[Dysphagia] traumatic fall and tongue mobility

[naomislp at aol.com (naomislp@aol.com)]

Hello all,
Recently saw a young patient s/p 3-story fall, currently on trach collar and s/p PEG placement. There were multiple fractures but no documented head trauma or fractures around skull or face. Oral motor function is intact except for what seems to be isolated but significantly impaired lingual mobility and strength.  This has resolved slightly, with better range of motion at tongue tip and front but poorer movement mid-back and likely poorest movement at base, given poor swallow function and gross aspiration on single trial puree during bedside eval.  He was initially aphonic (despite cuff deflation, trach occlusion) but vocal function is gradually improving.
What could be causing the isolated impairment of tongue function - is this cranial nerve damage? Would that also explain initially poor laryngeal function (or is that more likely due to period of intubation prior to trach and/or presence of trach currently?)
He seems to be responding to traditional OM exs - any other suggestions?
Thanks in advance,
Naomi