Recurrent aspiration pneumonia due to bilateral associated laryngeal paralysis after tooth extraction under general anesthesia: a case report

BACKGROUND: Associated laryngeal paralysis is a clinical condition merged with other cranial nerve disorders associated with vocal cord paralysis. It is a rare complication in patients after general anesthesia. Here, we report our experience with a patient who developed associated laryngeal paralysis after oral surgery. CASE PRESENTATION: A healthy 31-year-old man underwent extraction of horizontally impacted wisdom teeth in the bilateral mandible under general anesthesia. During the surgery, no significant changes in respiratory and cardiovascular parameters or neurosurgical abnormalities occurred. After the surgery, the patient was diagnosed with aspiration pneumonia. Furthermore, the results of otorhinolaryngological and neurological examinations led to a diagnosis of a combination of bilateral glossopharyngeal and vagus nerve paralysis, right recurrent nerve paralysis, and right hypoglossal nerve paralysis. In this case, seriously associated peripheral laryngeal paralysis with repeated episodes of aspiration pneumonia improved in approximately 6 months with rehabilitation and vitamin B12 administration, and no complications remained. CONCLUSIONS: We suggest that the anesthesiologist should take care of each procedure minutely. It is important to diagnose cases of nerve palsy as soon as possible to reduce the damage. Having had experience with this case, we believe sharing our experience with anesthesiologists is important.