Unilateral hypoglossal nerve palsy following orthognathic surgery: A case report and literature review

by Selleckchem | Feb 01 2024

Introduction: Hypoglossal nerve palsy (HNP) can be caused by nerve damage from the central nerve to a peripheral nerve, and individuals with multiple factors could be predisposed to HNP. We report a case of isolated unilateral HNP after orthognathic surgery.

Case presentation: A 56-year-old Japanese woman complained of jaw distortion and malocclusion. She had undergone a Le Fort I osteotomy and bilateral sagittal split ramus osteotomy (BSSRO) under general anesthesia in August 2021. On postoperative day 3, she experienced tongue motility, and when the tongue protruded forward, the tongue tip shifted to the right, and swelling of the right lateral pharyngeal wall was observed. An additional blood test revealed increased antibody titer levels (40×), cytomegalovirus IgG EIA titer (16.9 U/mL), HSV-IgG EIA titer (40 U/mL), and EBV-viral capsid antigen (VCA) IgG EIA titer (1.4 U/mL). We administered valacyclovir hydrochloride 1000 mg/day for 7 days, prednisolone (PSL) 60 mg/day, mecobalamin 1500 μg/day, and adenosine triphosphate (ATP) disodium hydrate 300 mg/day. A neurological examination revealed no central lesions, and we continued the patient's tongue-function training and oral hygiene guidance. The tongue apex deviation was resolved approx. 3 months postoperatively.

Discussion: There are no major reports on the etiology of HNP after orthognathic surgery. The possibility of HNP triggered by endotracheal intubation or through packing gauze under general anesthesia and viral infection cannot be ruled out.

Conclusion: Clinicians should be aware of the possibility of unilateral HNP following orthognathic surgery.

Comments:

The case you've presented highlights the occurrence of isolated unilateral hypoglossal nerve palsy (HNP) following orthognathic surgery in a 56-year-old Japanese woman. Her symptoms, notably tongue motility issues and deviation upon protrusion, were observed postoperatively. The additional blood tests indicated heightened antibody titers for cytomegalovirus, HSV, and EBV. Treatment involved medications like valacyclovir hydrochloride, prednisolone, mecobalamin, and adenosine triphosphate (ATP) disodium hydrate, coupled with tongue-function training and oral hygiene guidance. Remarkably, resolution of the tongue apex deviation occurred approximately three months after the surgery.

The discussion points out the lack of extensive reports on the origins of HNP after orthognathic surgery. It suggests potential triggers such as endotracheal intubation, packing gauze during anesthesia, and viral infections. This suggests a need for clinicians to remain vigilant regarding the prospect of unilateral HNP post-orthognathic surgery.

Overall, this case underscores the importance of considering HNP as a possible complication following orthognathic surgery, necessitating further research and awareness among clinicians to recognize and manage such occurrences effectively.