隆鼻术后单侧喉返神经和舌下神经麻痹：一例病例报告及文献复习
Unilateral recurrent laryngeal and hypoglossal nerve paralysis following rhinoplasty: a case report and review of the literature.
作者信息
Bakhshaee Mehdi, Bameshki Ali Reza, Foroughipour Mohsen, Zaringhalam Mohammad Ali
机构信息
Sinus and Surgical Endoscopic Research Center, Imam Reza Hospital, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
Cardiac Anesthesia Research Center, Imam Reza Hospital, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
出版信息
Iran J Otorhinolaryngol. 2014 Jan;26(74):47-50.
INTRODUCTION
Injury to cranial nerves IX, X, and XII is a known complication of laryngoscopy and intubation. Here we present a patient with concurrent hypoglossal and recurrent laryngeal nerve paralysis after rhinoplasty.
CASE REPORT
The patient was a 27-year-old woman who was candidate for rhinoplastic surgery. The next morning after the operation, the patient complained of dysphonia and a sore throat .7 days after the operation she was still complaining of dysphonia. She underwent a direct laryngoscopy, and right TVC paralysis was observed. Right hypoglossal nerve paralysis was also detected during physical cranial nerve function tests. Hypoglossal and recurrent laryngeal nerve function was completely recovered after 5 and 7 months, respectively, and no complication was remained.
CONCLUSION
Accurate and atraumatic intubation and extubation, true positioning of the head and neck, delicate and gentle packing of the oropharynx, and maintenance of mean blood pressure at a safe level are appropriate methods to prevent this complication during anesthesia and surgical procedures.
引言
第九、十和十二对颅神经损伤是喉镜检查和插管的已知并发症。在此，我们报告一例隆鼻术后并发舌下神经和喉返神经麻痹的患者。
病例报告
患者为一名27岁女性，拟行隆鼻手术。术后次日早晨，患者主诉声音嘶哑和咽痛。术后7天，她仍诉说声音嘶哑。她接受了直接喉镜检查，观察到右侧杓状软骨活动受限。在体格检查颅神经功能时也发现右侧舌下神经麻痹。舌下神经和喉返神经功能分别在5个月和7个月后完全恢复，且未遗留任何并发症。
结论
准确且无创的插管和拔管、头颈部的正确定位、口咽的精细轻柔填塞以及将平均血压维持在安全水平是在麻醉和手术过程中预防该并发症的合适方法。
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