[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"doc-seo-408171-105":3,"detail-sidebar-cat-0-en-105":81,"doc-detail-408171-en":130},{"code":4,"msg":5,"data":6},0,"ok",{"site_id":7,"language":8,"slug":9,"title":10,"keywords":11,"description":12,"schema_data":13,"social_meta":74,"head_meta":76,"extra_data":78,"updated_unix":80},105,"en","respiratory-arrest-from-bilateral-hypoglossal-nerve-paralysis-case-report","Respiratory Arrest From Bilateral Hypoglossal Nerve Paralysis - Case Report","","Bilateral hypoglossal nerve paralysis (BHNP) can threaten airway safety through tongue collapse and impaired secretion management. This case report describes a 52-year-old man who developed BHNP after undergoing multiple debridements for cervical necrotizing fasciitis of both submandibular regions. Respiratory arrest occurred 12 hours after extubation, likely related to supine positioning, tongue-base prolapse, and limited secretion tolerance. An emergent bedside cricothyroidotomy was performed successfully.",{"@graph":14,"@context":73},[15,34,56],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/document/","Document",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/document/healthcare/","Healthcare",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/document/respiratory-arrest-from-bilateral-hypoglossal-nerve-paralysis-case-report/408171/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/respiratory-arrest-from-bilateral-hypoglossal-nerve-paralysis-case-report/408171.png","ImageObject",300,407,{"name":42,"@type":43},"Muffet","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/pdf","2026-10-30","2026-09-28",true,{"@type":52,"interactionType":53,"userInteractionCount":55},"InteractionCounter",{"@type":54},"ViewAction",8,{"@type":57,"mainEntity":58},"FAQPage",[59,65,69],{"name":60,"@type":61,"acceptedAnswer":62},"What causes airway compromise in bilateral hypoglossal nerve paralysis (BHNP)?","Question",{"text":63,"@type":64},"BHNP can compromise the airway due to tongue collapse and impaired secretion management, which can lead to ineffective airway protection.","Answer",{"name":66,"@type":61,"acceptedAnswer":67},"When did respiratory arrest occur in this case and what factors were suspected?",{"text":68,"@type":64},"Respiratory arrest occurred 12 hours after extubation. It was likely secondary to a combination of supine position, prolapse of the paralyzed tongue base, and poor tolerance of secretions.",{"name":70,"@type":61,"acceptedAnswer":71},"How was the airway managed during the emergency?",{"text":72,"@type":64},"An emergent bedside cricothyroidotomy was successfully performed.","https://schema.org",{"og:url":32,"og:type":75,"og:title":10,"og:site_name":45,"og:description":12},"article",{"robots":77,"canonical":32},"index,follow",{"doc_id":79,"site_id":7},408171,1791053567,{"code":4,"msg":82,"data":83},"success",[84,88,92,96,101,106,110,114,119,122,126],{"id":22,"doc_module":4,"doc_module_name":25,"category_name":85,"show_sort_weight":86,"slug":87},"Story & Novel",90,"story-novel",{"id":26,"doc_module":4,"doc_module_name":25,"category_name":89,"show_sort_weight":90,"slug":91},"Literature",80,"literature",{"id":33,"doc_module":4,"doc_module_name":25,"category_name":93,"show_sort_weight":94,"slug":95},"Exam",70,"exam",{"id":97,"doc_module":4,"doc_module_name":25,"category_name":98,"show_sort_weight":99,"slug":100},5,"Comic",60,"comic",{"id":102,"doc_module":4,"doc_module_name":25,"category_name":103,"show_sort_weight":104,"slug":105},6,"Technology",50,"technology",{"id":107,"doc_module":4,"doc_module_name":25,"category_name":29,"show_sort_weight":108,"slug":109},7,40,"healthcare",{"id":55,"doc_module":4,"doc_module_name":25,"category_name":111,"show_sort_weight":112,"slug":113},"Research & Report",30,"research-report",{"id":115,"doc_module":4,"doc_module_name":25,"category_name":116,"show_sort_weight":117,"slug":118},9,"Religion & Spirituality",20,"religion-spirituality",{"id":117,"doc_module":4,"doc_module_name":25,"category_name":120,"show_sort_weight":117,"slug":121},"World Cup","world-cup",{"id":123,"doc_module":4,"doc_module_name":25,"category_name":124,"show_sort_weight":123,"slug":125},10,"Lifestyle","lifestyle",{"id":127,"doc_module":4,"doc_module_name":25,"category_name":128,"show_sort_weight":97,"slug":129},19,"General","general",{"code":4,"msg":82,"data":131},{"doc_id":79,"user_id":132,"nickname":42,"user_avatar":133,"doc_module":4,"category_id":107,"category_name":29,"doc_title":10,"doc_description":12,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":55,"is_deleted":4,"is_public":22,"is_downloadable":22,"audit_status":22,"page_count":107,"language":139,"language_code":8,"site_id":7,"html_lang":8,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":12,"update_tm":143,"read_time":144,"preview_page_count":4},962090768927,"https://ap-avatar.wpscdn.com/davatar_085a072bc5b1113ac321206ff7593b45","Review began 11/05/2025  \nReview ended 11/27/2025  \nPublished 12/01/2025  \n© Copyright 2025  \nGomez et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0. , which permits unrestricted use , distribution , and reproduction in any medium , provided the original author and source are credited.  \nDOI: 10.7759/cureus.98234  \nOpen Access Case Report  \nRespiratory Arrest From Bilateral Hypoglossal Nerve Paralysis  \nCharlyn N. Gomez 1, Sunny J. Haft 1  \n1. Department of Otorhinolaryngology-Head and Neck Surgery, University of Maryland School of Medicine, Baltimore, USA  \nCorresponding author: Charlyn N. Gomez, [charlyn.gomez@som.umaryland.edu](charlyn.gomez@som.umaryland.edu)  \nAbstract  \nBilateral hypoglossal nerve paralysis (BHNP) can cause airway compromise due to tongue collapse and impaired secretion management. This report underscores the importance of timely airway management. We present a case of a 52-year-old male with cervical necrotizing fasciitis of the left and right submandibular area who underwent multiple debridements, resulting in a BHNP. Sudden respiratory arrest occurred 12 hours after extubation, likely secondary to a combination of supine position, prolapse of a paralyzed tongue base, and poor secretion tolerance. An emergent bedside cricothyroidotomy was successfully performed. In this case, we emphasize the importance of early intervention for patients presenting with signs of BHNP, as well as careful airway surveillance following neck surgery.  \nCategories: Otolaryngology  \nKeywords: airway, bilateral hypoglossal nerve palsy, critical airway, emergency tracheostomy, hypoglossal nerve paralysis, necrotizing fasciitis (nf)  \nIntroduction  \nBilateral hypoglossal nerve paralysis (BHNP) is a rare event, occurring secondary to surgery, trauma, orintubation [1-13]. The hypoglossal nerves innervate nearly all intrinsic and extrinsic muscles of the tongue, making them essential for articulation, swallowing, and airway patency [14]. The sequelae of complete immobility of the tongue may include dyspnea, dysarthria, dysphagia, and the inability to tolerate oral secretions [5-8, 10]. These complications not only impact quality of life but can be fatal if decompensation occurs due to airway compromise. Although respiratory decompensation is not a universal finding in isolated bilateral hypoglossal nerve palsy, it may occur when there is concurrent involvement of other lower cranial nerves [15] or when airway protection is compromised due to severe dysphagia and secretions. Given its rarity and wide range of etiologies, no consensus has been established on airway management in bilateral hypoglossal nerve palsy [5, 16] . We present a rare case of BHNP secondary to necrotizing fasciitis to illustrate the potential for acute airway decompensation. Through a review of similar cases, we underscore the need for early recognition and proactive airway protection in this high-risk population. Accordingly, the objective of this case report is to illustrate how BHNP can precipitate abrupt airway compromise and to reinforce the importance of vigilant monitoring and early intervention.  \nCase Presentation  \nA 52-year-old male with two days of progressive submandibular swelling, pain, and dysphagia wasintubated at an outside hospital and transferred to our tertiary care institution with concern for necrotizingfasciitis. On arrival, he was tachycardic, febrile, and hypotensive. CT demonstrated a left submandibular abscess with extensive soft tissue gas in the floor of the mouth that extended to Level I of the contralateral neck, as shown in Figure 1.  \nHow to cite this article  \nGomez C N , Haft S J (December 01 , 2025) Respiratory Arrest From Bilateral Hypoglossal Nerve Paralysis. Cureus 17(12): e98234. DOI 10.7759/cureus.98234  \nFIGURE 1 : Pre-operative CT soft tissue neck  \nAn ill-defined collection of fluid and air, and associated skin thickening at the left anteromandibl","cbCaifVWRI8udKo9","https://ap.wps.com/l/cbCaifVWRI8udKo9","pdf",3038419,"English","# Abstract\n# Introduction\n# Case Presentation\n## Figure 1: Pre-operative CT soft tissue neck\n## Figure 2: Post-operative CT soft tissue neck","[{\"question\":\"What causes airway compromise in bilateral hypoglossal nerve paralysis (BHNP)?\",\"answer\":\"BHNP can compromise the airway due to tongue collapse and impaired secretion management, which can lead to ineffective airway protection.\"},{\"question\":\"When did respiratory arrest occur in this case and what factors were suspected?\",\"answer\":\"Respiratory arrest occurred 12 hours after extubation. It was likely secondary to a combination of supine position, prolapse of the paralyzed tongue base, and poor tolerance of secretions.\"},{\"question\":\"How was the airway managed during the emergency?\",\"answer\":\"An emergent bedside cricothyroidotomy was successfully performed.\"}]","Respiratory Arrest From Bilateral Hypoglossal Nerve Paralysis - Case Report | PDF",1790578441,18]