Abstract
We encountered a case of hypoglossal nerve palsy after laryngomicrosurgery. The patient was a 56-year-old female who visited our hospital complaining of hoarseness, and was diagnosed as having a left vocal cord polyp. We performed LMS under general anesthesia, and laryngeal expansion under direct laryngoscopic guidance was found to be difficult. The patient complained of throat pain and swelling after surgery. On the first day after surgery, laryngoscopy revealed redness and hemorrhage under the left side of the tongue and limitation of tongue movement. We started treatment of the hypoglossal nerve palsy with steroids and vitamin B12, and the symptoms improved by 53 days postoperatively. It is considered that strong pressure to the tongue base exerted during intubation or laryngeal expansion during direct laryngoscopic examination caused swelling and hematoma, which in turn may have caused hypoglossal nerve palsy due to local circulatory failure. Thus, it is important to operate gently in difficult cases of requiring laryngeal expansion, which may cause circulatory failure by compression of the surrounding tissues, including the hypoglossal nerve. Other means of treatment may also be considered in cases of difficult laryngeal expansion.
