Transient nerve damage following intubation for trans-sphenoidal hypophysectomy

Purpose: To describe a case of transient lingual and hypoglossal nerve dama ge following intubation for a transsphenoidal hypophysectomy. Clinical features: A 56-yr-old acromegalic man was scheduled for trans-sphe noidal hypophysectomy. He had been treated with octreotide six months previ ously which had reduced the swelling of the tongue to an acceptable degree to the patient, During the anesthetic procedure there were no problems. The intubation was per formed without any difficulty, no force had been used t o place the endotracheal tube, a throat pack was inserted and, before extub ation, an ore-gastric tube was inserted. Three days after surgery the patie nt complained of numbness and swelling of the left side of the tongue, he h ad difficulty in moving the tongue, speaking difficulties and problems in s wallowing food were noted, Also taste was lost on this side of the tongue. Left lingual and hypoglossal nerve damage was diagnosed, which was confirme d by the neurologist. After four months of intensive physiotherapy and spee ch therapy, the symptoms disappeared. Conclusion: This is a report of a very rare complication of lingual and hyp oglossal nerve damage in an acromegalic patient. This incident suggests for ceful laryngoscopy, hyperextension of the head and the throat pack (tightly packed in the oropharynx) can result in injury of the lingual and the hypo glossal nerves.