Hypoglossusparese nach Tonsillektomie*

Abstract

Lesions of the lingual nerve and the glossopharyngeal nerve following tonsillectomy are rare but can be expected because of their anatomical course. What is extremely rare is a lesion of the hypoglossal nerve, whose course behind the carotid artery protects it from direct injury. The few cases described in the literature are thought to have been caused by inflammatory processes. It became necessary to look for other causes when, after a regular tonsillectomy, a hypoglossal palsy became evident in the absence of any inflammation. In an experiment, it was possible to demonstrate that both the insertion of a spatula and of an intubation spatula caused a strain of the hypoglossal nerve when the spatulas were inserted in the lateral lingual region. The nerve was distended by as much as 1.3 cm. The more the head was reclined, the more the nerve was distended. It would seem probable that this extension of the hypoglossal nerve causes its palsy following tonsillectomy.

Gustatory function after microlaryngoscopy

“…Michel and Brusis [15] seemed to confirm this idea, identifying the MLS procedure, and especially neck extension to considerably stretch the lingual, glossopharyngeal, and even the hypoglossal nerve in certain cases. Their findings might also explain why sometimes even orotracheal intubation has been claimed to cause cranial nerve injuries (e.g.…”

“…However, based on case reports [6] and anatomical studies [15] there were reasons to believe that even quantitative changes of gustatory function may occur more frequently after MLS than is usually assumed. Michel and Brusis [15] seemed to confirm this idea, identifying the MLS procedure, and especially neck extension to considerably stretch the lingual, glossopharyngeal, and even the hypoglossal nerve in certain cases.…”

Hypoglossal Nerve Palsy After Airway Management for General Anesthesia

“…Several authors reported complete resolution 1 year after diagnosis, 6,9,12,14,20,22 while others found only partial recovery at variable follow-up periods. 1,15,33,49 Five patients (8.3%) had persistent tongue deviation and dysarthria at follow-up intervals. The follow-up interval was not reported for four additional patients with persistent symptoms.…”

“…In addition, direct pressure exerted by the Macintosh blade at the base of the tongue causes soft tissue compression against the hyoid bone, possibly exacerbating the neurapraxia. 1,3,12,15,26,30,46,49,73,74 …”

“…However, HNP is frequently reported after otolaryngologic surgery. Dysarthria and ipsilateral tongue deviation are mentioned after rhinoplasty 3,7,22,38,52 and sinus surgery, 30,34 as well as after tonsillectomy 1,4,49,51,58,59 and periglottic excisions. 1,8,14 Throat pack placement during these surgeries can create pressure at the greater cornu of the hyoid, 2 and their frequent use is linked to combined hypoglossal-recurrent (Tapia’s syndrome) and lingual nerve palsies.…”