Respiratory Arrest From Bilateral Hypoglossal Nerve Paralysis

Bilateral hypoglossal nerve paralysis (BHNP) can cause airway compromise due to tongue collapse and impaired secretion management. This report underscores the importance of timely airway management. We present a case of a 52-year-old male with cervical necrotizing fasciitis of the left and right submandibular area who underwent multiple debridements, resulting in a BHNP. Sudden respiratory arrest occurred 12 hours after extubation, likely secondary to a combination of supine position, prolapse of a paralyzed tongue base, and poor secretion tolerance. An emergent bedside cricothyroidotomy was successfully performed. In this case, we emphasize the importance of early intervention for patients presenting with signs of BHNP, as well as careful airway surveillance following neck surgery.