Post-Intubation Hypoglossal Nerve Injury Presenting as Tongue Mass: A Case Report

Abstract

Hypoglossal nerve palsy is a rare complication related to airway management during general anesthesia. Its diagnosis can be delayed when postoperative tongue swelling mimics a neoplasm. This paper reports a case of isolated hypoglossal nerve palsy after endotracheal intubation. A 65-year-old woman developed dysphagia and impaired tongue protrusion after orbital floor fracture surgery. Fiberoptic endoscopic evaluation revealed a 3-mm mass-like lesion at the tongue base, and magnetic resonance imaging showed asymmetric swelling of the left tongue and oropharyngeal wall. The tongue strength measured using the Iowa Oral Performance Instrument (IOPI) at six days post-onset was 10 kPa, which was markedly lower than the age norms. Electromyography revealed the fibrillation potentials and positive sharp waves in the left tongue muscle, confirming isolated hypoglossal nerve palsy. Oral methylprednisolone was administered for five days, followed by a five-day taper, with concurrent tongue-strengthening rehabilitation. One month later, the tongue strength improved, reaching a maximal pressure of 24 kPa. The mass-like lesion had resolved on follow-up and was interpreted as a pseudotumor caused by edema and mechanical compression. Complete recovery was achieved by the six-month follow-up. This case highlights the utility of IOPI for early quantitative assessment of tongue weakness and highlights that early diagnosis and steroid treatment can facilitate recovery.