Transient Unilateral Hypoglossal Nerve Palsy Associated With Video Laryngoscopy in Shoulder Surgery

We report the case of a 51‐year‐old male who experienced transient unilateral hypoglossal nerve palsy (HNP) after undergoing elective shoulder surgery under general anesthesia. Tracheal intubation was performed using a C‐MAC D‐Blade video laryngoscope (Karl Storz). Intubation was uneventful, with clear visualization of the vocal cords corresponding to a Cormack–Lehane Grade I view, no airway trauma was visible. Shortly after extubation, the patient complained of tongue swelling, dysarthria, and dysphagia. Clinical examination confirmed an isolated ipsilateral HNP. A brain and neck MRI conducted 4 h postoperatively showed no structural abnormalities along the hypoglossal nerve pathway, and an otolaryngological assessment identified no additional lesions. The patient was managed conservatively, including supportive speech therapy, and made a complete recovery within 14 weeks. This case report highlights a rare incidence of isolated HNP, which occurred in a patient with prior cervical spine fusion and obesity during video laryngoscopy. Possible contributing factors include compression or stretching of the hypoglossal nerve due to airway manipulation, patient positioning, or instrumentation in proximity of cicatrized cervical soft tissue. It is the first case report of HNP following video laryngoscopy with complete recording of the video laryngoscopy. Although video laryngoscopy enhances visual access during intubation, clinicians should remain cautious about potential localized tissue and nerve stress, particularly when using hyperangulated blades. This case highlights that video laryngoscopy does not inherently guarantee reduced soft tissue trauma when compared with traditional direct laryngoscopy.