{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T11:17:57Z","timestamp":1781522277198,"version":"3.54.1"},"reference-count":11,"publisher":"BMJ","issue":"1","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2020,1,17]]},"published-print":{"date-parts":[[2020,1]]},"abstract":"<jats:p>We describe the case of a 68-year-old man who presented with an anterior floor of mouth squamous cell carcinoma and underwent bilateral neck dissection. Subsequently, the patient developed permanent bilateral hypoglossal palsies, causing significant dysphagia, dysarthria and breathing difficulties. Hypoglossal nerve damage from surgical causes is uncommon, occurring in only 0.42% of functional neck dissections. However, it is the bilateral and permanent features of this case which make it unique. This injury may have been caused by incorrect use of the Harmonic Focus scalpel. Therefore, we discuss the literature demonstrating that the Harmonic Focus scalpel causes more lateral thermal damage than alternative tools, and the widely accepted 3\u2009mm safety limit is not enough to protect important surrounding structures. This case report aims to highlight the need for proper training and specific identification of the hypoglossal nerve to prevent this rare and debilitating complication occurring in future patients.<\/jats:p>","DOI":"10.1136\/bcr-2019-231573","type":"journal-article","created":{"date-parts":[[2020,1,27]],"date-time":"2020-01-27T04:55:14Z","timestamp":1580100914000},"page":"e231573","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Bilateral hypoglossal nerve damage due to the use of the harmonic focus scalpel"],"prefix":"10.1136","volume":"13","author":[{"given":"Katherine","family":"Radcliffe","sequence":"first","affiliation":[{"name":"Maxillofacial Surgery, Royal Preston Hospital, Preston, UK"},{"name":"Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shakeel","family":"Akhtar","sequence":"additional","affiliation":[{"name":"Maxillofacial Surgery, Royal Preston Hospital, Preston, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ajay","family":"Wilson","sequence":"additional","affiliation":[{"name":"Maxillofacial Surgery, City Hospitals Sunderland NHS Foundation Trust, Sunderland, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2020,1,26]]},"reference":[{"key":"2025082703483370000_13.1.e231573.1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1445-2197.2010.05436.x"},{"key":"2025082703483370000_13.1.e231573.2","unstructured":"Hui A , Tsui I , Chan D . Hypoglossal nerve palsy. Hong Kong Medical Journal 2009;15."},{"key":"2025082703483370000_13.1.e231573.3","unstructured":"Fritz M , Kang B , Fox T , et al . Iatrogenic hypoglossal nerve palsy. Pract Neurol 2014."},{"key":"2025082703483370000_13.1.e231573.4","doi-asserted-by":"publisher","DOI":"10.1007\/s00405-005-1028-9"},{"key":"2025082703483370000_13.1.e231573.5","doi-asserted-by":"crossref","unstructured":"Gorelick PB , Testai FD , Hankey GJ , et al . Hankey\u2019s clinical neurology. 975. Second edition. Boca Raton: CRC Press, 2014.","DOI":"10.1201\/b16337"},{"key":"2025082703483370000_13.1.e231573.6","doi-asserted-by":"publisher","DOI":"10.1016\/B978-0-12-420045-6.00007-9"},{"key":"2025082703483370000_13.1.e231573.7","doi-asserted-by":"crossref","unstructured":"Thiel DD , Winfield HN . Harmonic scalpel. In: Contemporary interventional ultrasonography in urology. Springer, 2009: 75\u201381.","DOI":"10.1007\/978-1-84800-217-3_8"},{"key":"2025082703483370000_13.1.e231573.8","doi-asserted-by":"crossref","DOI":"10.1186\/1916-0216-42-62","article-title":"Focus harmonic scalpel compared to conventional hemostasis in open total thyroidectomy - a prospective randomized study","volume":"42","author":"Duan","year":"2013","journal-title":"J Otolaryngol Head Neck Surg"},{"key":"2025082703483370000_13.1.e231573.9","doi-asserted-by":"publisher","DOI":"10.5625\/lar.2012.28.4.223"},{"key":"2025082703483370000_13.1.e231573.10","doi-asserted-by":"publisher","DOI":"10.1177\/0003489415588556"},{"key":"2025082703483370000_13.1.e231573.11","doi-asserted-by":"crossref","first-page":"E283","DOI":"10.1002\/lary.25362","article-title":"Electrophysiologic monitoring correlates of recurrent laryngeal nerve heat thermal injury in a porcine model","volume":"125","author":"Lin","year":"2015","journal-title":"Laryngoscope"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2019-231573","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T10:48:43Z","timestamp":1756291723000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2019-231573"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,1]]},"references-count":11,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2020,1,26]]},"published-print":{"date-parts":[[2020,1]]}},"alternative-id":["10.1136\/bcr-2019-231573"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2019-231573","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,1]]}}}