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152:Unilateral Hypoglossal Nerve Palsy[AAOM2020}
EP35996
Poster Title: 152:Unilateral Hypoglossal Nerve Palsy[AAOM2020}
Submitted on 29 Mar 2021
Author(s): Rawan Ashshi BDS*., Eric T Stoopler, DMD, FDSRCS, FDSRCPS., Takako I Tanaka, DDS, FDS RCSEd., Thomas Sollecito DMD FDS RCSEd
Affiliations: Department of Oral Medicine, University of Pennsylvania School of Dental Medicine, Philadelphia, Pennsylvania
This poster was presented at 2021 American Academy of Oral Medicine Virtual Conference
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Poster Information
Abstract: Background: The hypoglossal nerve (cranial nerve XII) innervates all extrinsic and intrinsic muscles of the tongue, with the exception of the palatoglossus muscle, and controls all tongue movements. Although unilateral hypoglossal nerve palsy is uncommon, major causes for the condition include tumors, infection, inflammation, amyotrophic lateral sclerosis (ALS) or neck injury within its course. Manifestations of hypoglossal nerve palsy include difficulty in speaking, chewing, and swallowing. Treatment is dependent on etiology.

Case report: A 78-year-old malecomplained of tongue changes noted by lisping speech and inability to whistle. He reported a flaccid appearance of the left tongue. He denied infection, neck pain, trauma or difficulty turning his head. He also denied dysphagia. He did not experience weakness or numbness elsewhere in his face or head region. Medical history was significant for a sulphur amino acid metabolic disorder,ascending aorta dilation, hypertension, renal carcinoma, thoracic aneurysm, ulnar nerve lesion and pulmonary nodules. Surgical history was significant for tonsillectomy, partial nephrectomy, and cataract removal. Medications included atorvastatin, multivitamins, low-dose aspirin, sildenafil and irbesartan. Review of systems was unremarkable. An extraoral exam was unremarkable except for CN XII abnormality evidenced by decreased strength with tongue movement to the left. The intraoral exam revealed atrophy of the left side of tongue.Brain MRI with and without contrast showed incidental 7 mm right anterior clinoid meningioma. Differential diagnosis included left hypoglossal nerve weakness secondary to viral etiologyand dysarthria secondary to tongue weakness. The patient was referred for a second opinion to neurology and otolaryngology ENT for occult pathology. Extensive evaluation, includingelectromyogram and flexible laryngoscopy, was unrevealing. Patient has had no clinical improvement nor progression upon 1 year follow up.

Conclusions:A patient with an isolated unilateral cranial nerve XII palsy can be a diagnostic and therapeutic challenge. An extensive history and oral examination should be performed. Referral to a neurologist and otolaryngologist should be considered to rule out any underling tumors or systemic conditions.
Summary: The hypoglossal nerve (cranial nerve XII) innervates all extrinsic and intrinsic muscles of the tongue, with the exception of the palatoglossus muscle, and controls all tongue movements. Although unilateral hypoglossal nerve palsy is uncommon, major causes for the condition include tumors, infection, inflammation, amyotrophic lateral sclerosis (ALS) or neck injury within its course.

Ask the author questions about this poster:Rawan3shi@hotmail.com
References: 1. Vilensky J, Robertson W, Suárez-Quian C,The Hypoglossal Nerve. 1st ed.The Clinical Anatomy of the Cranial Nerves;2015:229-237.
2.Cant A, Collard B, et al. Oral medicine: Isolated unilateral hypoglossal nerve palsy. Br Dent
J;2018: 95,225.
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