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Dysarthria associated with hypoglossal nerve palsy and COVID-19
Published in Margaret Walshe, Nick Miller, Clinical Cases in Dysarthria, 2021
This case report describes the management of a motor speech disorder as a consequence of COVID-19. The cause of dysarthria was attributed to CNXII. Lesions of hypoglossal nerve during manoeuvring for oral intubation have been described in several studies (Cinar, Seven, Cinar, & Turgut, 2005; De Luca et al., 2020; Decavel, Petit, & Tatu, 2020; Dziewas & Lüdemann, 2002; Lykoudis & Seretis, 2012; Shah, Barnes, Spiekerman, & Bollag, 2015). Hypoglossal nerve damage may also occur as a result of proning. Decavel et al. describe a patient with COVID-19 who required prolonged prone-position ventilation with lateral flexion of the head (Decavel et al., 2020). In a post-acute care unit, this patient presented with left hypoglossal nerve paralysis and left soft palate weakness along with complete paralysis of the left vocal cord in the abducted position. The authors concluded that the prone-position ventilation could be the main aetiological factor; nevertheless, they did not report about intervention and whether the patient recovered.
Surgical Emergencies
Published in Anthony FT Brown, Michael D Cadogan, Emergency Medicine, 2020
Anthony FT Brown, Michael D Cadogan
Damage to the following nerves causes specific signs and symptoms: Recurrent laryngeal branch of the vagus: hoarseness and vocal cord paralysis.Accessory nerve: loss of function of trapezius and sternomastoid.Phrenic nerve: loss of diaphragmatic movement, elevated hemidiaphragm on x-ray.Hypoglossal nerve: deviation of the tongue to the affected side.Cervical sympathetic cord: Horner's syndrome, with partial ptosis, a constricted pupil, and decreased sweating on the same side of the face.
Anatomy and Embryology of the Mouth and Dentition
Published in John C Watkinson, Raymond W Clarke, Terry M Jones, Vinidh Paleri, Nicholas White, Tim Woolford, Head & Neck Surgery Plastic Surgery, 2018
The muscles of the tongue are supplied by the hypoglossal nerve. These muscles develop primarily from occipital somites that migrate into the developing tongue carrying their nerve supply, the hypoglossal nerve, with them. The hypoglossal nerve is seen in the neck crossing over the internal and external carotid and then the loop of the lingual artery (Figure 41.8). It then passes upwards and forwards between the mylohyoid and hyoglossus muscles. Here, the hypoglossal nerve is situated below the deep part of the submandibular gland, the submandibular duct and the lingual nerve. It then passes on to the lateral aspect of the genioglossus muscle, continuing forwards in its substance as far as the tip of the tongue.
Effects of Peak Inspiratory Pressure-Guided Setting of Intracuff Pressure for Laryngeal Mask Airway Supreme™ Use during Laparoscopic Cholecystectomy: A Randomized Controlled Trial
Published in Journal of Investigative Surgery, 2021
Mao-Hua Wang, Dong-Sheng Zhang, Wei Zhou, Shun-Ping Tian, Tian-Qi Zhou, Wei Sui, Zhuan Zhang
Blood was seen on the LMA at the time of its removal in two patients in the PIP group and in three patients in the control group (P > 0.05). There were no instances of bucking, regurgitation, aspiration, or laryngospasm in either group. The incidences of sore throat and dysphagia in the PACU and at 24 h postoperatively were significantly lower in the PIP group than in the control group (95% CI: 0.07 to 0.36, P = 0.005, sore throat in PACU; 95% CI: 0.08 to 0.35, P = 0.003, sore throat at 24 h postoperatively; 95% CI: 0.08 to 0.38, P = 0.003, dysphagia in PACU; 95% CI: 0.10 to 0.37, P = 0.001, dysphagia at 24 h postoperatively). The incidences of pharyngeal hematoma and dysphonia were lower in the PIP group than in the control group, although the difference was not significant (95% CI: −0.03 to 0.19, P = 0.144, pharyngeal hematoma in PACU and at 24 h postoperatively; 95% CI: −0.04 to 0.11, P = 0.404, dysphagia in PACU and at 24 h postoperatively). No cases of nerve damage, such as recurrent laryngeal nerve paralysis, hypoglossal nerve paralysis, and lingual nerve paralysis, occurred in either group (Table 4).
A rare cause of unilateral hypoglossal nerve palsy: case report of intraneural ganglion cyst of the hypoglossal nerve and review of the literature
Published in Case Reports in Plastic Surgery and Hand Surgery, 2019
Jeremie D. Oliver, Antonio J. Forte
Ganglion cysts causing hypoglossal compression are rare. They are typically found in peripheral nerves near tendon sheaths, often near the carpal tunnel, or in the knee region near the fibular head [1–3]. Cranial nerves are rarely affected by intraneural ganglion cysts [3]. These cysts can present clinically by causing compression of the adjacent nerve fascicles, resulting in pain, paresthaesia, weakness, muscle denervation, and atrophy [1]. Significant clinical findings to be expected from an intraneural ganglion cyst of the hypoglossal nerve include unilateral tongue deviation and atrophy on the affected side, as well as potentially slurred speech or compression of nerves of the jugular foramen [4–7]. The present literature documents only four cases being reported [4–7]. We report an extremely rare case of a patient with a hypoglossal cystic lesion. The aim of this report is to present our surgical approach to treatment and to compare our findings with previous reported cases of unilateral hypoglossal nerve palsy, highlighting the importance of an intraneural (or extraneural) ganglion cyst in the differential diagnosis of such.
Prediction in obstructive sleep apnoea: diagnosis, comorbidity risk, and treatment outcomes
Published in Expert Review of Respiratory Medicine, 2018
Kate Sutherland, Fernanda R. Almeida, Philip de Chazal, Peter A. Cistulli
There are various surgeries which have been developed to treat sleep apnea. These may target the nose to increase airflow through the nasal passages, pharyngeal structures which compromise airway space (e.g. tonsils or soft palate), or the jaw to increase the size of the maxillomandibular enclosure [137]. Pharyngeal surgeries can target a single region (such as uvulopalatopharyngoplasty) or be multilevel [138]. Identifying the right type of surgical intervention requires anatomical predictors of the particular airway malfunctions of that individual. Tools such as staging systems for intraoral anatomy and drug-induced sleep endoscopy are used to inform which patients will benefit from particular surgical options [139]. A relatively recent novel surgical approach is hypoglossal nerve stimulation to enhance upper airway dilator muscle function [140]. This surgical option consists of inserting a cuff around the hypoglossal nerve, which is attached to a pulse generator implanted into the chest. Intermittent electrical stimulation of the hypologlossal nerve activates the genioglossus muscle resulting in its protrusion and an increase in pharyngeal airway space. This therapy has been shown to be successful over the long-term in a subset of patients [140]. Predictors of a good therapeutic response to hypoglossal nerve stimulation have been investigated. A concentric pattern of collapse observed during drug-induced sleep endoscopy suggests a poor result [141] and OSA severity and obesity may also be negative predictors [142].