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Aly M, Dadak R, Lin C, Kumar K. Postoperative lingual nerve injury following airway management: A literature review. J Perioper Pract 2024:17504589241270238. [PMID: 39189112 DOI: 10.1177/17504589241270238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/28/2024]
Abstract
Postoperative lingual nerve injury is a rare but serious complication following airway management and can lead to significant discomfort and disability. This literature review explores the aetiology, clinical presentation, management strategies and potential preventive measures for lingual nerve injuries associated with airway management during surgery. A search of PubMed, MEDLINE, EMBASE Science Direct, Cochrane library and Web of Science databases was done since inception to January 2024, including any observational studies and clinical trials describing patients diagnosed with lingual nerve injury following airway instrumentation. Multiple risk factors for lingual nerve injury were identified. Anaesthesia factors include difficulty with intubation and use of laryngeal mask airway. Surgical factors are long duration of operation and surgery of the head and neck. Patient factor includes female sex. Anaesthetists should proactively inform patients about the potential for this nerve injury and control modifiable risk factors to mitigate the risk of injury.
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Affiliation(s)
- Mohamed Aly
- Schulich School of Medicine and Dentistry, The University of Western Ontario, London, ON, Canada
| | - Rohan Dadak
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Cheng Lin
- Schulich School of Medicine and Dentistry, The University of Western Ontario, London, ON, Canada
- London Health Sciences Centre, London, ON, Canada
| | - Kamal Kumar
- Schulich School of Medicine and Dentistry, The University of Western Ontario, London, ON, Canada
- London Health Sciences Centre, London, ON, Canada
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Xian L, Yuan J, Li H, Gao Z, He J, Deng H. Unilateral sublingual nerve paralysis after laryngeal mask airway in a patient with congenital heart disease: a case report. J Int Med Res 2023; 51:3000605231190899. [PMID: 37561563 PMCID: PMC10416657 DOI: 10.1177/03000605231190899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 07/10/2023] [Indexed: 08/11/2023] Open
Abstract
Laryngeal masks are widely used by anesthesiologists in clinical practice because of their advantages of no tracheal injury, minimal airway stimulation, limited airway tissue invasion, and easy implantation and airway establishment. We herein describe a patient with congenital heart disease who developed unilateral sublingual nerve paralysis after application of a laryngeal mask airway. The patient reported perioral numbness and exhibited unclear speech and slight right deviation of the tip of the tongue after surgery. On physical examination, the patient had normal muscle strength, symmetrical frontal lines, normal occlusion, and a normal nasolabial groove. We performed head computed tomography and computed tomography angiography to rule out cerebrovascular disease, and no abnormalities were found. The patient's imaging findings and clinical symptoms suggested unilateral right sublingual nerve palsy. After active treatment, the patient's symptoms improved by 75% on the third postoperative day and by 90% on the fifth postoperative day. Despite the extremely low incidence of sublingual nerve palsy after application of a laryngeal mask airway, anesthesiologists should be aware of this complication. Although the nerve palsy can resolve spontaneously, the nerve damage may be permanent.
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Affiliation(s)
- Li Xian
- Department of Anesthesiology, No. 363 Hospital, Sichuan Province, Chengdu, China
| | - Jinlong Yuan
- Department of Anesthesiology, No. 363 Hospital, Sichuan Province, Chengdu, China
| | - Hong Li
- Department of Anesthesiology, No. 363 Hospital, Sichuan Province, Chengdu, China
| | - Zhiyong Gao
- Department of Anesthesiology, No. 363 Hospital, Sichuan Province, Chengdu, China
| | - Jing He
- Department of Nursing, No. 363 Hospital, Sichuan Province, Chengdu, China
| | - Haijun Deng
- Department of Nursing, No. 363 Hospital, Sichuan Province, Chengdu, China
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Wang ZY, Liu WZ, Wang FQ, Chen YZ, Huang T, Yuan HS, Cheng Y. Lingual nerve injury caused by laryngeal mask airway during percutaneous nephrolithotomy: A case report. World J Clin Cases 2021; 9:11095-11101. [PMID: 35047623 PMCID: PMC8678870 DOI: 10.12998/wjcc.v9.i35.11095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 08/07/2021] [Accepted: 10/27/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Lingual nerve injury (LNI) is a rare complication following the use of laryngeal mask airway (LMA). The occurrence of this unexpected complication causes uncomfortable symptoms in patients and worsens their quality of life. We present an unusual case of LNI caused by the use of an LMA in percutaneous nephrolithotomy (PCNL).
CASE SUMMARY A 49-year-old man presented to our hospital with a 3-year history of intermittent left lower back pain. Abdominal computed tomography showed a 25 mm × 20 mm stone in the left renal pelvis. PCNL surgery using LMA was performed to remove the renal stone. The patient reported numbness on the tip of his tongue after the operation, but there were no signs of swelling or trauma. The patient was diagnosed with LNI after other possible causes were ruled out. The symptom of numbness eventually improved after conservative medical therapy for 1 wk. The patient completely recovered 3 wk after surgery.
