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Case report
Bilateral hypoglossal nerve damage due to the use of the harmonic focus scalpel
  1. Katherine Radcliffe1,2,
  2. Shakeel Akhtar1 and
  3. Ajay Wilson3
  1. 1Maxillofacial Surgery, Royal Preston Hospital, Preston, UK
  2. 2Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
  3. 3Maxillofacial Surgery, City Hospitals Sunderland NHS Foundation Trust, Sunderland, UK
  1. Correspondence to Katherine Radcliffe; katherine.radcliffe{at}


We describe the case of a 68-year-old man who presented with an anterior floor of mouth squamous cell carcinoma and underwent bilateral neck dissection. Subsequently, the patient developed permanent bilateral hypoglossal palsies, causing significant dysphagia, dysarthria and breathing difficulties. Hypoglossal nerve damage from surgical causes is uncommon, occurring in only 0.42% of functional neck dissections. However, it is the bilateral and permanent features of this case which make it unique. This injury may have been caused by incorrect use of the Harmonic Focus scalpel. Therefore, we discuss the literature demonstrating that the Harmonic Focus scalpel causes more lateral thermal damage than alternative tools, and the widely accepted 3 mm safety limit is not enough to protect important surrounding structures. This case report aims to highlight the need for proper training and specific identification of the hypoglossal nerve to prevent this rare and debilitating complication occurring in future patients.

  • oral and maxillofacial surgery
  • head and neck surgery
  • head and neck cancer
  • neurological injury
  • healthcare improvement and patient safety

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  • Contributors All authors contributed to the original writing of this article. SA and KR have redrafted subsequent versions. AW and SA were directly involved in patient care.

  • 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 None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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