Hypoglossal paralysis after septum correction with intubation anesthesia

BACKGROUND We report a case of irreversible unilateral hypoglossal nerve palsy in connection with nasal septum surgery in intubation anaesthesia. On account of the spatial distance, there is no danger of injuring the hypoglossal nerve during nasal surgery. However, in the otorhinolaryngological and anaesthesiological literature, some cases of hypoglossal palsy following endotracheal intubation, use of the laryngeal mask airway, bronchoscopy and laryngoscopy are reported. CASE REPORT One day after uneventful nasal septoplasty in intubation anaesthesia in a 45-year-old male patient, an unilateral hypoglossal nerve palsy and a hematoma in the area of the ipsilateral lingual tonsil were observed. A detailed diagnostic work-up failed to provide additional insights into the cause of the nerve injury. Despite pharmacological treatment, the palsy was irreversible and the patient sued for recovery of damages. DISCUSSION AND CONCLUSIONS According to the available publications, it must be assumed that in the process of intubation pressure from the MacIntosh blade was the cause of the hypoglossal palsy. This complication is extremely rare, so that routine preoperative briefing of the patient does not appear necessary.