cause tongue laceration in rare cases. Bite blocks are essential in order to prevent tongue and mucosal injury during monitoring with MEP, but there is no consensus on the ideal bite block to use for this purpose. Potential concerns include tongue necrosis from prolonged use of an oral airway as a hard bite block, and TMJ dysfunction caused by occlusal interference when blocks interrupt the normal occlusal surface. We had a case of tongue laceration during MEPs. Bite blocks should be placed prior to the start of monitoring to prevent teeth occlusion. Because rigid bite blocks may cause pressure injury to oropharyngeal structures soft bite blocks are recommended. The bite block needs to be placed in a way to prevent occlusion by both front teeth and molars and to keep the tongue in the middle of the mouth. Ongoing vigilance to bite block placement is strongly recommended.

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S. Pisklakov, V. Le and P. Sandoval, "Tongue Laceration during Neurophysiologic Monitoring with Motor Evoked Potentials," Open Journal of Anesthesiology, Vol. 2 No. 5, 2012, pp. 226-227. doi: 10.4236/ojanes.2012.25052.

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1] N. Malhotra and C. Shaffrey, “Intraoperative Electro-physiologic Monitoring during Spine Surgery,” Spine, Vol. 35, No. 25, 2010, pp. 2167-2179. doi:10.1097/BRS.0b013e3181f6f0d0
[2] D. Schwartz, et al. “Transcranial Electric Motor Evoked Potentials Monitoting for Spinal Surgery, Is It Safe?” Spine, Vol. 36, No. 13, 2011, pp. 1046-1049. doi:10.1097/BRS.0b013e3181ecbe77
[3] D. MacDonald, “Intraoperative Motor Evoked Potential Monitoring: Overview and Update,” Journal of Clinical Monitoring and Computing, Vol. 20, No. 5, 2006, pp. 347-377. doi:10.1007/s10877-006-9033-0
[4] S. Deiner and I. Osborn, “Prevention of Airway Injury during Spine Surgery: Rethinking Bite Blocks,” Journal of Neurosurgical Anesthesiology, Vol. 21, No. 1, 2009, pp. 68-69. doi:10.1097/ANA.0b013e31818d205e
[5] A. Lam and M. Vavilala, “Macroglossia: Compartment Syndrome of the Tongue?” Anesthesiology, Vol. 92, No. 6, 2000, pp. 1832-1835. doi:10.1201/9780849376276
[6] A. Tamkus and K. Rice, “The Incidence of Bite Injuries Associated with Transcranial Motor-Evoked Potential Monitoring,” Anesthesia & Analgesia, Vol. 115, No. 3, 2012, pp. 663-667.

  
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