喉顯微手術後之罕見併發症－暫時性單側舌麻痺

A Rare Complication after Micro-laryngeal Surgery-Transient Unilateral Tongue Paralysis

陳建志(Jiann-Jy Chen) ； 劉正鴻(Cheng-Hung Liu) ； 劉智仰(Chih-Yang Liu) ； 魏銘華(Ming-Hua Wei) ； 林明正(Ming-Cheng Lin)

《台灣耳鼻喉頭頸外科雜誌》 42卷6期 (2007/12) Pp. 221-225

https://doi.org/10.6286/2007.42.6.221

摘要

喉部直達鏡顯微手術是耳鼻喉科常見的手術，其併發症包括全身麻醉本身的風險及可能對牙齒、口腔或咽喉黏膜造成傷害，此外，不當的挑管及架設喉鏡可能對舌體或舌下神經造成傷害。一56歲男性，因疑似喉部腫瘤於本院接受喉部直達鏡顯微手術，手術耗時1小時，術後1日發生延遲性的單側舌運動麻痺，說話不順、咀嚼困難及容易嗆食等症狀經保守治療6週後才消失。造成本個案單側舌運動麻痺最有可能的原因爲硬式喉鏡的壓迫，造成舌內肌損傷；舌內肌持續發炎水腫壓迫到舌下神經，造成舌下神經失用症。由於這種併發症尚屬罕見，特提出報告，日後若需要長時間的喉部直達鏡顯微手術，需定時鬆弛硬式喉鏡以解除對舌根的壓迫，避免造成舌運動麻痺。

關鍵字

喉部直達鏡顯微手術 ； 神經失用症 ； 舌運動麻痺

並列摘要

Micro-laryngeal surgery (MLS) is a common otorhinolaryngologic surgery. Its complications include the risks of general anesthesia, mucosal damage of tooth, oral cavity, pharynx & larynx. Besides, poor manipulation of direct laryngeal exposure and long-term rigid laryngoscope setting can cause tongue or hypoglossal nerve injury. A 56-year-old male received MLS for a suspected laryngeal neoplasm. It took one hour to finish the whole procedure. One day after surgery, delayed unilateral tongue paralysis developed. Dysarthria, dys-mastication, and easy choking were noted. All symptoms subsided after 6-week conservative treatment. It is probably that long-term setting of rigid laryngoscope has injured tongue-base muscle; then, the muscular inflammation and swelling gradually compressed the hypoglossal nerve, and lead to his unilateral hypoglossal neuropraxia. Because of rarity, we reported this case. In long-term MLS, the rigid laryngoscope should be relaxed on a regular time to relieve the compression of tongue base; otherwise, tongue paralysis may happen.

並列關鍵字

micro-laryngeal surgery ； neuropraxia ； tongue paralysis