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Bilateral glossopharyngeal nerve palsy following tonsillectomy: a very rare and difficult complication of a common procedure

  • A Trinidade (a1) and C M Philpott (a1)

Abstract

Objectives:

Tonsillectomy is one of the most commonly performed otolaryngological procedures. Bilateral palsy of the glossopharyngeal nerve is an exceedingly rare complication that can result in significant morbidity. This case report aimed to raise awareness of this complication and outline management strategies.

Case report:

A 31-year-old woman who underwent routine tonsillectomy presented with progressive numbness of the palate, dysgeusia, xerostomia, paraesthesia of the tongue and the feeling of something in her throat within 2 weeks of surgery. She reported the post-operative onset of snoring. Examination revealed a symmetrically low, ‘dropped’ soft palate. Over time, her symptoms have lessened, but dysgeusia and snoring remain.

Conclusion:

The position of the glossopharyngeal nerve in the tonsillar bed makes it prone to injury during tonsillectomy, especially if ‘hot’ methods are used. Bilateral injury can result in significant morbidity that can be difficult to treat. Patients should be warned about this risk and care should be taken to minimise it.

Copyright

Corresponding author

Address for correspondence: Mr A Trinidade, ENT Department, James Paget University Hospital, Lowestoft Road, Great Yarmouth NR31 6LA, UK E-mail: aarontrinidade@gmail.com

References

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1Uzun, C, Adali, MK, Karasalihoglu, AR. Unusual complication of tonsillectomy: taste disturbance and the lingual branch of the glossopharyngeal nerve. J Laryngol Otol 2003;117:314–7
2Scinska, A, Jodkowska, A, Korkosz, A, Kukwa, W, Sienkiewicz-Jarosz, H. Post-tonsillectomy dysgeusia with weight loss: possible involvement of soft palate. J Laryngol Otol 2008;122:e5
3Ohtsuka, K, Tomita, H, Murakami, G. Anatomy of the tonsillar bed: topographical relationship between the palatine tonsil and the lingual branch of the glossopharyngeal nerve. Acta Otolaryngol Suppl 2002:99109
4Ford, LC, Cruz, RM. Bilateral glossopharyngeal nerve paralysis after tonsillectomy: case report and anatomic study. Laryngoscope 2004;114:2196–9
5Haapanen, ML, Ignatius, J, Rihkanen, H, Ertama, L. Velopharyngeal insufficiency following palatine tonsillectomy. Eur Arch Otorhinolaryngol 1994;25:186–9
6Back, GW, Nadig, S, Uppal, S, Coatesworth, AP. Why do we have a uvula?: literature review and a new theory. Clin Otolaryngol Allied Sci 2004;29:689–93

Keywords

Bilateral glossopharyngeal nerve palsy following tonsillectomy: a very rare and difficult complication of a common procedure

  • A Trinidade (a1) and C M Philpott (a1)

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