Correspondence  |   April 2001
Transient Lingual and Glossopharyngeal Nerve Injury: A Complication of Cuffed Oropharyngeal Airway
Author Affiliations & Notes
  • Marc Laffon, M.D.
  • *Hopital Bretonneau, Tours, France.
Article Information
Correspondence   |   April 2001
Transient Lingual and Glossopharyngeal Nerve Injury: A Complication of Cuffed Oropharyngeal Airway
Anesthesiology 4 2001, Vol.94, 719-720. doi:
Anesthesiology 4 2001, Vol.94, 719-720. doi:
To the Editor:—
Lingual nerve injury is an uncommon complication of anesthetic airway management. 1–8 We report the first case of transient bilateral lingual and glossopharyngeal nerve injury after use of a cuffed oropharyngeal airway (COPA).
A healthy 32-yr-old female with a height of 164 cm and a weight of 65 kg was anesthetized for suction and curettage after spontaneous abortion. Anesthesia was induced using 2.5 mg/kg propofol and 1 μg/kg remifentanil. A 9-cm COPA was inserted easily, and the cuff was inflated with 30 ml air, according to the recommendations of the manufacturer, and secured with ribbon. Because of an audible leak during manual ventilation, 8 ml air was added subsequently into the cuff of the device. Anesthesia was maintained using nitrous oxide–oxygen (50/50) and remifentanil (0.5 μg · kg−1· min−1). At the time of recovery, the COPA was removed, i.e.  , 20 min after its insertion. The patient immediately reported numbness of the entire tongue. Neurologic examination showed decreases in temperature and in response to light touch and pin prick in the presulcal and postsulcal parts of the tongue, indicating lingual and glossopharyngeal nerve injury. There was neither a motor function deficit nor intraoral trauma. The symptoms resolved spontaneously within 2 h after the operation.
This uncommon complication of the lingual nerve previously described with a laryngeal mask airway is not surprising. 1,2,4,6 Anesthetic airway management with both laryngeal mask airway and COPA uses pharyngeal cuff inflation, which causes an increase of oropharyngeal soft tissue pressure. Excessive pressure exerted against the oropharyngeal mucosa could explain the injury of superficial nerves, such as the lingual nerve and the lingual branch of the glossopharyngeal nerve. Over the styloglossus muscle, these nerves are close to each other and can be injured simultaneously. 9,10 In the case we report, the 8 ml air added into the cuff of the COPA overinflated the cuff by 25% of the maximum volume recommended by the manufacturer (COPA size 9, 30 ml), and was probably the cause of excessive pressure exerted against the oropharyngeal mucosa. With an 11-cm COPA, Brimacombe et al.  11 recently showed that even with an inflated volume according to the recommendation of the manufacturer, pharyngeal mucosal perfusion is decreased and decreases further with additional volume. Moreover, nitrous oxide, even used during a brief period, could increase the cuff pressure further. A 30-min exposure to 66% N2O in oxygen induces a 30-mmHg mean increase in laryngeal mask airway cuff pressure. 12 
In conclusion, this case shows the natural course of lingual nerve injury after misuse of the COPA, which is typical of acute compression because of its brief duration and subsequent resolution. The fact remains that the COPA inflated cuff volume recommendation must be followed. In case of air leakage, a change to a larger-sized COPA is probably better than a moderate overinflation of the cuff.
*Hopital Bretonneau, Tours, France.
Ahmad NS, Yentis SM: Laryngeal mask airway and lingual nerve injury. Anaesthesia 1996; 51: 707–8Ahmad, NS Yentis, SM
Brain AI, Howard D: Lingual nerve injury associated with laryngeal mask use. Anaesthesia 1998; 53: 713–4Brain, AI Howard, D
Jones BC: Lingual nerve injury: A complication of intubation (letter). Br J Anaesth 1971; 43: 730Jones, BC
Laxton CH, Kipling R: Lingual nerve paralysis following the use of laryngeal mask airway. Anaesthesia 1996; 51: 869–70Laxton, CH Kipling, R
Loughman E: Lingual nerve injury following tracheal intubation (letter). Anaesth Intensive Care 1983; 11: 171Loughman, E
Majumder S, Hopkins PM: Bilateral lingual nerve injury following the use of laryngeal mask airway. Anaesthesia 1998; 53: 184–6Majumder, S Hopkins, PM
Silva DA, Colingo KA, Miller R: Lingual nerve injury following laryngoscopy. A nesthesiology 1992; 76: 650–1Silva, DA Colingo, KA Miller, R
Teichner RL: Lingual nerve injury: a complication of orotracheal intubation. Br J Anaesth 1971; 43: 413–4Teichner, RL
Mozsary PG, Middleton RA: Microsurgical reconstruction of the lingual nerve. J Oral Maxillofac Surg 1984; 42: 415–20Mozsary, PG Middleton, RA
Williams PL, Warwick R, Dyson M, Bannister LH: Gray’s Anatomy, 37th edition. London, Churchill Livingston, 1989, pp 1105–13
Brimacombe J, Keller C, Puhringer F: Pharyngeal mucosal pressure and perfusion: A fiberoptic evaluation of the posterior pharynx in anesthetized adult patients with a modified cuffed oropharyngeal airway. A nesthesiology 1999; 91: 1661–5Brimacombe, J Keller, C Puhringer, F
Lumb AB, Wrigley MW: The effect of nitrous oxide on laryngeal mask cuff pressure. Anaesthesia 1992; 47: 320–3Lumb, AB Wrigley, MW