Oral Injuries Following Cerebellopontine Angle Surgery with or without Motor Evoked Potential Monitoring: three Case Reports and Literature Review

Background Oral injuries are occasional yet notable complications in neurosurgical procedures and are often associated with motor-evoked potential (MEP) monitoring; however, they are also influenced by factors such as prolonged neck flexion and inadequate oral protection. Case presentation This paper discusses three cases of oral injuries following pontocerebellar lesion resection surgeries, illustrating varying outcomes with different monitoring and intubation techniques. In one patient, orotracheal intubation with unilateral MEP monitoring led to fractured alveolar bones and dislodged teeth. Another patient, who was intubated nasally with bilateral MEP monitoring, experienced severe tongue biting, facial swelling, and subsequent airway obstruction requiring tracheotomy. A third patient, also nasally intubated but without MEP monitoring, developed a swollen and bleeding tongue postoperatively. Conclusion MEP monitoring is not the sole cause of oral injuries in neurosurgical procedures. Key factors contributing to these injuries, aside from the nonspecific stimulation of MEP, include prolonged surgical positioning, inappropriate anesthesia strategies, and patient-specific factors. The medical team should understand the underlying mechanisms of these complications, master systematic preventive strategies, and engage in effective collaboration to more efficiently reduce the incidence of these complications.