Abstract
BackgroundLingual nerve injury or neuropraxia is a rare but potentially serious perioperative complication following airway instrumentation during general anesthesia. This study explored the the incidence and perioperative risk factors for lingual nerve injury in patients receiving laryngeal mask (LMA) or endotracheal (ETGA) general anesthesia in a single center experience.Methods and resultsAll surgical patients in our hospital who received LMA or ETGA from 2009 to 2013 were included, and potential perioperative risk factors were compared. Matched controls were randomly selected (in 1:5 ratio) from the same database in non-case patients. A total of 36 patients in the records had reported experiencing tongue numbness after anesthesia in this study. Compared with the non-case surgical population (n = 54314), patients with tongue numbness were significantly younger (52.2±19.5 vs 42.0±14.5; P = 0.002) and reported lower ASA physical statuses (2.3±0.7 vs 1.6±0.6; P<0.001). Patient gender, anesthesia technique used, and airway device type (LMA or ETGA) did not differ significantly across the two groups. A significantly higher proportion of patients underwent operations of the head-and-neck region (38.9 vs 15.6%; P = 0.002) developed tongue numbness after anesthesia. Multivariate logistic regression analysis indicated that head-and-neck operations remained the most significant independent risk factor for postoperative lingual nerve injury (AOR 7.63; 95% CI 2.03–28.70).ConclusionThe overall incidence rate of postoperative lingual neuropraxy was 0.066% in patients receiving general anesthesia with airway device in place. Young and generally healthy patients receiving head-and-neck operation are at higher risk in developing postoperative lingual neuropraxy. Attention should be particularly exercised to reduce the pressure of endotracheal tube or laryngeal mask on the tongue during head-and-neck operation to avert the occurrence of postoperative lingual neuropraxy.
Highlights
Lingual nerve injury or neuropraxia is a rare but potentially serious perioperative complication following airway manipulation [1], in patients received supraglottic airway instrumentation [2] or endotracheal intubation [3] during general anesthesia
Multivariate logistic regression analysis indicated that head-and-neck operations remained the most significant independent risk factor for postoperative lingual nerve injury (AOR 7.63; 95% CI 2.03–28.70)
It is vulnerable to compression and stretching by laryngeal mask airways (LMA), endotracheal tube general anesthesia (ETGA), and other devices situated on the base of the tongue and inner surface of the mandible close to the third molar [9]
Summary
Lingual nerve injury or neuropraxia is a rare but potentially serious perioperative complication following airway manipulation [1], in patients received supraglottic airway instrumentation [2] or endotracheal intubation [3] during general anesthesia. It is vulnerable to compression and stretching by laryngeal mask airways (LMA), endotracheal tube general anesthesia (ETGA), and other devices situated on the base of the tongue and inner surface of the mandible close to the third molar [9]. Patients who received supraglottic airway instrumentation [2] or endotracheal intubation [3] during general anesthesia are at risk. Our long-term goal was to develop preventive strategies for intraoperative lingual nerve injuries due to airway instrumentation
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