Cranial nerves VII and XII palsy after shoulder surgery

Area of Science:

• Neurology
• Surgical Complications
• Anesthesiology

Background:

• Beach chair position is common for shoulder surgery.
• Interscalene blocks and general anesthesia are frequently used.
• Patient positioning and surgical maneuvers can pose risks.

Observation:

• A patient experienced severe headaches, Horner's sign, facial paresis, and lingual paralysis post-surgery.
• Imaging ruled out carotid dissection or parapharyngeal lesions.
• Neurological examination and EMG confirmed peripheral VII and XII cranial nerve lesions.

Findings:

• The patient's symptoms were most likely caused by Eagle syndrome neurapraxia.
• A long styloid process was implicated as the underlying anatomical factor.
• Ischemic complications were considered but deemed less probable.

Implications:

• This case suggests Eagle syndrome as a potential cause of cranial nerve deficits after shoulder surgery.
• Awareness of this rare complication is important for surgeons and anesthesiologists.
• Proper patient positioning and monitoring are crucial to prevent such adverse events.