title: Two-year-old with post-surgical hypoglossal nerve injury and obstructive sleep apnea.
abstract: BACKGROUND
  Airway patency in both children and adults depends on the tonic and phasic activation of muscles of the tongue and pharynx supplied by the hypoglossal nerve arising at the medullary level.
  We report a case of a 2-year-old who after resection of fourth ventricle anaplastic ependymoma developed severe sleep disordered breathing and tongue fasciculation.
  
  
  RESULTS
  Polysomnography showed severe obstructive sleep apnea with oxygen desaturation to 33%. Magnetic resonance imaging of the brain showed post-surgical effacement of the dorsal lateral medulla.
  
  
  CONCLUSIONS
  We postulate that damage to the hypoglossal nerve at the level of the medulla contributed to the patient's severe obstructive sleep apnea. Patient was treated with tracheostomy.
authors.affiliation: Division of Sleep Medicine, Department of Neurology, Louisiana State University School of Medicine, Shreveport, LA.
authors.forename: Lourdes M
authors.initials: LM
authors.lastname: Delrosso
authors.affiliation: Division of Sleep Medicine, Department of Neurology, Louisiana State University School of Medicine, Shreveport, LA.
authors.forename: Romy
authors.initials: R
authors.lastname: Hoque
authors.affiliation: Department of Radiology, Louisiana State University School of Medicine, Shreveport, LA.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Gonzalez-Toledo
mesh_terms: D001932:Brain Neoplasms / Q000601:surgery; D002675:Child, Preschool; D004806:Ependymoma / Q000601:surgery; D005260:Female; D020546:Fourth Ventricle / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D061228:Hypoglossal Nerve Injuries / Q000209:etiology* / Q000503:physiopathology* / Q000601:surgery; D008279:Magnetic Resonance Imaging / Q000379:methods; D017286:Polysomnography / Q000379:methods; D011183:Postoperative Complications / Q000503:physiopathology* / Q000601:surgery; D020181:Sleep Apnea, Obstructive / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery; D014139:Tracheostomy / Q000379:methods
keywords: Hypoglossal nerve injury; pediatric OSA; sleep disordered breathing; tracheostomy