Case Report: Resolution of Hypoglossal Nerve Palsy Following Aspiration of a Branchial Cyst

Althawadi Noora,Alreefi Mohamed,Jawad Susan,Sinha Deepti

doi:10.36959/605/550

Althawadi Noora, Alreefi Mohamed + Show 2 more

Open Access

https://doi.org/10.36959/605/550

Copy DOI

Abstract

Abstract Cranial nerve palsies caused directly by branchial cysts is a rare entity. We report a case of hypoglossal nerve palsy in a 47-year-old female with a right anterior neck mass presenting with symptoms of speech disturbances, altered tongue sensation and deviation on protrusion. An ultrasound scan showed a cystic lesion highly suspicious for a branchial cyst, which was confirmed with a head and neck MRI. An ultrasound guided aspiration of the cyst resulted in resolution of the nerve palsy in our patient. There have been cases reported in literature whereby the nerve palsies resolve following surgical excision of the branchial cyst.

Highlights

Branchial cleft cysts are benign congenital anomalies that present as anterior neck masses either at birth or following an upper respiratory tract infection
We report a case of hypoglossal nerve palsy caused by a branchial cyst, which completely resolved following aspiration
In 2013, K Long, et al described a case where a 10-yearold boy was intraoperatively found to have a branchial cyst completely encircling the hypoglossal nerve. Their patient had no pre-operative symptoms that would have suggested nerve involvement, as opposed to the patient we described in this case report [4]. In another case report published by S Mukherjee, et al in 2012, reported iatrogenic hypoglossal nerve palsy in an 11-year-old boy following surgical excision of the branchial cyst [8]

Summary

Introduction

Branchial cleft cysts are benign congenital anomalies that present as anterior neck masses either at birth or following an upper respiratory tract infection. We report a case of hypoglossal nerve palsy caused by a branchial cyst, which completely resolved following aspiration. The only other structural cause for the palsy was compression of the hypoglossal nerve at the level of the right posterior belly of digastric by the branchial cyst (Figure 1). The patient reported return of normal speech and tongue sensation, along with resolution of her neck mass. She is awaiting surgical excision of right branchial cyst

Discussion

Findings

Conclusion