Article Text
Summary
Upper airway stimulation of the tongue using an implantable neurostimulator has recently been approved for select patients with moderate to severe obstructive sleep apnoea (OSA) and intolerance to continuous positive airway pressure therapy. Effective implantation depends on the integrity of the hypoglossal nerve as well as the tongue musculature, notably the genioglossus. Prior trauma to either of these structures may be viewed as a relative contraindication to implantation. We describe a case of successful right hypoglossal nerve implantation in a patient with a history of left cardiac pacemaker placement and severe left penetrating tongue trauma with decreased mobility from contracture and deviation mimicking a hypoglossal nerve palsy. Preoperative and postoperative apnoea–hypopnoea index values were 52/hour and 5/hour, respectively. Prior soft tissue trauma to the tongue may not necessarily preclude surgical candidacy for upper airway stimulation in patients with OSA.
- ear, nose and throat
- cranial nerves
- sleep disorders (respiratory medicine)
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Footnotes
Contributors JWJ: design and analysis of the work, drafting and revision of manuscript, final approval of manuscript. KL: acquisition of data, revision of case report and figures, final approval of manuscript. SS: acquisition of data, revision of the manuscript, final approval of manuscript. CL: conception and design, acquisition of data, revision of the manuscript, final approval of manuscript.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests KL is an employee for Inspire Medical Systems and also has stock ownership.
Patient consent Obtained.
Provenance and peer review Not commissioned; externally peer reviewed.