Hypoglossal Nerve Palsy and Related Airway Management Challenges

Hypoglossal nerve palsy entails dysfunction of the twelfth cranial nerve, which provides motor innervation to intrinsic and extrinsic tongue muscles. Lesions may arise from neoplastic compression, vascular insult, trauma or iatrogenic injury during surgical procedures and airway manipulation. Clinically, palsy manifests as tongue deviation, atrophy, dysarthria and dysphagia, often complicating mastication, speech and swallowing. In critical care and peri-operative settings, hypoglossal impairment can exacerbate airway obstruction, impede endotracheal intubation and challenge extubation, heightening the risk of aspiration pneumonia. Specific syndromes, such as Tapia’s syndrome, combine hypoglossal and recurrent laryngeal nerve injury, underscoring the anatomical vulnerability within the oropharyngeal corridor. Current management demands precise anatomical knowledge, early recognition through clinical and imaging assessments, and a multidisciplinary strategy encompassing surgical correction, rehabilitative therapy and cautious airway handling. Rehabilitation protocols—targeting tongue strength and swallowing mechanics—have shown promise in restoring function over months. Advances in imaging techniques and bedside ultrasound have improved detection of nerve pathology, facilitating timely intervention. Despite its rarity, hypoglossal palsy bears global significance owing to its potential to precipitate life-threatening airway compromise, and ongoing research seeks to refine preventive measures, diagnostic accuracy and rehabilitative outcomes.

Research from Nature Portfolio

No recent Nature Portfolio content available.

Hypoglossal Nerve Palsy and Related Airway Management Challenges publication trend

The graph below shows the total number of articles in hypoglossal nerve palsy and related airway management challenges across all publications each year (not limited to Nature Index journals).

Technical terms

Hypoglossal nerve: The twelfth cranial nerve responsible for motor control of tongue muscles.

Dysphagia: Difficulty or discomfort in swallowing.

Dysarthria: Impaired articulation of speech due to neuromuscular dysfunction.

Orotracheal intubation: Placement of a tube through the mouth into the trachea to secure the airway.

Tapia’s syndrome: Concurrent injury to hypoglossal and recurrent laryngeal nerves, often after intubation, causing tongue and vocal cord paralysis.

Tongue ptosis: Drooping or sagging of the tongue resulting from muscle denervation.

References

1. Hypoglossal Nerve Neuropathies—Analysis of Causes and Anatomical Background. Biomedicines (2024).
2. The ptotic tongue—imaging appearance and pathology localization along the course of the hypoglossal nerve. Neuroradiology (2023).
3. Tapia’s syndrome: pathogenetic mechanisms, diagnostic management, and proper treatment: a case series. Journal of Medical Case Reports (2016).
4. Ultrasound of the Hypoglossal Nerve in the Neck: Visualization and Initial Clinical Experience with Patients. American Journal of Neuroradiology (2015).
5. A Physical Medicine and Rehabilitation Approach to Bilateral Hypoglossal Palsy After Orotracheal Intubation: A Case Report. Cureus (2022).