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[Hypoglossal nerve paralysis following tonsillectomy].

O Michel1, T Brusis

  • 1Klinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde, Universität zu Köln.

Laryngo- Rhino- Otologie
|May 1, 1990
PubMed
Summary

Tonsillectomy can rarely cause hypoglossal nerve palsy. Experiments show surgical instruments can stretch the hypoglossal nerve, likely leading to palsy, especially with head reclinement.

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Area of Science:

  • Otolaryngology
  • Neurology
  • Surgical Anatomy

Background:

  • Tonsillectomy is a common surgical procedure.
  • Lingual and glossopharyngeal nerve injuries are known, rare complications.
  • Hypoglossal nerve palsy post-tonsillectomy is exceptionally rare, with inflammation previously suspected.

Observation:

  • A case of hypoglossal nerve palsy occurred after a standard tonsillectomy without inflammation.
  • This prompted an investigation into alternative causes for hypoglossal nerve injury during the procedure.

Findings:

  • Experimental insertion of spatulas (surgical and intubation) in the lateral lingual region caused significant strain on the hypoglossal nerve.
  • The nerve was observed to distend up to 1.3 cm.
  • Increased head reclinement during the simulated procedure exacerbated hypoglossal nerve distension.

Implications:

  • Surgical manipulation and patient positioning during tonsillectomy may be causative factors in hypoglossal nerve palsy.
  • This finding suggests a mechanical etiology for this rare complication.
  • Awareness of these mechanical risks may inform surgical technique and patient positioning to prevent hypoglossal nerve injury.

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