Our Summary

This paper talks about a rare case where a healthy 29-year-old woman experienced problems with swallowing and speech after having her tonsils removed. She also had to be hospitalized again due to dehydration. The problem wasn’t likely caused by a direct injury during the operation, since the affected nerve is usually well-protected. The authors discuss potential reasons for the issue and suggest some precautions to prevent similar problems in future. These include being careful not to inflate the throat airway too much, regularly reducing pressure on the tongue, and being very gentle when manipulating the base of the tongue if needed. Despite her difficulties, the woman fully recovered after 6-8 weeks.

FAQs

  1. What is hypoglossal nerve paresis and how can it occur after a tonsillectomy?
  2. What precautions can be taken to avoid hypoglossal nerve paresis during a tonsillectomy?
  3. What symptoms did the 29-year-old woman experience due to hypoglossal nerve paresis after her tonsillectomy?

Doctor’s Tip

A helpful tip a doctor might give a patient about tonsillectomy is to follow the post-operative care instructions provided by the surgeon closely. This may include staying hydrated, avoiding strenuous activities, and eating soft foods to avoid irritation to the surgical site. It is also important to communicate any unusual symptoms or concerns to the healthcare provider promptly.

Suitable For

Patients who are typically recommended for tonsillectomy include those who suffer from recurrent tonsillitis, sleep-disordered breathing (such as obstructive sleep apnea), difficulty swallowing due to enlarged tonsils, or cancer of the tonsils. In some cases, tonsillectomy may also be recommended for patients with chronic tonsillitis that does not respond to other treatments. It is important for patients to discuss their individual symptoms and medical history with their healthcare provider to determine if tonsillectomy is the right treatment option for them.

Timeline

Before Tonsillectomy:

  • Patient consults with an otolaryngologist to discuss symptoms and potential need for tonsillectomy
  • Patient undergoes pre-operative evaluation and testing to assess overall health and suitability for surgery
  • Patient receives pre-operative instructions, including fasting guidelines and medications to avoid
  • Surgery is scheduled and patient prepares for the procedure

Day of Tonsillectomy:

  • Patient arrives at the hospital or surgical center and is prepped for surgery
  • Anesthesia is administered and the procedure is performed, typically lasting 30-45 minutes
  • Patient wakes up in the recovery room and is monitored for a period of time before being discharged home

After Tonsillectomy:

  • Patient experiences pain and discomfort in the throat, which may be managed with pain medications and ice packs
  • Patient follows post-operative instructions, including rest, hydration, and avoiding certain foods
  • Patient may experience difficulty swallowing, speaking, and breathing due to swelling and inflammation
  • Patient may require a follow-up appointment with the surgeon to assess healing and address any concerns

Recovery:

  • Patient gradually improves over the course of 1-2 weeks, with resolution of symptoms such as pain and difficulty swallowing
  • Patient returns to normal activities and diet as directed by the surgeon
  • Patient may experience long-term benefits such as reduced frequency of throat infections and improved quality of life

In the case report mentioned, the patient experienced a rare complication of hypoglossal nerve paresis after tonsillectomy, leading to dysphagia and dysarthria. Despite the challenges faced, the patient eventually made a full recovery after 6-8 weeks of symptoms and required rehospitalization for dehydration. The authors suggest precautions to prevent similar complications in the future, such as avoiding overinflation of the laryngeal mask airway and careful manipulation of the tongue base during surgery.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with tonsillectomy, including rare complications like hypoglossal nerve paresis?
  2. How common is hypoglossal nerve paresis after tonsillectomy?
  3. What symptoms should I look out for after surgery that may indicate a complication like hypoglossal nerve paresis?
  4. What steps will be taken during the surgery to minimize the risk of nerve damage?
  5. How will my recovery be managed if I experience complications like hypoglossal nerve paresis?
  6. Are there any specific precautions or techniques that can be used during the surgery to reduce the risk of nerve damage?
  7. How likely is it that I will experience complications like hypoglossal nerve paresis based on my individual health and medical history?
  8. Are there any alternative treatment options to tonsillectomy that may carry a lower risk of complications?
  9. What is the typical recovery time for a tonsillectomy, and how might complications like hypoglossal nerve paresis impact this timeline?
  10. How will my post-operative care plan be adjusted if I experience complications like hypoglossal nerve paresis?

Reference

Authors: Barfred M, Howitz MF. Journal: Ugeskr Laeger. 2024 Dec 16;186(51):V07240481. doi: 10.61409/V07240481. PMID: 39749630