Acute Lower Extremity Weakness Following Oral Surgery Under General Anesthesia

Case at a Glance

A 33-year-old healthy female developed severe bilateral lower extremity weakness and truncal muscle rigidity 24 hours after wisdom tooth extraction under general anesthesia with succinylcholine administration.

Patient's Story

The patient presented with a one-month history of completed root canal treatment on tooth #18 with temporary crown placement. One week prior to the incident, she developed severe pain from an erupting lower left wisdom tooth with associated facial swelling. After permanent crown placement, she was referred for urgent wisdom tooth extraction due to progressive swelling described as 'two softballs' on the left side of her face. Pre-operatively, she was treated with clindamycin 300mg and ibuprofen 600mg.

Initial Assessment

A healthy 33-year-old female (5'4", 170 lbs) with no significant medical history or medications. Physical examination revealed significant left facial swelling and partially erupted lower left wisdom tooth. Patient had never undergone surgery or general anesthesia previously. Vital signs were stable, and she was deemed appropriate for outpatient oral surgery under general anesthesia.

The Diagnostic Journey

The patient underwent uncomplicated wisdom tooth extraction under general anesthesia with IV sedation including Valium and succinylcholine administration. Surgery duration was approximately one hour. Post-operatively, she was prescribed acetaminophen/hydrocodone 300-7.5mg and continued on antibiotics. Initially, recovery appeared normal with expected post-operative pain and swelling. However, 24 hours post-surgery, she developed progressive bilateral lower extremity weakness, requiring assistance for ambulation and transfers. She also experienced severe truncal muscle rigidity affecting cervical and thoracic regions, with pain exacerbated by movement or laughter.

Final Diagnosis

Post-operative bilateral lower extremity weakness of unknown etiology following general anesthesia with succinylcholine administration. Differential diagnosis includes succinylcholine-induced myalgia, positioning injury, spinal cord compression, or rare neuromuscular complications.

Treatment Plan

Patient was advised by urgent care to seek immediate emergency department evaluation due to concerning neurological symptoms. Emergency medical records and complete anesthesia records were requested for review. Conservative management with pain control and physical therapy was considered pending further neurological workup including MRI and electromyography studies.

Outcome and Follow-up

Patient required emergency department evaluation for comprehensive neurological assessment. Long-term outcome pending further diagnostic workup and specialist consultation. Case highlights the importance of thorough pre-operative assessment and post-operative monitoring for rare but serious complications following routine oral surgery procedures.