Hypoglossal nerve injury as a complication of anterior surgery to the upper cervical spine

Abstract

Injury to the hypoglossal nerve is a recognised complication after soft tissue surgery in the upper part of the anterior aspect of the neck, e.g. branchial cyst or carotid body tumour excision. However, this complication has been rarely reported following surgery of the upper cervical spine. We report the case of a 35-year-old woman with tuberculosis of C2-3. She underwent corpectomy and fusion from C2 to C5 using iliac crest bone graft, through a left anterior oblique incision. She developed hypoglossal nerve palsy in the immediate postoperative period, with dysphagia and dysarthria. It was thought to be due to traction neurapraxia with possible spontaneous recovery. At 18 months' follow-up, she had a solid fusion and tuberculosis was controlled. The hypoglossal palsy persisted, although with minimal functional disability. The only other reported case of hypoglossal lesion after anterior cervical spine surgery in the literature also failed to recover. It is concluded that hypoglossal nerve palsy following anterior cervical spine surgery is unlikely to recover spontaneously and it should be carefully identified.

A variation in the course of the hypoglossal nerve

“…(Clinical Otolaryngology 39, 128–129), and we totally agree with the authors that the intraoperative identification of the hypoglossal nerve (HN) by following a single landmark is difficult because its course and anatomical relationships are not constant . Iatrogenic lesions of the HN may worsen significantly the postoperative patients’ capability to correctly speak and swallow; therefore, every effort to identify and preserve it during procedures such as neck dissection, carotid endarterectomy and other cervicotomic approaches should be made . The authors state that the HN invariably passes, on a deeper plane, inside a triangle delimited by the posterior belly of the digastric muscle superiorly, by the internal jugular vein posteriorly and by the common facial vein inferiorly.…”

Hypoglossal Nerve Palsy After Airway Management for General Anesthesia

“…The follow-up interval was not reported for four additional patients with persistent symptoms. 1,3,4,13,55,56 Patients with partial recovery demonstrated similar demographics and operative durations when compared to fully recovered patients. More than half of the patients with partial recovery are associated with Tapia’s syndrome, and remaining neurologic deficits include persistent tongue deviation 15 or vocal fold immobility.…”

Minimally Invasive Anterior Approach to Upper Cervical Spine

“…Although rare, this approach can carry an inherent risk of injury to the marginal mandibular, hypoglossal, and superior laryngeal nerves as these nerves traversing the operative field may resemble blood vessels leading to incidental ligation and division. [22][23][24] The course of the right and left superior laryngeal nerves and their branches is almost identical and constant. The proximal portions of both the superior laryngeal nerve and its branches lie directly deep to the loop of superior thyroid artery.…”