We report an unusual intraoperative finding of an aberrant branch of the hypoglossal nerve, encountered during a facial reanimation procedure. Cadaveric dissections of the high anterior cervical spine were performed, demonstrating the anatomy and vulnerability of the hypoglossal nerve, internal and external superior laryngeal nerves, superior thyroid artery, and superior laryngeal artery. It then descends vertically between the vessels and anterior to the vagus to a point level with the angle of the mandible. The dissection proceeded posteriorly to reveal the retroclival, intradural anatomy of the vertebrobasilar system, and the lower cranial nerves. Ultimately, the terminal branches ramus hypoglossus innervate the hypobranchial. Cranial nerves neuropraxia after shoulder arthroscopy in beach. Highly specialized structures, microanatomy of individual components, and overall structural density make the head and neck one of the most challenging areas in radiology. If it no longer meets these criteria, you can reassess it. The hypoglossal nerve in carotid arterial reconstructions. Imaging anatomy head and neck 1st edition pdf free books. The nerve exits the skull through the hypoglossal canal and goes ventrorostrally to run parallel to the lingual artery. The hypoglossal nerve hn is motor to all the muscles of the tongue, except palatoglossus.
The hypoglossal nerve is the twelfth cranial nerve, and innervates all the extrinsic and intrinsic muscles of the tongue, except for the palatoglossus. Netters atlas of human anatomy 7th edition pdf free books. These fibers originate from the hypoglossal nucleus, which consists of a longitudinal arrangement of neurons lying beneath the floor of the fourth ventricle and extending caudally to the lower limit of the medulla. Imaging anatomy brain and spine 1st edition pdf free download. Clinical examination a comprehensive collection of clinical examination osce guides that include stepbystep images of key steps, video demonstrations and pdf mark schemes. High this article has been rated as highimportance on the. Case reports that describe hypoglossal neurapraxia after endotracheal intubation are summarized in the table. Functional anatomy of the hypoglossal innervated muscles. The hypoglossal nerve, providing motor innervation for the tongue, can be affected in many diseases of the neck and skull base, leading to dysarthria, dysphagia, and ultimately atrophy of the tongue.
Regarding hypoglossal nerve injury at one side, the deviation of the tongue is produced mainly due to the. Hypoglossal nerve roots emerge at about 28 days pc and form into a hypoglossal nerve at about 32 days pc. The goal is to include branches of the hypoglossal nerve that innervate muscles that protrude the tongue while excluding branches that retract the tongue 4. The hypoglossal nerve stimulator inspire medical systems, maple grove, mn is an implantable device that senses respiratory patterns and delivers electrical impulses to the anterior branches of the hypoglossal nerve during inspiration, resulting in stimulation of the genioglossus, which protrudes the tongue and can.
It leaves the medulla oblongata laterally to the pyramids by means of several rootlets. Five adult cadaver heads providing 10 facial nerves cranial nerve. This richly illustrated and superbly organized textatlas is an excellent pointofcare resource for practitioners at. We determined the feasibility of direct visualization of the hypoglossal nerve in the neck with ultrasound, testing this technique on healthy volunteers and evaluating it. The hypoglossal nerve twelfth cranial nerve, cn xii, latin. Detailed anatomy of the intracranial segment of the. Jun 01, 2017 the hypoglossal nerve hn is motor to all the muscles of the tongue, except palatoglossus. A study carried out with the genioglossus muscle of rats demonstrated that there is reduction in number of neuromuscle. The hypoglossal nerve was correctly identified bilaterally in all cadaveric specimens 2424 and all volunteers 3333. The rootlets from this nucleus then gather and exit between the olive and pyramid. Hypoglossal nerve has been listed as one of the natural sciences good articles under the good article criteria. Rami of thewx hypoglossal nerve innervate the neck musculature and the lateral muscles of the otic capsule. Each cranial nerve is composed of nerve fibers of variable functional modalities.
