Introduction: Nervus hypoglossus (NH) is the 12th of the cranial nerves which is a pure motor nerve and innervates the intrinsic muscles of the tongue. It is sensitive to the pressure of airway devices’ during it’s crossing through the stylohyoid ligament and the big horn of hyoid bone on the level of the mandibular corner (1). Isolated NH paralysis is a complication that can occur after airway management, accompanied by ipsilateral deviation of tongue, dysarthria, dysphagia and even dyspnea (2). In this case report, the hypoglossal nerve palsy seen in the patient who underwent lumbar disc surgery in the prone position was discussed. 
Case Report: A 50-year-old, 90-kg male patient who was scheduled for lumbar disc herniation surgery was evaluated as ASA-I and mallampatia III. Following routine monitoring, induction with propofol, fentanyl, and rocuronium was performed. The patient intubated with 8.5-mm diameter spiral endotracheal tube in the first trial without any complications. The patient positioned to knee-elbow position for the surgery. Inhalation of sevoflurane 2% in oxygen and medical air mixture and intravenous dexmedetomidine infusion 0.2 mcg/kg/hr used for maintenance of anesthesia. Surgery lasts for 160 minutes without any complications. After 2 hours of the patient’s transference to the clinic, complaining of drowsiness, limitation of movement and speech disorder started. His tongue deviated to the right when he put his tongue out of his mouth. After physical and exhaustive neurological examination, he diagnosed as right isolated NH paralysis. It was thought that it could be attributed to airway management due to the fact that any other etiologic cause could not be detected, and the incident occurred postoperatively. The patient consulted by the department of ear, nose, throat, and methylprednisolone recommended for 1 week. The patient healed without any seckel after 1 month. 
Discussion:  Isolated NH paralysis is a rare complication related to neuropraxia following an endotracheal intubation, bronchoscopy or usage of laryngeal mask airway (LMA). Laryngoscopy, endotracheal intubation, endotracheal tube malposition, overinflation of the cuff, LMA use, and poor patient position can be in the etiology (1). In generally a short time steroid treatment is curative and it heals without any sequels in 2-4 months (2). Isolated NH palsy should be kept in mind as a complication in patients who have undergone airway manipulation in some way even if that may be uncommon.     
Learning objective: This is a rare and transient complication which can be seen after intubation. We discussed the causes and treatment options.
References: 
1.	Shah AC et al. Anesth Analg. 2015; 120(1): 105–120. 
2.	Ulusoy H et al. Braz J Anesth 2014; 64 (2): 124-7.

02 / Paralysis of Nervus Hypoglossus Following a Surgery of a Lumbal Disc Hernia