Ann Rehabil Med.  2014 Oct;38(5):689-693. 10.5535/arm.2014.38.5.689.

Occipital Condyle Fracture With Isolated Unilateral Hypoglossal Nerve Palsy

• Yoon JW
• Lim OK
• Park KD
• Lee JK

• KMID: 2266504
• DOI: http://doi.org/10.5535/arm.2014.38.5.689

Abstract

Occipital condyle fractures (OCFs) with selective involvement of the hypoglossal canal are rare. OCFs usually occur after major trauma and combine multiple fractures. We describe a 38-year-old man who presented with neck pain and a tongue deviation to the right side after a traffic accident. Severe limitations were detected during active and passive range of neck motion in all directions. A physical examination revealed a normal gag reflex and normal mobility of the palate, larynx, and shoulder girdle. He had normal taste and general sensation in his tongue. However, he presented with a tongue deviation to the right side on protrusion. A videofluoroscopic swallowing study revealed piecemeal deglutition due to decreased tongue mobility but no aspiration of food. Plain X-ray film findings were negative, but a computed tomography study with coronal reconstruction demonstrated a right OCF involving the hypoglossal canal. An electrodiagnostic study revealed evidence of right hypoglossal nerve palsy. We report a rare case of isolated hypoglossal nerve palsy caused by an OCF.

Keyword

Occipital condyle fracture; Hypoglossal nerve; Multidetector computed tomography; Electrodiagnosis

MeSH Terms

Accidents, Traffic
Adult
Deglutition
Electrodiagnosis
Humans
Hypoglossal Nerve
Hypoglossal Nerve Diseases*
Larynx
Multidetector Computed Tomography
Neck
Neck Pain
Palate
Physical Examination
Reflex
Sensation
Shoulder
Tongue
X-Ray Film

Figure

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  Fig. 1 Tongue deviates to the right side on protrusion, and it is atrophied on the right side.

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  Fig. 2 (A) Computed tomography scan reveals an Anderson and Montesano type III occipital condyle fracture (arrow) and no widening of the occipitoatlantal or atlantoaxial joints. (B) The occipital condyle fracture involves the right hypoglossal canal (arrow) but the left hypoglossal canal is intact (arrowhead). Structural stability of the craniocervical joints is maintained with (C) a basiondens interval of 5 mm and (D) an anterior atlanto-dens interval of 1.31 mm.

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  Fig. 3 Follow-up computed tomography (CT) scan and plain X-ray performed 16 weeks after the motor vehicle crash. (A) The CT scan reveals structural stability of craniocervical joints with no widening of the occipitoatlantal or atlantoaxial joints. (B) Basiondens interval of 4.93 mm and (C) anterior atlanto-dens interval of 1.22 mm. (D) Lateral view cervical radiograph shows structural stability of the craniocervical joints.

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