Pdf physiotherapy management of peripheral unilateral isolated. To determine the anatomic relationship of the hypoglossal nerve hn, internal and external superior laryngeal nerves eslns, superior thyroid artery sta, and superior laryngeal artery sla to cervical spine and demonstrate any vulnerability. Hypoglossal nerve 12th cranial nerve originconnection. Hypoglossal canalanterolateral and superior to foramen magnum, transmits hypoglossal nerve cn xii foramina of skull anatomy of the skull numerous holes appear in. An overview of the hypoglossal nerve cn xii, including its course, branches. Surgical anatomy and procedures used to accomplish the nerve connection are described. The proximal end of the hypoglossal nerve was directly apposed i. This page intentionally left blank elearning medistra. Netters concise atlas of orthopaedic anatomy uotbih. Surgical anatomy of hypoglossal nerve as a guide for. The nerve emerges from the preolivary sulcus, runs through the hypoglossal canal, passes behind the inferior ganglion of the vagus nerve, and between the in. Damage to this nerve can affect speech, chewing, and swallowing.
Isolated hypoglossal nerve paralysis is an uncommon cranial nerve palsy. One week later the left carotid was similarly explored under general anesthesia, with identical findings. This video is part of a playlist of short videos which are intended to combine multiple choice questions answering experience with an improved understanding. Delayed hypoglossal nerve palsy following occipital condyle fracture. Renowned for comprehensive coverage, the bestselling clinically oriented anatomy guides students from initial anatomy and foundational science courses through clinical training and practice. Paul rea, in clinical anatomy of the cranial nerves, 2014. See letter hypoglossal nerve injury after cervical spine surgery in volume 9.
Pdf anatomy q bank head and neck hosam eldeen elsadig. Physical examinationreveals deviation ofthetongueandglossal paralysis and atrophy. Hypoglossal nerve the nucleus of the hypoglossal nerve is situated along the paramedian area of the anterior wall of the fourth ventricle in the medulla. A detailed understanding of the anatomy of the hypoglossal nerve in relation to various anatomical landmarks and surrounding structures is important to reduce procedural complications and the risk of nerve damage. The cell bodies of the nerve are located in the hypoglossal nucleus which lies in the medulla along the floor of the fourth ventricle. Doppler excluded the possibility of dissection of the. The endotracheal tube was removed before the patient was fully awake while in the supine position. Abstract background selective upper airway stimulation uas has shown effectiveness in treating patients with obstructive sleep apnea osa. Glossopharyngeal and hypoglossal nerve paralysis secondary to. The hypoglossal nucleus appears at approximately 26 days pc orahilly and muller, 1984. Ventrolateral view of the base of the tongue demonstrating the course and attachments of the styloglossus sg, hyoglossus hg, and genioglossus gg muscles.
The hypoglossal nerve cranial nerve xii is the motor nerve of the tongue. Cheong jh, kim jm, yang ms and kim ch 2011 resolution of. The study was carried out using 21 sagittal sections of head and neck of male cadavers 16. Hypoglossalvertebral entrapment syndrome neurology. Occipital release technique for newborns and infants support the patients body by cradling it with your forearm support the head and palpate for motion with the ipsilateral hand support the sacrum and palpate for motion with 2 or 3 fingers of the contralateral hand grasp the cranium with fingers evenly splayed as firmly as you would a ripe tomato so as not to leave. The glossopharyngeal nerve is both a sensitive and motor entity that emerges.
This ninth cranial nerve has a close relation to the vagus nerve both structurally and functionally. An intimate understanding of neck anatomy is required along with knowledge of branching patterns of the hypoglossal nerve and innervation of tongue musculature. Jugular foramen syndrome does not generally involve damage to the hypoglossal nerve 711. Hypoglossal nerve stimulator implantation selective upper. The hypoglossal nerve xii can be seen bifurcating into its lateral and medial divisions note the origin of the sg above and the hg below the base of the tongue.
Hypoglossal nerve palsy as a complication of an anterior approach. Surgical management of iatrogenic hypoglossal nerve injury. Unilateral hypoglossal neurapraxia following endotracheal. It passes anterior to the inferior aspect of the hyoglossus muscle and then to the lateral aspect of the genioglossus muscle.
The nerve arises from the hypoglossal nucleus in the medulla as a number of small rootlets, passes through the hypoglossal canal and down through the neck, and. Surgical anatomy for direct hypoglossalfacial nerve side. I had visited the orthopaedic surgeon who diagnosed me to have occipital. Hfa using a ytube has also been described previously 10, 25.
While some cranial nerves are purely sensory in their functions e. She had been seen by an orthopedist to manage pain and reduced strength on. The hypoglossal nucleus is found closely related to the fourth ventricle and extending down to the closed part of the medulla oblongata. Cn vii and 10 hypoglossal nerves cn xii were fixed in formalin. Gain a solid understanding of the human head and neck anatomy, including the osteology, muscles, neurovasculature and other anatomical structures. Clinically relevant anatomy of high anterior cervical approach.
