Bilateral traumatic hypoglossal nerve transection in a blast injury

Background: The hypoglossal nerve supplies motor function to the tongue. Case Description: A 21-year-old man was injured in a blast injury to his mandible, resulting in severe maxillofacial hemorrhaging. Irreversible injury was evident from lack of improvement to tongue; patient underwent transplantation by end-to-end coaptation of right injured nerve 6 months after injury, with subsequent repair to left nerve 2 months later. At 11-year follow up, there was acceptable force and normal motor activity. Only speech, mastication, and swallowing did not return to normal despite prolonged physiotherapy. Conclusion: In hypoglossal nerve injury, the proximity of the injury site to the primary muscle and, therefore, the short time required for the nerve fibers to repair toward the muscle are expected to predict an excellent outcome after transplantation. However, this is not usually the case, as in our patient. (C) 2007 Elsevier Inc. All rights reserved.