CONCLUSION This is the first case report describing LNI with the use of LMA in PCNL. In our case, an inappropriate LMA size, intraoperative movement, and a specific surgical position might be potential causes of this rare complication.
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Affiliation(s)
- Zheng-Yi Wang
- Medical College, Ningbo University, Ningbo 315211, Zhejiang Province, China
| | - Wan-Zhang Liu
- Department of Urology, Ningbo First Hospital, The Affiliated Hospital of Ningbo University, Ningbo 315010, Zhejiang Province, China
| | - Feng-Qi Wang
- Medical College, Ningbo University, Ningbo 315211, Zhejiang Province, China
| | - Ying-Zhi Chen
- Medical College, Ningbo University, Ningbo 315211, Zhejiang Province, China
| | - Ting Huang
- Department of Urology, Ningbo First Hospital, The Affiliated Hospital of Ningbo University, Ningbo 315010, Zhejiang Province, China
| | - He-Sheng Yuan
- Department of Urology, Ningbo First Hospital, The Affiliated Hospital of Ningbo University, Ningbo 315010, Zhejiang Province, China
| | - Yue Cheng
- Department of Urology, Ningbo First Hospital, The Affiliated Hospital of Ningbo University, Ningbo 315010, Zhejiang Province, China
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Unilateral lingual nerve and hypoglossal nerve injury caused by a novel laryngeal mask airway: a case report. Braz J Anesthesiol 2021; 72:666-668. [PMID: 34848319 PMCID: PMC9515685 DOI: 10.1016/j.bjane.2021.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 10/10/2021] [Accepted: 10/24/2021] [Indexed: 11/28/2022] Open
Abstract
Cranial nerve injury by a laryngeal mask airway is rare but a serious complication. The nerve injuries must be prevented during the intubation using a laryngeal mask airway. We report a female patient who complained of tongue numbness, slurred speech, and slight difficulty in swallowing solid food after a hand surgery. She was then diagnosed with unilateral lingual nerve and hypoglossal nerve injuries. Extreme head rotation, relatively small oral cavity, and wide rigid composition at the lower part of the novel laryngeal mask probably resulted in cranial nerve injury.
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Yoo S, Park SK, Kim WH, Hur M, Bahk JH, Lim YJ, Kim JT. Influence of head and neck position on performance of the Ambu® AuraGain™ laryngeal mask: a randomized crossover study. Minerva Anestesiol 2019; 85:133-138. [DOI: 10.23736/s0375-9393.18.12579-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Incidence and risk factors for postoperative lingual neuropraxia following airway instrumentation: A retrospective matched case-control study. PLoS One 2018; 13:e0190589. [PMID: 29329350 PMCID: PMC5766107 DOI: 10.1371/journal.pone.0190589] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 12/18/2017] [Indexed: 12/15/2022] Open
Abstract
Background Lingual nerve injury or neuropraxia is a rare but potentially serious perioperative complication following airway instrumentation during general anesthesia. This study explored the the incidence and perioperative risk factors for lingual nerve injury in patients receiving laryngeal mask (LMA) or endotracheal (ETGA) general anesthesia in a single center experience. Methods and results All surgical patients in our hospital who received LMA or ETGA from 2009 to 2013 were included, and potential perioperative risk factors were compared. Matched controls were randomly selected (in 1:5 ratio) from the same database in non-case patients. A total of 36 patients in the records had reported experiencing tongue numbness after anesthesia in this study. Compared with the non-case surgical population (n = 54314), patients with tongue numbness were significantly younger (52.2±19.5 vs 42.0±14.5; P = 0.002) and reported lower ASA physical statuses (2.3±0.7 vs 1.6±0.6; P<0.001). Patient gender, anesthesia technique used, and airway device type (LMA or ETGA) did not differ significantly across the two groups. A significantly higher proportion of patients underwent operations of the head-and-neck region (38.9 vs 15.6%; P = 0.002) developed tongue numbness after anesthesia. Multivariate logistic regression analysis indicated that head-and-neck operations remained the most significant independent risk factor for postoperative lingual nerve injury (AOR 7.63; 95% CI 2.03–28.70). Conclusion The overall incidence rate of postoperative lingual neuropraxy was 0.066% in patients receiving general anesthesia with airway device in place. Young and generally healthy patients receiving head-and-neck operation are at higher risk in developing postoperative lingual neuropraxy. Attention should be particularly exercised to reduce the pressure of endotracheal tube or laryngeal mask on the tongue during head-and-neck operation to avert the occurrence of postoperative lingual neuropraxy.