Hypoglossal nucleus an overview sciencedirect topics. The lingual vein passes medial to the hyoglossus, and the lingual artery passes deep to the hyoglossus. The submandibular gland can be resected to facilitate superior. The hypoglossal nerve reaches the tongue muscles by 37 days and the ansa cervicalis becomes apparent at 41 days. Thus, the hypoglossal nerve should cover approximately 60% of this distance at least, so the stump of cn xii can reach cn vii without tension. The hypoglossal nerve hn may be damaged during neck surgeries. Arising from the brainstem at the level of the medulla, it passes through its own canalthe hypoglossal canal. The authors used a combination of sequences to increase the reliability of mr imaging in its demonstration of the 12th cranial nerve as well as to assess the course of the nerve, display its relationships to adjacent vessels, and provide landmarks for evaluating the nerve in daily practice. Isolated unilateral hypoglossal neuropathy caused by dural.
The hypoglossal canal, condylar canal, mastoid foramen and foramen magnum are all located in the posterior cranial fossa as part of occipital bone, the only exception is the jugular foramen which is located inbetween. The hypoglossal nerve passes through the hypoglossal canal and exits the canal through the hypoglossal foramen, and descends medially to the internal jugular vein and internal carotid artery. Based on these findings, a diagnosis of delayed hypoglossal nerve palsy. This video is about the hypoglossal nerve 12th cranial nerve, its nucleus, connections, course, relations, branches communicating and distributing branch. The anterior approach is a common approach to the cervical spine. Hypoglossal canalanterolateral and superior to foramen magnum, transmits hypoglossal nerve cn xii foramina of skull anatomy of the skull numerous holes appear in the cranial floor and they are called foramina. This richly illustrated and superbly organized textatlas is an excellent pointofcare resource for practitioners at all levels of experience and training. Morphological features of the branching pattern of the. The endoscopic endonasal approach to the hypoglossal canal. More commonly, the hypoglossal nerve is involved along with the glossopharyngeal, vagus, and spinal accessory nerves within the nearby jugular foramen.
Glossopharyngeal and hypoglossal nerve paralysis secondary. By using the technique described, a length of facial nerve sufficient to achieve a tensionless communication can consistently be obtained. If you would like to participate, please visit the project page, where you can join the discussion and see a list of open tasks. Imaging anatomy head and neck 1st edition pdf free download. Clinically oriented anatomy 8th edition pdf free books pdf epub. Osce checklist booklet containing over 100 osce checklists in pdf format. The size of a halfcut end of the hypoglossal nerve matches a cut end of the injured facial nerve very well. The hypoglossal nerve is the final of the cranial nerves. We experienced a case of glossopharyngeal and hypoglossal nerve paralysis. These neurovascular structures did not demonstrate sidetoside anatomic variation, allowing patient pathology to dictate the operative side. Clinically relevant anatomy of high anterior cervical approa.
Indeed, hn partly derives its blood supply from vertebral branches. Hypoglossal nerve stimulator implantation in an adolescent. The resident physicians were able to locate the nerve in 19 of 22 cases, demonstrating that locating the nerve is reproducible and feasible even with intermediate experience in ultrasound. Olfactory nerves, optic nerves, and vestibulocochlear nerves.
The hypoglossal nerve is the twelfth cranial nerve, and innervates all the extrinsic and intrinsic muscles of the tongue, except for the palatoglossus which is innervated by the vagus nerve. Glossopharyngeal schwannoma causing vocal fold paralysis scielo. Perioperative hypoglossal nerve palsy is a rare postoperative complication. A 57yearold man presented with right hypoglossal nerve paralysis and symptoms ofdysarthria and oral incompetence. The hypoglossal nerve supplies all of the motor function to your tongue. The hypoglossal nerve was cut just before its division into medial and lateral branches. A variation in the course of the hypoglossal nerve.
The hypoglossal nerve is motor to muscles of the tongue intrinsic and extrinsic and to the genihyoideus and thyrohyoideus muscles. Clinical anatomy of the cranial nerves 1st edition pdf. The hypoglossal nerve required retraction during the procedure. The hypoglossal nerve which supplies the tongue emerges from the skull through the hypoglossal canal. Oculomotor, trochlear, abducent, hypoglossal, and accessory nerves accessory nerve has a cranial root and a spinal root. We report a case of neuropraxia of the 9th, 10th and 12th cranial nerve pairs after arthroscopic rotator. Suspected mechanisms of unilateral hypoglossal nerve injury related to intubation include compression of the hypoglossal nerve against the hyoid bone,5 compres. The hypoglossal vertebral entrapment syndrome 1 occurs as the hypoglossal rootlets converge directly over the distorted vessel with resultant mechanical compression and direct nerve ischemia.
