18236639 Visualization

A 30 Age - year Age - old Age female Sex (65 kg) underwent rhinoplasty Therapeutic_procedure under general Medication anaesthesia Medication , which was induced using a combination of a bolus of Remifentanyl Medication ( 0.5 Dosage μg/kg Dosage ) and Propofol Medication 2 Dosage mg/kg Dosage .
Muscle Disease_disorder paralysis Disease_disorder was obtained with Cisatracurium Medication ( 0.15 Dosage μg/kg Dosage ).
Transoral Detailed_description intubation Therapeutic_procedure was performed with a Macintosh Therapeutic_procedure blade Therapeutic_procedure ( No.3 Detailed_description ) and a size 7 Detailed_description mm Detailed_description diameter Detailed_description reinforced Detailed_description tracheal Therapeutic_procedure tube Therapeutic_procedure was easily and gently placed in the trachea Biological_structure , on the first attempt and was then fixed to the right Biological_structure corner Biological_structure of Biological_structure the Biological_structure mouth Biological_structure .
No problems Disease_disorder were encountered during laryngoscopy Therapeutic_procedure and intubation Coreference .
The cuff of the tube Coreference was inflated with a pressure Lab_value ≤ Lab_value 20 Lab_value cm Lab_value H2O.
No adjustment Therapeutic_procedure of Therapeutic_procedure cuff Therapeutic_procedure volume Therapeutic_procedure was made intra-operatively.
N2O Medication was not used for inhalation anaesthesia.
The throat Therapeutic_procedure pack Therapeutic_procedure was placed in the pharynx Biological_structure to avoid the passage of blood in the aero-digestive tract.
General Medication anaesthesia Medication was maintained with Sevofluorane Medication in Administration oxygen/air Administration and Remifentanyl Medication in continuous Administration infusion Administration 0.25 Dosage μg/kg/min Dosage .
Moderate Severity arterial Sign_symptom hypotension Sign_symptom was maintained with a cuff systolic Diagnostic_procedure artery Diagnostic_procedure pressure Diagnostic_procedure of approximately 90 Lab_value mmHg Lab_value .
The operation was carried out in a semi Therapeutic_procedure - supine Therapeutic_procedure position Therapeutic_procedure with the head Detailed_description slightly Detailed_description inclined Detailed_description forward Detailed_description and laterally and trunk Detailed_description slightly Detailed_description elevated Detailed_description .
Duration of the operation Therapeutic_procedure was 100 Duration minutes Duration .
The patient was extubated Therapeutic_procedure , after removal of the throat Therapeutic_procedure pack Therapeutic_procedure without problems Disease_disorder .
The following Date day Date the patient complained of difficulty Sign_symptom in Sign_symptom swallowing Sign_symptom , dysphonia Sign_symptom and hoarseness Sign_symptom .
Examination Diagnostic_procedure revealed deviation Sign_symptom of the tongue Biological_structure to the right Detailed_description side Detailed_description and vocal Biological_structure cord Biological_structure paralysis Disease_disorder , expression of hypoglossal Biological_structure and recurrent Detailed_description laryngeal Biological_structure nerve Disease_disorder injury Disease_disorder without local Detailed_description oedema Sign_symptom or haematoma Sign_symptom .
The movements Diagnostic_procedure of the pharynx Biological_structure and soft Biological_structure palate Biological_structure were normal Lab_value .
Meticulous neurological Diagnostic_procedure examination Diagnostic_procedure , including also magnetic Diagnostic_procedure resonance Diagnostic_procedure imaging Diagnostic_procedure ( MRN Diagnostic_procedure ) revealed no other evidence of central Biological_structure or cranial Biological_structure nerve Sign_symptom involvement Sign_symptom .
Conservative management included steroids Medication , vitamins Medication together with speech Detailed_description and swallowing Detailed_description therapy Therapeutic_procedure .
Full Lab_value recovery Lab_value of lingual Biological_structure and laryngeal Biological_structure functions Diagnostic_procedure was obtained within Date four Date months Date after Date surgery.