Transient Unilateral Hypoglossal Nerve Injury associated with the Laryngeal Mask Airway in Reconstructive Surgery-A Case Report and Review of the Literature

使用喉罩氣道導致重建手術後單側舌下神經暫時性麻痹之病例報告及文獻回顧

馮晉榮(Chin-Jung Feng) ； 馬旭(Hsu Ma)

《臺灣整形外科醫學會雜誌》 24卷3期 (2015/09) Pp. 256-263

摘要

背景：喉罩氣道相較於傳統氣管插管可以大幅減少插管時對口腔及喉部造成損傷，但回顧文獻，我們發現仍有八例個案因使用喉罩氣道導致術後舌下神經痲痹。目的及目標：我們描述一例個案並針對此罕見術後併發症的鑑別診斷、治療及預後作文獻回顧與探討。材料及方法：將一位21歲男性病患手術中使用喉罩氣道導致重建手術後單側舌下神經暫時性痲痹之臨床表現、檢查（驗）結果及治療作一回顧與呈現。結果：該病患接受保守性治療，三週後舌頭運動功能恢復正常且無任何後遺症。結論：此罕見術後併發症預後相對良好，惟須及早正確診斷，臨床醫師應加小心。

並列摘要

Background: The laryngeal mask airway (LMA) was introduced into adult practice since 1980s. Compared with the endotracheal tube, the LMA has been reported to pose less risk to laryngeal function. However, a literature review of complications following use of LMAs found that eight cases have been described in which transient hypoglossal nerve injury as a postoperative complication. Aim and Objectives: The aim of this report is to draw plastic surgeons' and anesthesiologists' attention to this rare and unexpected complication and summarize the potential preventive measures. Materials and Methods: We present a case of transient unilateral hypoglossal nerve palsy following the use of the laryngeal mask airway in elective reconstructive surgery, along with a concise review of the pertinent literature. Results: Conservative management included dietary modifications, speech therapy and regular assessment. Tongue mobility gradually improved within one week and the patient's symptoms resolved completely three weeks later. Conclusion: The overall safety and effectiveness of the LMA is attested to by its widespread use in reconstructive surgery. However, disabilities including transient hypoglossal nerve injury may occur as a complication of LMA use. Understanding the course of the hypoglossal nerve and awareness of these LMA-associated nerve injuries may aid in the diagnosis. Careful device positioning and attention to cuff pressure might minimize the risk.

並列關鍵字

hypoglossal nerve injury ； unilateral ； laryngeal mask airway ； reconstructive surgery ； postoperative complications