Cranial nerve hypoglossal nervehypoglossal nerve, cervical plexus, and their branches. Research report the functional anatomy and evolution of. The hypoglossal nucleus is located internal to the hypoglossal trigone. The lingual branches are the branches of the hypoglossal nerve proper to supply the muscles of the tongue. Morphometric aspects of the human hypoglossal nerve in. Onwards, it passes to supply the muscles of the tongue.
Surgical anatomy for direct hypoglossalfacial nerve sideto. Mr neurographic evaluation of facial and neck pain. Imaging anatomy brain and spine 1st edition pdf free books. The hypoglossal nerve is the 12th cranial nerve, and knowledge of the detailed anatomy and relationship with critical structures is of paramount importance in neurosurgery, head and neck surgery, and vascular surgery.
Hypoglossal nerve palsy caused by carotid dissection. After exiting the hypoglossal canal, the hypoglossal nerve is joined by the superior root of the cervical plexus, which is formed by the anterior root of. Clinically relevant anatomy of high anterior cervical. Variant anatomy of the hypoglossal nerve is very rare. Chapter 5 retropharyngeal approaches to the upper cervical spine.
Jul 31, 2020 the hypoglossal nerve is the twelfth cranial nerve, and innervates all the extrinsic and intrinsic muscles of the tongue, except for the palatoglossus which is innervated by the vagus nerve. Axons of hypoglossal motor neurons pass anteriorly in the medulla along the lateral aspect of the medial lemniscus and the pyramid see fig. Oct 28, 2020 an overview of the hypoglossal nerve cn xii, including its course, branches, function, clinical assessment and clinical relevance. Netters concise atlas of orthopedic anatomy is an easytouse reference and compact atlas of. The prefix hypo is of greek origin and means under. It is essential for supplying the muscles of the tongue being a somatic motor nerve. Clinically oriented anatomy 8th edition pdf free download.
The worlds most trusted clinically focused anatomy text. Facial reanimation by means of the hypoglossal nerve. Dentistry operating theatre suturing general surgery orthopaedic surgery plastic. Isolated peripheral hypoglossal palsy caused by a kinking of the left vertebral artery hypoglossal vertebral entrapment syndrome. Functional anatomy of the hypoglossal innervated muscles of. Images in delayed hypoglossal nerve palsy following occipital. This article is within the scope of wikiproject anatomy, a collaborative effort to improve the coverage of anatomy on wikipedia. The only anatomy atlas illustrated by physicians, atlas of human anatomy, 7th edition, brings you worldrenowned, exquisitely clear views of the human body with a clinical perspective. The hypoglossal nerve is the twelfth and last cranial nerve and supplies the tongue with motor control. You can also check out our cranial nerve anatomy quiz. Ga this article has been rated as gaclass on the projects quality scale. Which one of the following structures is located inferior to mylohyoid muscle. The hypoglossal nerve carries motor fibers to the intrinsic tongue muscles and to the thyrohyoid, hyoglossus, styloglossus, genioglossus, and geniohyoid muscles.
A 50yearold man was referred to the head and neck surgery department by the neurosurgeons for hypoglossal facial nerve. The thin hypoglossal nerve can be very difficult to distinguish on magnetic resonance mr images. The nerve arises from the hypoglossal nucleus in the medulla as a number of small rootlets, passes through the hypoglossal canal and down through the neck, and eventually passes up again over the tongue muscles it supplies into the tongue. Anatomy of nerve archives mobile physiotherapy clinic. In the present case, the patient had hypoglossal nerve paralysis, which made us believe that the pathogenesis was due to pressure on the carotid space. Resuehr using complete anatomy to explain anatomical concepts. The department of otolaryngology and the university of iowa wish to acknowledge the support of those who share our goal in improving the care of patients we serve. Describe the anatomy of cranial nerves in the neck. Gibo h, marinkovic s, nikodijevic i, stimec b, erden a. In addition to covering the anatomy, the course presents a range of clinical correlates.
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