Bilateral hypoglossal nerve injury following the use of the laryngeal mask without the use of nitrous oxide.

Hypoglossal nerve injury is a rare complication of anaesthesia airway management in adults. Until now the use of nitrous oxide for anaesthesia supposedly contributed to this complication. We present a case of bilateral hypoglossal nerve injury following the use of a laryngeal mask airway without the use of nitrous oxide. At the conclusion of 3 h of surgery in extreme side rotation, a 15-year-old boy of 88 kg could not extend his tongue beyond his teeth. An MRI confirmed the absence of pharyngeal haematoma and the absence of thrombosis of the basilar artery. We conclude that even when patients have no medical history and nitrous oxide is not being used, prolongation of the operation in an extreme position might increase the risk of major complications with a laryngeal mask.