Keywords
Hemiatrophy - Hypoglossal nerve - Brancial cyst
Introduction
Injury of the hypoglossal nerve is a recognized complication following soft tissue
surgery in the upper and anterior part of the neck [[1],[2]] and [[3]]. Among 100 cases of hypoglossal nerve palsy (33 bilateral) reported by Keane [[4]], five cases were the result of a surgical procedure: for clival tumors in 2 cases,
and carotid endarterectomy and a tonsillectomy in 1 case each, one case was not specified.
In this series in most patients, 12th-nerve involvement was asymptomatic or a minor
component of dysarthria. On the contrary acute 12th-nerve transection causes early
and late serious oral problems in children [[5]].
Branchial cleft (branchiogenic) cysts are congenital epithelial cysts, which arise
on the lateral part of the neck from failure of obliteration of the second branchial
cleft [[6]]. Their location makes them prone for 12th-nerve lesions, but literature mentions
are scarce.
Case report
An 11 years’ old boy was operated because of a branchial cyst. The cyst was not infected
but the surgeon faced the problem of tissue retraction during operation. One week
after operation deviation of the tongue was noted and examination revealed marked
atrophy of the ipsilateral side of the tongue. Electromyography revealed partial 12th-nerve
injury. Explorative surgery of the hypoglossal nerve was regarded not to be indicated.
Improvement was not noted six months after operation.
Conclusion
Hypoglossal nerve palsy may be caused by tumors and cysts in the neck, but can also
be caused by surgery. It is important to note securely the preoperative situation.
Consent
Written informed consent was obtained from the patient for publication of this case
report and accompanying images. A copy of the written consent is available for review
by the Editor-in-Chief of this journal.
Competing interests
The authors declare that they have no competing interests.
Authors’ contributions
SKM is the chief author who deals the patient clinically, BCG draws SKM attention
for this case, AS & RK perform EMG, MAF help SKM in every aspect and JB take care
of this patient preoperatively. All authors have read and approved the final manuscript.
Authors information
1. Sudipta Kumer Mukherjee- Junior consultant-MS(neurosurgery).- Dept of Neurosurgery-Shaheed
Sheikh Abu Naser Hospital (SSANSH)-Khulna-Bangladesh.
2. BC Gowshami–Assistant Professor - MD(Cardiology)- Dept of Cardiology-Shaheed Sheikh
Abu Naser Hospital (SSANSH)-Khulna-Bangladesh.
3. Abdus salam- Junior consultant -MD (neurology)-Dept of Neurology-Shaheed Sheikh
Abu Naser Hospital (SSANSH)-Khulna-Bangladesh.
4. Ruhul kuddus -Assistant Professor-MD(Neurology). Dept of Neurology-Shaheed Sheikh
Abu Naser Hospital (SSANSH)-Khulna-Banglaesh.
5. Mohshin Ali Farazi -MS(neurosurgery). Registrar Dept of Neurosurgery-Shaheed Sheikh
Abu Naser Hospital (SSANSH)-Khulna-Banglaesh.
6. Jahid Baksh -Assistant professor -MS(Paediatric surgery)-Dept of Paediatric Surgery-
Khulna Medical college Hospital - Bangladesh.
Figure 1
Show marked hemiatrophy of tongue after injury of hypoglossal nerve.
Cite this article as: Mukherjee et al.: A case with unilateral hypoglossal nerve injury in branchial cyst surgery. Journal of Brachial Plexus and Peripheral Nerve Injury 2012 7:2.
