Challenge of the Week / Spine / 05.17.19

A 48-year-old male patient who is a cigarette smoker undergoes a C2-C4 fusion with C3 corpectomy for treatment of metastatic lung cancer. The approach to the cervical spine is difficult with the tissue planes being more adherent than in non-smoking patients. Throughout the case, the anesthesia team has maintained a low endotracheal tube cuff pressure and you have maintained meticulous hemostasis and cautious retractor placement. Despite best efforts, the patient reports dysphagia and dysarthria postoperatively. Which of the following examination findings would support an injury to the hypoglossal nerve?

  • Decreased sensation over 2 inch band ipsilateral to the incision
  • Ipsilateral tongue deviation
  • Difficulty singing high notes and speaking with a high-pitched voice
  • Crepitus in the subcutaneous tissue overlying the incision