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: Case report  USA

[In Press] Bilateral Lingual Nerve Injury Following Endotracheal Intubation: Risk Factors and Diagnostic Considerations

Challenging differential diagnosis, Diagnostic / therapeutic accidents, Rare disease

Abdallah Khashan1EF, Michael Carson ORCID logo1E, Vanil Pandya2EF, Abram R. Wahba2E, Doha Mohamed Ahmed Khashan3BEF, Emad Noor4E

Am J Case Rep In Press; DOI:   :: ID: 937192

Available online: , In Press, Corrected Proof

Publication in the "In-Press" formula aims at speeding up the public availability of the pending manuscript while waiting for the final publication. The assigned DOI number is active and citable. The availability of the article in the Medline, PubMed and PMC databases as well as Web of Science will be obtained after the final publication according to the journal schedule

Abstract

BACKGROUND
Endotracheal intubation is an essential procedure to protect the airway. However, immediate complications like voice hoarseness, cervical spine injury, and tooth trauma are common. One of the rarest complications is lingual nerve palsy. Risk factors include small airway instruments, non-supine position, nitrous oxide use, and difficult intubation. Only 15 cases of lingual nerve injury were identified worldwide, and only 2 of them were bilateral. This case report describes the third case of bilateral lingual nerve palsy after intubation.
CASE REPORT
We present a 52-year-old woman admitted for a total abdominal hysterectomy. Postoperatively, the patient noted voice hoarseness, left tongue numbness, and loss of taste on both sides of the tongue. MRI brain revealed no new masses or lesions, and a diagnosis of bilateral lingual nerve palsy was made. She was treated conservatively with symptom observation for 14 weeks. On follow-up, she remained with only a patch of numbness and dryness, and loss of taste on the top middle area of the tongue.
CONCLUSIONS
Lingual nerve palsy is a very rare but devastating adverse effect of airway manipulation. Symptoms can include dryness, loss of sensation, and loss of taste of the anterior two-thirds of the tongue on the ipsilateral side. Salivary function assessment is important to determine the location of peripheral nerve injury. All possible causes like stroke, hemorrhage, and nerve impingement should be evaluated. MRI is advised to exclude central etiologies. Steroids may be used to decrease tissue edema and inflammation.

Keywords: Cranial Nerve Injuries; Intubation; Lingual Nerve Injuries; Taste

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American Journal of Case Reports eISSN: 1941-5923
American Journal of Case Reports eISSN: 1941-5923