Combined cranial nerve palsy after general anesthesia: a cas
Published in JA case reports, the authors present a case of concomitant paralysis of the unilateral vocal cord and tongue after upper extremity surgery under general anesthesia. This presentation is very rare but may be clinically instructive for both anesthesiologists and surgeons.

A 51-year-old man (165 cm, 81 kg) underwent internal fixation of a left proximal humeral fracture under general anesthesia. After inducing anesthesia with propofol, remifentanil, and rocuronium, an 8.0-mm tracheal tube was placed using a Macintosh blade uneventfully. The depth and intracuff pressure of the tracheal tube were 23 cm and ≤ 12 cmH2O, respectively.

The 105-min long procedure was performed in the beach-chair position. Anesthesia was uneventful, except for the displacement of the patient’s head and neck, which required repositioning—the head and neck were often deflected to the right while traction was applied to the left forearm during fracture reduction.

After emergence from anesthesia, the patient was hoarse. On postoperative day 1, he complained of dysarthria, dysphagia, and leftward deviation of the tongue. On postoperative day 2, magnetic resonance imaging of the head did not show any abnormalities.

Subsequent swallowing videofluoroscopy and laryngeal endoscopy revealed pharyngeal retention without aspiration and left vocal cord paralysis. He was diagnosed with combined left hypoglossal and recurrent laryngeal nerve palsy. All symptoms subsided within 8 months, without systemic administration of corticosteroids.

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