Anesth Pain Med.  2016 Jul;11(3):322-325. 10.17085/apm.2016.11.3.322.

Cranial nerve XII (hypoglossal nerve) palsy after arthroscopic shoulder surgery under general anesthesia combined with sono-guided interscalene brachial plexus block: A case report

• Kim CJ
• Oh HS
• Park JJ
• Chung MY

• KMID: 2344940
• DOI: http://doi.org/10.17085/apm.2016.11.3.322

Abstract

Neurologic complications after shoulder surgery may result from surgical procedures or anesthesia. Hypoglossal nerve is a pure motor nerve that supplies mylohyoid and hyoglossus muscles. Isolated hypoglossal nerve injury may be caused by direct trauma, head malposition (hyperextension or hyperflexion), and indirect compression or traction during intubation. We report a case of left hypoglossal nerve palsy after arthroscopic left shoulder surgery in the beach chair position under general anesthesia combined with brachial plexus block.

Keyword

Arthroscopic shoulder surgery; Beach chair position; Hypoglossal nerve palsy

MeSH Terms

Anesthesia
Anesthesia, General*
Brachial Plexus Block*
Brachial Plexus*
Cranial Nerves*
Craniocerebral Trauma
Equipment and Supplies
Hypoglossal Nerve Diseases
Hypoglossal Nerve Injuries
Hypoglossal Nerve*
Intubation
Muscles
Paralysis*
Shoulder*
Traction

Figure

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  Fig. 1 Beach chair position for arthroscopic shoulder surgery.

• 

  Fig. 2 Left hypoglossal nerve injury causes an inability to stick the right part of the tongue out straight, and it deviates towards the left side due to nerve damage.

Reference

1. Cogan A, Boyer P, Soubeyrand M, Hamida FB, Vannier JL, Massin P. Cranial nerves neuropraxia after shoulder arthroscopy in beach chair position. Orthop Traumatol Surg Res. 2011; 97:345–8. DOI: 10.1016/j.otsr.2010.09.020. PMID: 21459065.

2. Rhee YG, Cho NS. Isolated unilateral hypoglossal nerve palsy after shoulder surgery in beach-chair position. J Shoulder Elbow Surg. 2008; 17:e28–30. DOI: 10.1016/j.jse.2007.07.022. PMID: 18249570.

3. Boisseau N, Rabarijaona H, Grimaud D, Raucoules-Aimé M. Tapia’s syndrome following shoulder surgery. Br J Anaesth. 2002; 88:869–70. DOI: 10.1093/bja/88.6.869. PMID: 12173208.

4. Choi WJ, Shin HK, Kim DO, Park SW, Lee DI, Kim DS. Transient hypoglossal nerve palsy after general anesthesia in beach chair position for shoulder arthroscopic Bankart repair. Korean J Anesthesiol. 2004; 47:277–80. DOI: 10.4097/kjae.2004.47.2.277.

5. Mullins RC, Drez D Jr, Cooper J. Hypoglossal nerve palsy after arthroscopy of the shoulder and open operation with the patient in the beach-chair position. A case report. J Bone Joint Surg Am. 1992; 74:137–9. PMID: 1734004.

6. Shah AC, Barnes C, Spiekerman CF, Bollag LA. Hypoglossal nerve palsy after airway management for general anesthesia: an analysis of 69 patients. Anesth Analg. 2015; 120:105–20. DOI: 10.1213/ANE.0000000000000495. PMID: 25625257. PMCID: PMC4308816.

7. Ulusoy H, Besir A, Cekic B, Kosucu M, Geze S. Transient unilateral combined paresis of the hypoglossal nerve and lingual nerve following intubation anesthesia. Braz J Anesthesiol. 2014; 64:124–7. DOI: 10.1016/j.bjan.2012.12.003. PMID: 24794456.

8. Haslam B, Collins S. Unilateral hypoglossal neurapraxia following endotracheal intubation for total shoulder arthroplasty. AANA J. 2013; 81:233–6. PMID: 23923676.

9. Keane JR. Twelfth-nerve palsy. Analysis of 100 cases. Arch Neurol. 1996; 53:561–6. DOI: 10.1001/archneur.1996.00550060105023.

10. Hung NK, Lee CH, Chan SM, Yeh CC, Cherng CH, Wong CS, et al. Transient unilateral hypoglossal nerve palsy after orotracheal intubation for general anesthesia. Acta Anaesthesiol Taiwan. 2009; 47:48–50. DOI: 10.1016/S1875-4597(09)60022-9.

11. Johnson TM, Moore HJ. Cranial nerve X and XII paralysis (Tapia’s syndrome) after an interscalene brachial plexus block for a left shoulder Mumford procedure. Anesthesiology. 1999; 90:311–2. DOI: 10.1097/00000542-199901000-00040.

12. Bharati S, Karmakar M, Ghosh S. Ipsilateral paralysis of hypoglossal nerve following interscalene brachial plexus block. J Anaesthesiol Clin Pharmacol. 2014; 30:446–7. DOI: 10.4103/0970-9185.137304. PMID: 25190973. PMCID: PMC4152705.

13. Gautier P, Vandepitte C, Ramquet C, DeCoopman M, Xu D, Hadzic A. The minimum effective anesthetic volume of 0.75% ropivacaine in ultrasound-guided interscalene brachial plexus block. Anesth Analg. 2011; 113:951–5. DOI: 10.1213/ANE.0b013e31822b876f. PMID: 21821517.