Coronal section CT scan from one patient shows asymmetric soft tissue swelling in the right anterolateral oropharynx (*) extending from base of the tongue to vallecula. (Image source: Anesthesia & Analgesia)

Coronal section CT scan from one patient shows asymmetric soft tissue swelling in the right anterolateral oropharynx (*) extending from base of the tongue to vallecula. (Image source: Anesthesia & Analgesia)

Postoperative hypoglossal nerve palsy causes ipsilateral tongue deviation, dysarthria, and dysphagia. Dr. Aalap C. Shah, Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington, and colleagues identified 69 cases of HNP after procedural airway management reported in the literature from 1926 through 2013. Their review of the condition is published in this month’s issue of Anesthesia & Analgesia in the article titled titled “Hypoglossal nerve palsy (HNP) after airway management for general anesthesia: An analysis of 69 patients.”

The authors discuss the pathophysiological causes of hypoglossal nerve palsy, associated clinical characteristics, and the procedural factors influencing recovery duration. Male patients, airway management with an endotracheal tube versus laryngeal mask airway, and otolaryngology procedures are frequently mentioned in hypoglossal nerve palsy case reports. Signs and symptoms are self-limited, with resolution occurring within two months in 50% of patients, and 80% resolving within four months.

One might think this rarely happens, but as the authors indicate, it is probably also frequently missed: symptoms might not be apparent until after a patient has left the ambulatory care facility. In addition, if the patient is still sleepy once at home, symptom onset may be missed. This report will hopefully help make clinicians more aware of the problem.