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Michalek P, Donaldson W, Vobrubova E, Hakl M. Complications Associated with the Use of Supraglottic Airway Devices in Perioperative Medicine. BIOMED RESEARCH INTERNATIONAL 2015; 2015:746560. [PMID: 26783527 PMCID: PMC4691459 DOI: 10.1155/2015/746560] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 11/24/2015] [Indexed: 12/15/2022]
Abstract
Supraglottic airway devices are routinely used for airway maintenance in elective surgical procedures where aspiration is not a significant risk and also as rescue devices in difficult airway management. Some devices now have features mitigating risk of aspiration, such as drain tubes or compartments to manage regurgitated content. Despite this, the use of these device may be associated with various complications including aspiration. This review highlights the types and incidence of these complications. They include regurgitation and aspiration of gastric contents, compression of vascular structures, trauma, and nerve injury. The incidence of such complications is quite low, but as some carry with them a significant degree of morbidity the need to follow manufacturers' advice is underlined. The incidence of gastric content aspiration associated with the devices is estimated to be as low as 0.02% with perioperative regurgitation being significantly higher but underreported. Other serious, but extremely rare, complications include pharyngeal rupture, pneumomediastinum, mediastinitis, or arytenoid dislocation. Mild short-lasting adverse effects of the devices have significantly higher incidence than serious complications and involve postoperative sore throat, dysphagia, pain on swallowing, or hoarseness. Devices may have deleterious effect on cervical mucosa or vasculature depending on their cuff volume and pressure.
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Affiliation(s)
- Pavel Michalek
- Department of Anaesthesia and Intensive Medicine, 1st Medical Faculty, Charles University in Prague and General University Hospital, U Nemocnice 2, 120 21 Prague, Czech Republic
- University of East Anglia, Norwich Research Park, Norwich, Norfolk NR4 7TJ, UK
| | - William Donaldson
- Department of Anaesthetics, Antrim Area Hospital, Bush Road, Antrim BT41 4RD, UK
| | - Eliska Vobrubova
- Department of Anaesthesia and Intensive Medicine, 1st Medical Faculty, Charles University in Prague and General University Hospital, U Nemocnice 2, 120 21 Prague, Czech Republic
| | - Marek Hakl
- Department of Anaesthesia and Intensive Medicine, St. Anne University Hospital, Pekarska 53, 656 91 Brno, Czech Republic
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Thiruvenkatarajan V, Van Wijk RM, Rajbhoj A. Cranial nerve injuries with supraglottic airway devices: a systematic review of published case reports and series. Anaesthesia 2014; 70:344-59. [DOI: 10.1111/anae.12917] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2014] [Indexed: 12/12/2022]
Affiliation(s)
- V. Thiruvenkatarajan
- Department of Anaesthesia; The Queen Elizabeth Hospital; Woodville South Australia Australia
- Discipline of Acute Care Medicine; The University of Adelaide; Adelaide South Australia Australia
| | - R. M. Van Wijk
- Department of Anaesthesia; The Queen Elizabeth Hospital; Woodville South Australia Australia
- Discipline of Acute Care Medicine; The University of Adelaide; Adelaide South Australia Australia
| | - A. Rajbhoj
- Department of Anaesthesia; The Queen Elizabeth Hospital; Woodville South Australia Australia
- Discipline of Acute Care Medicine; The University of Adelaide; Adelaide South Australia Australia
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Unilateral hypoglossal nerve palsy after use of the laryngeal mask airway supreme. Case Rep Anesthesiol 2014; 2014:369563. [PMID: 25254120 PMCID: PMC4164424 DOI: 10.1155/2014/369563] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2014] [Accepted: 08/25/2014] [Indexed: 12/27/2022] Open
Abstract
Purpose. Hypoglossal nerve palsy after use of the laryngeal mask airway (LMA) is an exceptionally rare complication. We present the first case of unilateral hypoglossal nerve palsy after use of the LMA Supreme. Clinical Features. A healthy 67-year-old female was scheduled for a hallux valgus correction under general anesthesia combined with femoral and sciatic nerve blocks. A size 4 LMA Supreme was inserted successfully at the first attempt and the cuff was inflated with air at an intracuff pressure of 60 cmH2O using cuff pressure gauge. Anesthesia was maintained with oxygen, nitrous oxide (67%), and sevoflurane under spontaneous breathing. The surgery was uneventful and the duration of anesthesia was two hours. The LMA was removed as the patient woke and there were no immediate postoperative complications. The next morning, the patient complained of dysarthria and dysphasia. These symptoms were considered to be caused by the LMA compressing the nerve against the hyoid bone. Conservative treatment was chosen and the paralysis recovered completely after 5 months. Conclusion. Hypoglossal nerve injury may occur despite correct positioning of the LMA under the appropriate intracuff pressure. A follow-up period of at least 6 months should be taken into account for the recovery.
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