title: Bilateral glossopharyngeal nerve paralysis after tonsillectomy: case report and anatomic study.
abstract: OBJECTIVE
  To present a case report and to propose an anatomic explanation for a rare complication of tonsillectomy, severe dysphagia caused by bilateral paralysis of the glossopharyngeal nerve.
  
  
  METHODS
  Retrospective case review and prospective cadaveric dissection.
  
  
  METHODS
  The medical record and radiologic data were reviewed from a patient who had severe dysphagia after tonsillectomy. In addition, 10 formalin-preserved cadaver head and neck specimens were dissected to identify the anatomic course of 20 glossopharyngeal nerves. The distance between the nerve and tonsillar fossa was measured at two sites.
  
  
  RESULTS
  The patient was diagnosed with bilateral paralysis of the glossopharyngeal nerve and required use of gastrotomy tube for years postoperatively. The mean distance from the posterosuperior tonsillar fossa and the main trunk of the glossopharyngeal nerve was 10.7 mm, and the mean distance from the posteroinferior tonsillar fossa and the closest lingual branch of the glossopharyngeal nerve was 6.5 mm.
  
  
  CONCLUSIONS
  Direct nerve injury seems the most plausible explanation for this rare complication of tonsillectomy. The proximity of the glossopharyngeal nerve to the tonsillar fossa emphasizes the importance of maintaining the correct surgical plane during surgery.
authors.affiliation: Department of Head and Neck Surgery, Kaiser Permanente Medical Center, 280 W. MacArthur Boulevard, Oakland, CA 94611-5693, U.S.A.
authors.forename: Lloyd C
authors.initials: LC
authors.lastname: Ford
authors.forename: Raul M
authors.initials: RM
authors.lastname: Cruz
mesh_terms: D000328:Adult; D002102:Cadaver; D003680:Deglutition Disorders / Q000175:diagnosis / Q000209:etiology*; D004210:Dissection; D005260:Female; D005500:Follow-Up Studies; D005930:Glossopharyngeal Nerve; D020435:Glossopharyngeal Nerve Diseases / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D007828:Laryngoscopy; D008279:Magnetic Resonance Imaging; D010243:Paralysis / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology; D012189:Retrospective Studies; D018570:Risk Assessment; D014057:Tomography, X-Ray Computed; D014068:Tonsillectomy / Q000009:adverse effects* / Q000379:methods