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Tonsillektomie und Nervenverletzung: Risiken, beteiligte Nerven und Erholung

Tonsillectomy carries a small but real risk of cranial nerve injury due to the dense neurovascular anatomy of the peritonsillar space. Understanding which nerves are vulnerable and how to mitigate risk is essential for surgeons and patients alike.

Nerves at Risk

Nerve	Function	Injury Consequence
Glossopharyngeal (CN IX)	Posterior 1/3 tongue taste, pharyngeal sensation, parotid secretion, carotid sinus baroreflex	Dysphagia, ageusia (posterior tongue), impaired gag, carotid sinus hypersensitivity
Vagus (CN X) – pharyngeal branch	Pharyngeal constriction, laryngeal sensation (via internal laryngeal)	Velopharyngeal insufficiency (nasal regurgitation), hoarseness, aspiration risk
Hypoglossal (CN XII)	Tongue motor control	Tongue deviation, dysarthria, dysphagia
Spinal Accessory (CN XI)	Sternocleidomastoid, trapezius	Shoulder droop, weakness turning head
Facial (CN VII) – marginal mandibular	Lower lip depressors	Asymmetric smile (rare, retractor injury)

Risk Factors

Recurrent or chronic inflammation (distorted tissue planes)
History of peritonsillar abscess
Large tonsils (kissing tonsils)
Revision surgery
Electrocautery near tonsillar fossa (thermal spread)

Incidence and Recovery

Transient neuropraxia: ~1–5% (most commonly CN IX, X); resolves over weeks to months.
Permanent deficit: <1%
Taste disturbance: Up to 10–20% temporary (CN IX); usually resolves in 3–6 months.

Surgical Mitigation Strategies

Capsular dissection (intracapsular/partial) – preserves the capsule, reduces deep dissection.
Cold steel or coblation versus monopolar cautery near the fossa.
Careful visualization, gentle retraction, and nerve monitoring (rarely used).

Postoperative Monitoring

Assess palate elevation, gag reflex, tongue movement, and taste (sweet/sour/salty/bitter on posterior tongue).
Refer to speech-language pathology if persistent dysphagia or velopharyngeal insufficiency.
Most deficits resolve spontaneously; permanent injury may require rehabilitation or surgical repair.

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