Abstract
Introduction
Occipital condyle fractures are rare injuries resulting from high-energy blunt trauma. Due to their anatomic relationship to the hypoglossal canal, injury to the occipital condyle can result in hypoglossal nerve (CN XII) injury. This case report describes a rare case of delayed hypoglossal nerve palsy associated with an occipital condyle fracture involving the hypoglossal canal following electric bicycle trauma.
Case Info
A 38-year-old man presented following an electric bicycle accident with multiple facial and skull base fractures, including a nondisplaced left occipital condyle fracture extending into the hypoglossal canal. Initial examination by the otolaryngology service demonstrated midline tongue positioning with intact mobility. The occipital condyle fracture was managed nonoperatively with rigid cervical immobilization.
Discussion/Clinical findings: Twelve days after the injury, the patient returned for otolaryngology follow-up and reported new-onset dysarthria characterized by a lisp that had begun to improve. Examination demonstrated leftward deviation of the tongue on protrusion, decreased leftward tongue mobility, preserved rightward mobility, and mild left tongue fasciculations, consistent with a partial left hypoglossal nerve palsy. The delayed development of ipsilateral tongue weakness in the setting of fracture extension into the hypoglossal canal was consistent with delayed traumatic hypoglossal neuropathy. The patient reported poor compliance with cervical immobilization.
Conclusion
Hypoglossal nerve injury is a rare complication of occipital condyle fractures involving the hypoglossal canal and may present in a delayed fashion despite an initially normal cranial nerve examination. Serial cranial nerve examinations and careful evaluation of the hypoglossal canal on imaging are important following skull base trauma. Otolaryngology follow-up may facilitate recognition of subtle delayed neurologic deficits and allow for appropriate counseling and rehabilitation.