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Occipital condyle fracture with isolated unilateral hypoglossal nerve palsy.

Yoon JW, Lim OK, Park KD, Lee JK - Ann Rehabil Med (2014)

Bottom Line: A videofluoroscopic swallowing study revealed piecemeal deglutition due to decreased tongue mobility but no aspiration of food.An electrodiagnostic study revealed evidence of right hypoglossal nerve palsy.We report a rare case of isolated hypoglossal nerve palsy caused by an OCF.

View Article: PubMed Central - PubMed

Affiliation: Department of Physical & Rehabilitation Medicine, Gachon University School of Medicine, Incheon, Korea.

ABSTRACT
Occipital condyle fractures (OCFs) with selective involvement of the hypoglossal canal are rare. OCFs usually occur after major trauma and combine multiple fractures. We describe a 38-year-old man who presented with neck pain and a tongue deviation to the right side after a traffic accident. Severe limitations were detected during active and passive range of neck motion in all directions. A physical examination revealed a normal gag reflex and normal mobility of the palate, larynx, and shoulder girdle. He had normal taste and general sensation in his tongue. However, he presented with a tongue deviation to the right side on protrusion. A videofluoroscopic swallowing study revealed piecemeal deglutition due to decreased tongue mobility but no aspiration of food. Plain X-ray film findings were negative, but a computed tomography study with coronal reconstruction demonstrated a right OCF involving the hypoglossal canal. An electrodiagnostic study revealed evidence of right hypoglossal nerve palsy. We report a rare case of isolated hypoglossal nerve palsy caused by an OCF.

No MeSH data available.


Related in: MedlinePlus

Follow-up computed tomography (CT) scan and plain X-ray performed 16 weeks after the motor vehicle crash. (A) The CT scan reveals structural stability of craniocervical joints with no widening of the occipitoatlantal or atlantoaxial joints. (B) Basiondens interval of 4.93 mm and (C) anterior atlanto-dens interval of 1.22 mm. (D) Lateral view cervical radiograph shows structural stability of the craniocervical joints.
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Figure 3: Follow-up computed tomography (CT) scan and plain X-ray performed 16 weeks after the motor vehicle crash. (A) The CT scan reveals structural stability of craniocervical joints with no widening of the occipitoatlantal or atlantoaxial joints. (B) Basiondens interval of 4.93 mm and (C) anterior atlanto-dens interval of 1.22 mm. (D) Lateral view cervical radiograph shows structural stability of the craniocervical joints.

Mentions: A CT scan showed no structural instability of the craniocervical joints, so we applied a Philadelphia collar for 6 weeks to prohibit excess neck motion and physical therapy for pain control. The patient performed strength exercises and range of motion exercises for the oral tongue muscles. The Korean version of Neck Disability Index (NDI) was used to assess disability due to neck pain [6]. The NDI score was 50 at 1 day after the injury and it was 21 at 25 days after the injury. The NDI score had dropped to 12 at 56 days after the injury. Thus, neck pain had improved. Deviation of the tongue to the right side improved partially 8 weeks after the injury. A follow-up CT scan and dynamic cervical radiographs 16 weeks after the injury revealed stable craniocervical joint structure (Fig. 3).


Occipital condyle fracture with isolated unilateral hypoglossal nerve palsy.

Yoon JW, Lim OK, Park KD, Lee JK - Ann Rehabil Med (2014)

Follow-up computed tomography (CT) scan and plain X-ray performed 16 weeks after the motor vehicle crash. (A) The CT scan reveals structural stability of craniocervical joints with no widening of the occipitoatlantal or atlantoaxial joints. (B) Basiondens interval of 4.93 mm and (C) anterior atlanto-dens interval of 1.22 mm. (D) Lateral view cervical radiograph shows structural stability of the craniocervical joints.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4221398&req=5

Figure 3: Follow-up computed tomography (CT) scan and plain X-ray performed 16 weeks after the motor vehicle crash. (A) The CT scan reveals structural stability of craniocervical joints with no widening of the occipitoatlantal or atlantoaxial joints. (B) Basiondens interval of 4.93 mm and (C) anterior atlanto-dens interval of 1.22 mm. (D) Lateral view cervical radiograph shows structural stability of the craniocervical joints.
Mentions: A CT scan showed no structural instability of the craniocervical joints, so we applied a Philadelphia collar for 6 weeks to prohibit excess neck motion and physical therapy for pain control. The patient performed strength exercises and range of motion exercises for the oral tongue muscles. The Korean version of Neck Disability Index (NDI) was used to assess disability due to neck pain [6]. The NDI score was 50 at 1 day after the injury and it was 21 at 25 days after the injury. The NDI score had dropped to 12 at 56 days after the injury. Thus, neck pain had improved. Deviation of the tongue to the right side improved partially 8 weeks after the injury. A follow-up CT scan and dynamic cervical radiographs 16 weeks after the injury revealed stable craniocervical joint structure (Fig. 3).

Bottom Line: A videofluoroscopic swallowing study revealed piecemeal deglutition due to decreased tongue mobility but no aspiration of food.An electrodiagnostic study revealed evidence of right hypoglossal nerve palsy.We report a rare case of isolated hypoglossal nerve palsy caused by an OCF.

View Article: PubMed Central - PubMed

Affiliation: Department of Physical & Rehabilitation Medicine, Gachon University School of Medicine, Incheon, Korea.

ABSTRACT
Occipital condyle fractures (OCFs) with selective involvement of the hypoglossal canal are rare. OCFs usually occur after major trauma and combine multiple fractures. We describe a 38-year-old man who presented with neck pain and a tongue deviation to the right side after a traffic accident. Severe limitations were detected during active and passive range of neck motion in all directions. A physical examination revealed a normal gag reflex and normal mobility of the palate, larynx, and shoulder girdle. He had normal taste and general sensation in his tongue. However, he presented with a tongue deviation to the right side on protrusion. A videofluoroscopic swallowing study revealed piecemeal deglutition due to decreased tongue mobility but no aspiration of food. Plain X-ray film findings were negative, but a computed tomography study with coronal reconstruction demonstrated a right OCF involving the hypoglossal canal. An electrodiagnostic study revealed evidence of right hypoglossal nerve palsy. We report a rare case of isolated hypoglossal nerve palsy caused by an OCF.

No MeSH data available.


Related in: MedlinePlus