Wilson J R, Sumner A J, Eichelman J
Louisiana State University Medical Center, Department of Neurology, New Orleans 70112.
Muscle Nerve. 1994 Aug;17(8):931-5. doi: 10.1002/mus.880170813.
Hypoglossal nerve damage is a known complication of carotid endarterectomy, occurring in approximately 5% of endarterectomies. The vast majority of these patients recover without functional disability from this injury even if the tongue remains hemiplegic. We report 2 patients who suffered hypoglossal nerve section during neck surgery. Although they were initially mildly symptomatic, they developed increasingly severe dysarthria and dysphagia beginning 4 months after surgery. EMG revealed abnormal coactivation of the genioglossus and styloglossus muscles on the affected side, suggesting aberrant reinnervation. Aberrant reinnervation is a well-known complication of facial nerve injury, but has not been previously recognized in hypoglossal nerve injury. Like the face, the tongue is composed of many muscles that must perform complex movements. Normally, injury to one hypoglossal nerve causes little or no disability, but when aberrant reinnervation occurs, the tongue no longer moves in a coordinated manner, and significant dysarthria ensues.
舌下神经损伤是颈动脉内膜切除术已知的一种并发症，约5%的内膜切除术会出现该并发症。即使舌头仍呈偏瘫状态，这些患者中的绝大多数也能从这种损伤中恢复且不遗留功能残疾。我们报告2例在颈部手术期间发生舌下神经切断的患者。尽管他们最初症状较轻，但在术后4个月开始出现日益严重的构音障碍和吞咽困难。肌电图显示患侧颏舌肌和茎突舌肌异常共同激活，提示存在迷走神经再支配。迷走神经再支配是面神经损伤的一种众所周知的并发症，但此前在舌下神经损伤中尚未得到认识。与面部一样，舌头由许多必须进行复杂运动的肌肉组成。正常情况下，一侧舌下神经损伤很少或不会导致残疾，但当发生迷走神经再支配时，舌头不再以协调的方式运动，继而出现明显的构音障碍。
