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Cambridge English Empower Buy book. We use cookies. By continuing to use this website you are giving your consent for us to set cookies Dismiss. Reading and Listening. Elementary 1. Elementary 2. Intermediate 1. Intermediate 2. Advanced 1. Advanced 2. Lingual nerve injury commonly presents with unilateral or bilateral tongue numbness and altered taste perception [ 4 ].
Although symptoms of lingual neuropraxia often subside spontaneously after a few weeks [ 5 , 6 ], some patients may experience prolonged tongue numbness for up to six months [ 7 ].
The lingual nerve lies beneath the mucosa on the inner surface of the mandible below the roots of the third molar and and innervates the sensory and taste sensation of the anterior two thirds of the tongue [ 8 ]. 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 particularly at risk. Case-series studies and case reports also suggest that patient-related such as diabetes, peripheral vascular disease , anesthesia-related such as the size and placement of airway devices, cuff pressure, and poor technique and surgical-related patient positioning, head rotation, prolonged operation time risk factors might have contributed to the development of postoperative lingual nerve injury [ 9 ], but the exact incidence and risk factors for postanesthesia lingual neuropraxia are still undetermined [ 2 , 9 ].
Since prospective study design is underprivileged for the rare clinical events [ 10 ], we retrospectively analyzed all events of tongue numbness after airway instrumentation during general anesthesia from — in our hospital. The aim of this study was to determine the incidence and risk factors associated with the development of post-anesthesia lingual neuropraxia. Our long-term goal was to develop preventive strategies for intraoperative lingual nerve injuries due to airway instrumentation.
Our hospital is a tertiary teaching medical center supporting surgical beds. From January to December , all patients received anesthesia management for surgical or other medical interventions were visited within 24 hours after operation.
As all patients who complained of tongue numbness received ETGA or LMA Table 1 , matched controls were randomly chosen from surgical patients who received intraoperative airway instrumentation LMA or ETGA but didn't report abnormal sensory changes on the tongue during the same study period.
Age, American Society of Anesthesiologists physical status ASA PS , and gender were matched between case numbness and control non-numbness patients in a 1 to 5 ratio. These characteristic parameters were chosen as the matching variables as they are considered strong confounders [ 11 ]. Patients who only received regional anesthesia, dental, or orthognathic surgery and patients who were discharged from the hospital within 24 hours post-operative were excluded from the study.
The incidence of post-anesthesia tongue numbness was calculated as numbers of cases divided by total number of in-hospital surgical patients who received LMA or ETGA management during the study period. Difficult intubation was defined as failure to establish a secure airway i. The values of continuous variables were compared using an independent two-sample t test, one-way ANOVA or Wilcoxon rank-sum test, as appropriate.
Conditional logistic regression model was adopted to evaluate the associated risk factors patient demographic and clinical variables and postoperative tongue numbness. All statistical analyses were performed using SAS 9. It was recorded that a total of 36 patients reported tongue numbness after anesthesia over the 4-year study period, resulting in an overall incidence rate of 0.
A summary of patient demographic and operation information can be found in Table 1 and additional data are provided in S1 Table. There were 14 Patients who reported tongue numbness after operations were significantly younger A total of patients case-matched for age, gender, ASA PS, and anesthetic technique undergone were randomly selected from the non-case population in order to identify additional potential risk factors for postoperative tongue numbness.
A comparison of patient characteristics body mass index, BMI , surgery-related factors regions of operation and patient positioning , and anesthesia-related factors size of airway device, clinical experience of anesthetist for airway instrumentation, duration of anesthesia and volume of fluid administered between patients who reported tongue numbness and those who did not are presented in Table 3.
Patient characteristics and anesthesia-related factors were not found to be significantly different across the two groups. A significantly higher proportion of patients who reported postoperative tongue numbness had undergone surgeries in the head-and-neck regions Patient positioning during operations was also found to be significantly difference across the two groups Table 3.
Fewer patients were placed in lithotomy 2. Hospital stay length was not affected by the occurrence of postoperative tongue numbness Table 3. After multivariate logistic regression analysis, operations on the head-and-neck regions were still significantly higher in patients with tongue numbness with an adjusted odd ratio AOR of 7. However, the effect of patient positioning during operations became insignificant after multivariate analysis Table 4.
As patient age and ASA PS were matched in the second stage analysis, multivariate analyses were performed to confirm the interactions between these two parameters and head-and-neck surgery in the entire study population. During the study period, patients received non-head-and-neck surgery and patients received head-and-neck surgery. The multivariate regression analysis indicated that head-and-neck surgery and lower ASA PS class I-II remained associated with a significantly increased risk of postoperative lingual neuropraxy, while no significant differences in incidence between the age groups were found Table 5.
The present retrospective matched case-controlled study revealed a low incidence of postoperative lingual nerve injury during general anesthesia of 6. Numerous cases of postoperative tongue numbness, or lingual neuropraxy, have been reported in anesthesia-related [ 2 , 9 , 12 ] and surgery-related [ 13 , 14 ] journals. As a relatively rare postoperative complication, cases of postoperative lingual neuropraxy are mostly reported in the form of case reports or case series.
The exact risk factors associated with postoperative lingual neuropraxy can be difficult to isolate from case-based studies. To our knowledge, this is the first comparative study reporting the incidence and characterizing the associated risk factors for postoperative lingual neuropraxy.
Lingual nerve injury is a common, and sometimes inevitable, consequence of maxillofacial surgery, and of operations on the third molar in particular [ 8 ]. Therefore, in order to determine the independent risk factors that have not been clearly identified, we opted to exclude patients who received dental or orthognathic surgery from the analysis. The electronic postoperative registry database in Tzu Chi General Hospital only records the basic details of surgical patients e.
In order to analyze potential parameters and risk factors in more detail, non-case controls from our database were selected in a ratio after matching for age, gender, ASA PS, and anesthesia type. The most commonly reported risk factors associated with post-anesthesia lingual nerve injury have been summarized by Thiruvenkatarajan et al.
In general, more cases of postoperative lingual numbness in patients who have been anesthetized with supraglottis airway techniques e. LMA-related lingual nerve injury is generally thought to result from pressure neuropraxia, with inappropriate size or misplacement of the device due to poor technique, patient positioning lateral or prone , and cuff over-inflation of the device [ 2 , 4 , 9 ]. In this study, we tried to identify these factors from a collection of 36 patients who complained of tongue numbness after operations.
The size of the airway devices used in anesthesia maintenance did not differ among the case group in comparison to the matched controls, even after adjusting device size for patient BMI.
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