Unexpected Airway Obstruction Caused by Bilateral Hypoglossal Nerve Palsy Following Second Radical Neck Dissection


A 67-year-old woman underwent right radical neck dissection for cervical lymph node metastasis from maxillary gingival carcinoma. Two months later, metastasis in the left superior internal jugular lymph nodes were discovered, and left radical neck dissection was performed. Postoperatively, airway obstruction occurred despite performing extubation after confirming that the patient had fully recovered from anesthesia. Bilateral hypoglossal nerve palsy was diagnosed and the patient was reintubated. After extubation on the following day, airway obstruction was relieved, but slurred speech and impaired swallowing were persistent. In view of this, hypoglossal nerve function should be examined before the second radical neck dissection on the contralateral side.

Share and Cite:

S. Ito, S. Fujiwara, T. Yatabe, K. Yamashita and T. Yokoyama, "Unexpected Airway Obstruction Caused by Bilateral Hypoglossal Nerve Palsy Following Second Radical Neck Dissection," Open Journal of Anesthesiology, Vol. 3 No. 3, 2013, pp. 123-125. doi: 10.4236/ojanes.2013.33029.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] B. Olzowy, S. Lorenzl and R. Guerkov, “Bilateral and Unilateral Internal Carotid Artery Dissection Causing Isolated Hypoglossal Nerve Palsy: A Case Report and Review of the Literature,” European Archives of Oto-Rhino-Laryngology and Head & Neck, Vol. 263, No. 4, 2006, pp. 390-393. doi:10.1007/s00405-005-1005-3
[2] S. Omura, Y. Nakajima, S. Kobayashi, S. Ono and K. Fu-jita, “Oral Manifestations and Differential Diagnosis of Isolated Hypoglossal Nerve Palsy: Report of Two Cases,” Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology, Vol. 84, No. 6, 1997, pp. 635-640. doi:10.1016/S1079-2104(97)90365-6
[3] T. E. Bageant, D. Tondini and D. Lysons, “Bilateral Hypoglossal-Nerve Palsy Following a Second Carotid Endarterectomy,” Anesthesiology, Vol. 43, No. 5, 1975, pp. 595-596. doi:10.1097/00000542-197511000-00026
[4] J. P. Levelle and O. A. Martinez, “Airway Obstruction after Bilateral Carotid Endarterectomy,” Anesthesiology, Vol. 63, No. 2, 1985, pp. 220-222. doi:10.1097/00000542-198508000-00024
[5] J. T. Hong, S. W. Lee, B. C. Son, J. H. Sung, I. S. Kim and C. K. Park, “Hypoglossal Nerve Palsy after Posterior Screw Placement on the C-1 Lateral Mass,” Journal of neurosurgery. Spine, Vol. 5, No. 1, 2006, pp. 83-85. doi:10.3171/spi.2006.5.1.83
[6] W. J. S. Krieg, “Functional Neuroanatomy,” Blakiston, New York, 1953, pp. 73-77.
[7] G. S. Goding Jr., D. W. Eisele, R. Testerman, P. L. Smith, K. Roertgen and A. R. Schwartz, “Relief of Upper Airway Obstruction with Hypoglossal Nerve Stimulation in the Canine,” Laryngoscope, Vol. 108, No. 2, 1998, pp. 162-169. doi:10.1097/00005537-199802000-00003
[8] J. Ilomaki, G. A. Baer, T. Karhuketo, P. Talonen and H. Puhakka, “Pharyngeal Patency Caused by Stimulation of the Hypoglossal Nerve in Anaesthesia-Relaxed Patients,” Acta Oto-Laryngologica, Vol. 117, No. s529, 1997, pp. 210-211. doi:10.3109/00016489709124124
[9] M. A. Condado, D. Morais, J. Santos, J. Alonso-Vielba and V. Miyar, “Hypoglossal Nerve Paralysis after Intubation and Direct Laryngoscopy,” Acta Otorrinolaringologica Espanola, Vol. 45, No. 6, 1994, pp. 477-479.
[10] M. Streppel, G. Bachmann and E. Stennert, “Hypoglossal Nerve Palsy as a Complication of Transoral Intubation for General Anesthesia,” Anesthesiology, Vol. 86, No. 4, 1997, p. 1007. doi:10.1097/00000542-199704000-00036
[11] K. Nagai, C. Sakuramoto and F. Goto, “Unilateral Hypoglossal Nerve Paralysis Following the Use of the Laryngeal Mask Airway,” Anaesthesia, Vol. 49, No. 7, 1994, pp. 603-604.
[12] M. Sommer, M. Schuldt, U. Runge, S. Gielen-Wijffels and M. A. Marcus, “Bilateral Hypoglossal Nerve Injury Following the Use of the Laryngeal Mask without the Use of Nitrous Oxide,” Acta Anaesthesiologica Scandinavica, Vol. 48, No. 3, 2004, pp. 377-378. doi:10.1111/j.0001-5172.2004.0332.x

Copyright © 2022 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.