A case of combined cranial nerve palsy after general anesthesia

Abstract

To the editor We encountered concomitant paralysis of the unilateral vocal cord and tongue after upper extremity surgery under general anesthesia. This presentation is very rare but may be clinically instructive for both anesthesiologists and surgeons. Case presentation A 51-year-old man (165 cm, 81 kg) underwent internal fixation of a left proximal humeral fracture under general anesthesia. After inducing anesthesia with propofol, remifentanil, and rocuronium, an 8.0-mm tracheal tube was placed using a Macintosh blade uneventfully. The depth and intracuff pressure of the tracheal tube were 23 cm and ≤ 12 cmH 2 O, respectively. The 105-min long procedure was performed in the beach-chair position. Anesthesia was uneventful, except for the displacement of the patient's head and neck, which required repositioningthe head and neck were often deflected to the right while traction was applied to the left forearm during fracture reduction. After emergence from anesthesia, the patient was hoarse. On postoperative day 1, he complained of dysarthria, dysphagia, and leftward deviation of the tongue. On postoperative day 2, magnetic resonance imaging of the head did not show any abnormalities. Subsequent swallowing videofluoroscopy and laryngeal endoscopy revealed pharyngeal retention without aspiration and left vocal cord paralysis. He was diagnosed with

Tapia Syndrome after Cervical Laminoplasty: A Case Report and Literature Review

“…Some authors insisted the these nerve be stretched against anterior surface of the transverse process of C1 if hyperextension of this joint 9,19) . The others proposed the mechanism of the disease by inducing compression in the carotid sheath at the C2 level while the neck flexion pushes the mandible ramus back during surgery 17,22) . There are several reports that intraoperative position can have an effect.…”

“…There are several reports that intraoperative position can have an effect. Beach chair position on shoulder operation 12) , Fowler position on nasal septum operation or intraoperative position change is reported to have a relationship 22) , but it is not clear how these cause nerve injury. Some authors insisted that large throat packs in particular cause direct lingual and hypoglossal nerve injury in operation 14,19) .…”