Lingual nerve injury following the use of an oropharyngeal airway under endotracheal general anesthesia

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.