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Journal of the Korean Society of Plastic and Reconstructive Surgeons 2009;36(1):80-83.
Published online January 1, 2009.
Transient Hypoglossal Nerve Palsy after Open Reduction of Zygomatic Complex Fracture.
Jee Wook Kim, Woo Seob Kim, Nam Ho Kwon, Han Koo Kim, Tae Hui Bae
1VIZ Plastic Surgery Center, Seoul, Korea.
2Department of Plastic and Reconstructive Surgery, College of Medicine, Chung-Ang University, Seoul, Korea.
Abstract
PURPOSE
Isolated hypoglossal nerve palsy is a rare manifestation of various underlying disease. This article presents a rare complication of general anesthesia associated with an surgical procedure on a case of zygomatic fracture. METHODS: An 18-year-old female patient was referred to our department by painful swelling on her left zygomatic area after the traffic accident. Left zygomatic complex fracture was identified on the simple x-ray and facial bone CT scan, and the fracture was treated with open reduction and internal fixation under general anesthesia. On the first postoperative day, she complained of difficulty in swallowing solid food, dysarthria and deviated tongue to her right side. There was no abnormal findings on the neurological examination, brain MRI and routine chemistry. She was diagnosed with transient hypoglossal nerve palsy and dexamethasone with multi-vitamins was administrated intravenously for 5 days.
RESULTS
The symptoms were completely resolved by the ninth postoperative day and the patient was discharged without any other complications.
CONCLUSION
The hypoglossal(cranial nerve XII)nerve supplies motor innervation to all of the ipsilateral extrinsic and intrinsic tongue muscles. The hypoglossal nerve damage may caused by the compression between the airway and the hyoid bone during the endotracheal intubation, and direct trauma due to excessive pressure or neck extension. We described a rare case of unintended injury to hypoglossal nerve and care must be taken not to cause the hypoglossal nerve damage especially in facial plastic surgery with excessive neck extension under general anesthesia.
Keywords: Hypoglossal nerve palsy; Cranial nerve XII; Zygomatic fracture
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