全身麻醉插管下使用人工口咽氣道後發生之舌神經損傷

Lingual Nerve Injury Following the Use of an Oropharyngeal Airway under Endotracheal General Anesthesia

舌神經損傷是口腔內器械操作後的可能併發症。我們在此報告一例於全身麻醉插管下使用人工咽氣道後發生之舌神經損傷。本病例是24歲健康女性，以全身麻醉進行子宮肌瘤切除術，經喉鏡插管過程並無任何困難。術後患者主訴舌頭有麻木感，神經學檢查發現右舌尖知覺遲鈍，但運動、味覺及構音功能皆正常。雖未給予特定治療，症狀於四周後完全消失。依理學檢查及病史，致病機轉可能肇因於人工口咽氣道直接壓迫舌尖，進而造成右舌神經末端分支損傷。本病例報告為文獻上首例使用人工口咽氣道後造成舌神經損傷，也提醒麻醉醫師於使用人工口咽氣道時，須考量此一可能之併發症。

We report a patient who presented for elective myomectomy. Laryngoscopy and endotracheal intubation were achieved smoothly without unduly force. An oropharyngeal airway was inserted after endotracheal intubation for biting and was left in the oral cavity until the end of surgery. Two days after surgery, the patient complained of numbness on the right side of her tongue. Neurological examination revealed an area of hypesthesia about 1 cm in diameter on the right side of the tongue tip. The motor function, taste perception, and speech articulation were all intact. A right lingual nerve lesion with terminal branch involvement was diagnosed. The patient was then reassured and discharged home. At the 4-week follow-up, spontaneous resolution occurred. After reviewing the history, we speculated that the mechanism of nerve injury in this case was a direct compression of the tongue tip by the oropharyngeal airway. This is the first report of lingual nerve injury caused by improper placement of the oropharyngeal airway. We recommend careful manipulation in the use of the oropharyngeal airway and vigilant surveillance being undertaken when an oropharyngeal airway is left in place for a prolonged period.