Post-bronchoscopy Palatine Paresthesia

Abstract

To the Editor:Fiberoptic bronchoscopy is a common clinical procedure. Recently, we have encountered a minor complication that has not previously been reported. The subject, a healthy 30-year-old medical student (RDM), underwent transnasal fiberoptic bronchoscopy on two separate occasions for research purposes. No premedication was given and anesthesia was obtained with 4 percent topical intranasal cocaine and 4 percent lidocaine aerosol to the oropharynx and larynx. A flexible 5.9 mm diameter fiberoptic bronchoscope was passed through the right nostril on each occasion. Each bronchoscopic procedure lasted approximately 15 minutes and was performed without apparent complication. Shortly after the first procedure, the subject noted numbness and tingling in a small area of gum and hard palate midline behind the superior incisors. This paresthesia lasted 48 hours and resolved completely. The second procedure, performed ten weeks later, was followed by a similar paresthesia which lasted ten days.These symptoms and their distribution and time course are consistent with a neuropraxia of the nasopalatine nerve. This nerve courses along the nasal septum, passes through the incisive canal, and innervates a small region of mucosa just behind the incisor teeth. Anesthesia in this distribution can be obtained by blocking the nasopalatine nerve.1 It is likely that the neuropraxia in this case was caused by compression from the bronchoscope. Although the subject had a history of a rhinoseptoplasty, careful examination of the nares showed no abnormality. Review of the literature has not revealed any report of this complication following fiberoptic bronchoscopy,2 nasotracheal3 or nasogastric intubation.4 Still, this complication may be more frequent than recognized, as the superficial location of the nerve facilitates compression by foreign objects, but the area innervated is quite small. Since the symptoms resolved spontaneously each time, reassurance seems to be the appropriate form of therapy. To the Editor: Fiberoptic bronchoscopy is a common clinical procedure. Recently, we have encountered a minor complication that has not previously been reported. The subject, a healthy 30-year-old medical student (RDM), underwent transnasal fiberoptic bronchoscopy on two separate occasions for research purposes. No premedication was given and anesthesia was obtained with 4 percent topical intranasal cocaine and 4 percent lidocaine aerosol to the oropharynx and larynx. A flexible 5.9 mm diameter fiberoptic bronchoscope was passed through the right nostril on each occasion. Each bronchoscopic procedure lasted approximately 15 minutes and was performed without apparent complication. Shortly after the first procedure, the subject noted numbness and tingling in a small area of gum and hard palate midline behind the superior incisors. This paresthesia lasted 48 hours and resolved completely. The second procedure, performed ten weeks later, was followed by a similar paresthesia which lasted ten days. These symptoms and their distribution and time course are consistent with a neuropraxia of the nasopalatine nerve. This nerve courses along the nasal septum, passes through the incisive canal, and innervates a small region of mucosa just behind the incisor teeth. Anesthesia in this distribution can be obtained by blocking the nasopalatine nerve.1 It is likely that the neuropraxia in this case was caused by compression from the bronchoscope. Although the subject had a history of a rhinoseptoplasty, careful examination of the nares showed no abnormality. Review of the literature has not revealed any report of this complication following fiberoptic bronchoscopy,2 nasotracheal3 or nasogastric intubation.4 Still, this complication may be more frequent than recognized, as the superficial location of the nerve facilitates compression by foreign objects, but the area innervated is quite small. Since the symptoms resolved spontaneously each time, reassurance seems to be the appropriate form of therapy.