Liệt dây XII sau phẫu thuật nội soi khớp vai tư thế ngồi: Báo cáo ca lâm sàng

Shoulder arthroscopy, particularly when performed in the beach chair position, offers significant advantages, including improved surgical field exposure and reduced risk of brachial plexus injury. However, this position is associated with inherent risks, notably hemodynamic instability and potential neurological complications. Among these, cranial nerve palsies are rare but clinically significant, warranting careful consideration, especially regarding the cranial nerve XII (hypoglossal nerve). This report aims to highlight a case of left hypoglossal nerve palsy following shoulder arthroscopy in the beach chair position, emphasizing the importance of recognizing this uncommon yet impactful complication.

Anesthesiologists, orthopedic surgeons performing shoulder arthroscopy, neurologists, critical care physicians, and medical researchers interested in perioperative neurological complications and patient positioning.

Shoulder arthroscopy using the beach chair position provides superior surgical access and minimizes traction-related brachial plexus injuries, but carries specific risks. This case report details a 76-year-old female patient who underwent arthroscopic rotator cuff repair in the beach chair position and subsequently developed symptoms consistent with left cranial nerve XII palsy, manifesting as dysarthria and left-sided tongue deviation. Neurological examination confirmed the diagnosis, with brain MRI showing no focal lesions. The patient received conservative medical management and speech rehabilitation, leading to a complete recovery within 12 weeks. The discussion explores the potential mechanisms underlying such rare complications, including mechanical compression or stretch of the hypoglossal nerve due to head positioning, especially with tight restraints or an unneutral head position, and ischemic events related to hemodynamic instability in the beach chair position, particularly in older patients. Factors like head-to-neck desynchronization during manipulation and prolonged neck extension are implicated. The authors emphasize that despite the rarity, the clinical significance of such nerve injuries necessitates a thorough understanding of the anatomical and physiological factors involved. Prevention strategies highlighted include careful patient positioning, vigilant hemodynamic monitoring, ensuring neutral head alignment, and effective communication among the surgical and anesthetic teams throughout the procedure. This case underscores the critical need for awareness and meticulous management to mitigate risks and ensure patient safety during procedures performed in the beach chair position.