Lingual nerve injury after use of a cuffed oropharyngeal airway

Abstract

The cuffed oropharyngeal airway is a modified Guedel airway and is recommended for anaesthesia in spontaneously breathing patients. To our knowledge this is the first report of transient unilateral lingual nerve palsy after the use of a cuffed oropharyngeal airway to maintain anaesthesia during arthroscopy of an ankle. The aetiology of lingual nerve damage is multifactorial. The possible mechanisms involved include anterior displacement of the mandible during insertion of the cuffed oropharyngeal airway (as in the jaw thrust manoeuvre), compression of the nerve against the mandible, or stretching of the nerve over the hyoglossus by the cuff of the cuffed oropharyngeal airway. We recommend gentle airway manipulation with the use of the cuffed oropharyngeal airway, avoidance of excessive cuff inflation and early recognition of such a complication if it occurs.

Dexamethasone treatment for bilateral lingual nerve injury following orotracheal intubation

“…In conclusion, lingual nerve injury following orotracheal intubation is rare but can cause irritation to patients [ 14 15 ]. In the case presented here, early treatment with dexamethasone effectively aided the recovery of the injured lingual nerve.…”

Cranial nerve injuries with supraglottic airway devices: a systematic review of published case reports and series

“…We identified 25 cases of nerve injuries related to the peripheral branches of the trigeminal nerve (Table 2). Of these, 22 were lingual nerve injuries [24,[26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44], two inferior alveolar [45,46] and one infra-orbital [25].…”

“…Of the 22 lingual nerve injuries, 14 were associated with the use of the cLMA and its variants [24,[26][27][28][29][30][31][32][33][34][35][36][37]. The Pro-Seal, LMA Supreme TM , i-gel â and COPA TM (cuffed oropharyngeal airway) had two associated injuries each [38][39][40][41][42][43][44].…”

Temporomandibular joint dislocation after use of a laryngeal mask airway

“…A jaw thrust to lift the pharyngeal structures anteriorly facilitates the passage of a laryngeal mask airway into the hypopharynx with less epiglottic contact [6]. Loss of motor response to jaw thrust (to assess depth of anaesthesia for laryngeal mask airway inertion) [7] may predispose to TMJ dislocation, by anteriorly displacing the mandible [8].…”