A 45-Year-Old Man with Extensive Maxillofacial Injuries After an Automobile

A 45-year-old man with extensive maxillofacial injuries after an automobile accident was brought to the emergency department. Evaluation of the airway revealed partial obstruction. Despite an obvious fractured mandible, an attempt was made to move the tongue forward from the posterior pharyngeal wall by pushing the angles of the mandible forward. This maneuver failed to move the tongue, and it became necessary to hold the tongue forward directly to pull it away from the posterior pharyngeal wall.
-The most likely reason the physician was unable to pull the tongue forward in this patient is which?

A) The hypoglossal nerves were damaged on both sides of the neck.
B) Spasm of the styloglossus muscles
C) The mandibular origin of the genioglossus muscles was floating because of bilateral fractures of the body of the mandible.
D) The presence of a blood clot in the mouth
E) The resistance of the patient