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Dysphagia
Dec, 2024;39 (6): 1213-1217.

An Unusual Case of Contralateral Hypoglossal and Recurrent Laryngeal Nerve Palsies Following Endotracheal Intubation.

Anna Creagh Chapman, Briony Adshead, Lindsay Lovell, Nikolaos Gorgoraptis
Author Information
  1. Anna Creagh Chapman: Speech and Language Therapy Department, Royal London Hospital, Barts Health NHS Trust, London, UK. anna.creaghchapman@nhs.net. ORCID
  2. Briony Adshead: Speech and Language Therapy Department, Royal London Hospital, Barts Health NHS Trust, London, UK.
  3. Lindsay Lovell: Speech and Language Therapy Department, Royal London Hospital, Barts Health NHS Trust, London, UK.
  4. Nikolaos Gorgoraptis: Department of Neurology, Barts Health NHS Trust, London, UK.
PMID: 39162843 DOI: 10.1007/s00455-024-10743-w

Abstract

We present an unusual case of a 62-year-old male presenting with contralateral hypoglossal and recurrent laryngeal nerve palsies following endotracheal intubation for emergency cardiac surgery. Postoperative, the patient was referred to Speech and Language Therapy due to concerns regarding the safety of his swallow. Oromotor assessment revealed left-sided tongue weakness and aphonia. Flexible endoscopic evaluation of swallowing (FEES) revealed a right vocal cord palsy and severe oropharyngeal dysphagia. There were no other focal neurological signs. An MRI head did not demonstrate a medial medullary stroke or other intracranial lesion. CT neck showed no abnormality identified in relation to the course of the right vagus nerve or recurrent laryngeal nerve at the skull base or through the neck respectively. The patient required a gastrostomy for nutrition and hydration. He continued to be assessed at several month intervals over the course of a year using FEES to obtain a range of voice, secretion and swallowing outcome measures. The patient commenced intensive dysphagia therapy targeting pharyngeal drive, hyolaryngeal excursion and laryngeal sensation. Swallow manoeuvres were trialled during FEES and a head-turn to the side of the vocal cord palsy during deglutition reduced aspiration risk which expedited return to oral intake. The patient had partial recovery over twelve months. Hypoglossal nerve palsy completely resolved. The right vocal cord remained paralysed however the left vocal cord compensated enabling the patient to produce a normal voice. The patient was able to take thin fluids and regular diet and the gastrostomy was removed.

Keywords

Flexible endoscopic evaluation of swallowing (FEES) Hypoglossal nerve palsy Recurrent laryngeal nerve palsy Speech and language therapy Tapia���s syndrome

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MeSH Term

Humans
Male
Middle Aged
Intubation, Intratracheal
Deglutition Disorders
Vocal Cord Paralysis
Hypoglossal Nerve Diseases
Deglutition
Case Reports Journal Article

Word Cloud

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