Hypoglossal Nerve Palsy as a Cause of Severe Dysphagia along with the Oropharyngeal Stenosis due to Occipitocervical Kyphosis

Abstract

Hypoglossal nerve palsy (HNP) is a potential cause of dysphagia. A 66-year-old man presented to our hospital with dysphagia and neck pain. One year prior to his first visit, he had been diagnosed with upper cervical tuberculosis and had undergone posterior C1-2 fixation. The physical examination led to the diagnosis of dysphagia with HNP, and he had severe weight loss. Radiographic examination revealed that the O-C kyphosis had been exacerbated and that the deformity was likely the primary cause of HNP. To restore the swallowing function, O-C fusion surgery was performed. Postoperatively, the patient showed immediate improvement of dysphagia with gradual recovery of hypoglossal nerve function. In the last follow-up evaluation, swallowing function was confirmed with no signs of HNP. Our results indicate that HNP could be more prevalent in cases with severe cervical kyphosis, being underdiagnosed due to the more apparent signs of the oropharyngeal narrowing.

Figure 1

Lateral cervical X-ray at the first visit to our hospital showing instruments on C1/C2, O-C2 angle of 17-degree kyphosis, and vertical subluxation: Redlund-Johnell's distance, 22 mm. Space available for the cord (SAC), atlantodental interval (ADI), and C2-7 angle are 15 mm, 2 mm, and 33°, respectively.

Figure 2

Computed tomography (CT) of the cervical spine showing erosion of anterior arch of C1 vertebra and dens (black arrow).

Figure 3

Sagittal T2-weighted image of magnetic resonance imaging of the cervical spine at the first visit showing a mass on retropharyngeal space with heterogeneous intensity (white arrow).

Figure 4

Lateral cervical X-ray after the posterior O-C3 fusion surgery at our hospital showing O-C2 angle of 6-degree lordosis.

Figure 5

(a) Pre- and (b) postoperative lateral cervical X-rays showing the surgical plan for the change of direction of hypoglossal nerve (black dotted lines). The white arrow points the place at which the nerve exits from the hypoglossal foramen and is stretched backward due to the O-C kyphosis.