Discussion the hypoglossal nerve is a pure motor nerve innervating intrinsic as well as extrinsic tongue muscles. The hypoglossal nerve is a remarkably resilient nerve important for speech and swallowing. Hypoglossal nerve diseases is a descriptor in the national library of medicines controlled vocabulary thesaurus, mesh medical subject headings. The presentation of hypoglossal nerve palsy could be the harbinger of a more sinister underlying pathology. The nerve then crosses the lingual artery a little above the greater cornu. The reasons for its infrequency include anatomy, clinical presentation, and mechanism of injury. It is rarely injured unless intentionally sacrificed as part of a tumor resection. Pdf isolated hypoglossal nerve palsy hnp, or neurapraxia, a rare postoperative complication after airway. Damage to the hypoglossal nucleus or hypoglossal nerve can cause denervation atrophy of the tongue, as seen in this patient.
Isolated hypoglossal nerve palsy due to infected impacted tooth. The hypoglossal nerve is a motor nerve that innervates almost all the muscles of the tongue, as well as the one suprahyoid muscle, the geniohyoid muscle. Hypoglossal nerve definition of hypoglossal nerve by. Bells palsy and partial hypoglossal to facial nerve transfer. Hypoglossal definition of hypoglossal by medical dictionary. The hypoglossal nerve provides motor innervation to the extrinsic hyoglossus, styloglossus, and genioglossus and intrinsic muscles of the tongue. Case of isolated hypoglossal nerve palsy is an extremely rare condition. Hypoglossal nerve palsy due to carotid artery dissection. Idiopathic isolated unilateral hypoglossal nerve palsy is a rarely observed finding in clinical practice. Hypoglossal nerve the hypoglossal nerve is the twelfth cranial nerve xii, leading to the tongue. Isolated hypoglossal nerve palsy is uncommon and upon presentation should be treated with a high level of suspicion. Isolated hypoglossal nerve palsy hnp, or neurapraxia, a rare postoperative.
We visualized the pathology and the affected hypoglossal nerve. Hypoglossal nerve definition of hypoglossal nerve by the. The hypoglossal nerve is the twelfth and last cranial nerve and supplies the tongue with motor control. Hypoglossal nerve palsy hnp is a potential cause of dysphagia.
The median duration of facial paralysis prior to treatment was 11. For the integrity of the hypoglossal nerve to be tested, the patient is asked to protrude the tongue in the midline and to move it from side to side fig. We report a case of persistent idiopathic unilateral hypoglossal nerve palsy, with an emphasis on the investigations necessary to be undertaken on presentation of such a lesion. The nerve arises from the hypoglossal nucleus in the medulla as a number of small rootlets, passes through the. Clinicians should be suspicious in such circumstances and.
The nerve can be transected during trauma or surgery but there are also several reports in the otolaryngology, anesthesia, and neurology literature concerning. Any of these can lead to a problem with speaking, chewing. Isolated unilateral hypoglossal nerve palsy due to vertebral. Cases of persistent idiopathic isolated hypoglossal nerve palsy are extremely rare, one similar case documenting only one other documented case in the literature. At the moment after 18 months of follow up the patient is asymptomatic with totally normal systemic and neurological examination. Hypoglossal nerve palsy as a complication of an anterior. The procedure involves transferring all or part of the hypoglossal nerve to the stump of the facial nerve. It allows control of the tongue for such things as mixing food you have eaten into a ball. Persistent isolated unilateral hypoglossal nerve palsy. We report an isolated unilateral hypoglossal nerve palsy in a 59 year old gentleman.
Hypoglossal nerve injury caused by halosuspension traction. When a disorder of hypoglossal nerve exists, the corresponding half of the tongue becomes paralyzed, and the tongue muscles atrophy. Pdf hypoglossal nerve palsy after airway management for. The hypoglossal nerve is one of the least injured nerves in head injury. Despite considerable manipulation, dissection, and retraction, the hypoglossal nerve usually retains its function. Hypoglossal nerve palsy is an uncommon neurological deficit characterized by unilateral weakness andor atrophy of the tongue that may arise due to trauma, iatrogenic causes eg. Vertebrobasilar dolichoectasia with hypoglossal nerve palsy 40. Isolated hypoglossal palsy caused by synovial cyst 43. The meei facegram software detected a significant increase in. If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. Having said that though, hypoglossal nerve palsy ie paralysis of the muscles supplied by the hypoglossal nerve is well recognised complication of. A rare presentation of presumed pyogenic meningitis. Hypoglossal nerve palsy after airway management for. Introduction the hypoglossal nerve is the 12th cranial nerve which is primarily motor in nature, supplying the extrinsic and intrinsic muscles of the tongue.
The hypoglossal nerve cranial nerve xii supplies the extrinsic and intrinsic muscles of the tongue. Hypoglossal nerve disorders may be caused by tumors, strokes, infections, injuries, or amyotrophic lateral sclerosis. Hypoglossal to facial nerve transfer for treating bells palsy, a very. Hypoglossal nerve xii cranil nerve entirely motor,somatic efferent column innervates all muscles of tongue except palatoglossus represents fusion of four pre cervical nerves ventral roots i. On examination there was left hypoglossal nerve palsy tongue deviated to the left, with pronounced wasting of the left side, swelling of the left lateral pharyngeal wall, and left vocal fold palsy. Hypoglossal nerve disorders brain, spinal cord, and nerve. Damage to the hypoglossal nerve at the level of the medulla would contribute to severe obstructive sleep apnea 36, which is relevant in this discussion because hypoglossal nerve conduction has. The path of the nerve starts in the hypoglossal nucleus of the brainstem, which is located near the midline. Hypoglossal nerve disorders msd manual consumer version. Microsurgical anatomy of the hypoglossal nerve request pdf. Following thorough investigation it became apparent that this was the first presentation of widespread metastasis. The patient had a boggy tongue with a deviation to the right side but an otherwise normal neurological examination. Recognition of internal carotid artery dissection is critical for appropriate treatment and to minimise the risk of thromboembolicischaemic complications. Hypoglossal nerve transfer for facial paralysis surgery.
We report the case of a patient with unilateral tongue weakness secondary to an isolated lower motor neuron hypoglossal nerve palsy that was caused by a right vertebral artery dissection in the lower neck. A rare case of hypoglossal nerve palsy complicating a head injury. Hypoglossal nerve palsy medigoo health medical tests. The hypoglossal nerve is used for daily functions most people take for granted, like eating and speech. Hypoglossal nerve conduction findings in obstructive sleep. The clinical examination is the principal method by which hypoglossal nerve palsy can be detected, but imaging studies, either computed tomography or magnetic. Descriptors are arranged in a hierarchical structure, which enables searching at various levels of specificity. Hypoglossal nerve palsy hnp is a rare complication of airway management. Removal of the impacted tooth resulted in the improvement of function of the. In some cases of tumor or trauma, the hypoglossal nerve or the trigeminal nerve may not work normally and may not be usable for nerve transfer surgery.
Nov 17, 2015 this video is part of a playlist of short videos which are intended to combine multiple choice questions answering experience with an improved understanding of anatomy. The nerve arises from the hypoglossal nucleus and emerges from the medulla oblongata in the preolivary sulcus separating the olive and the pyramid. Hypoglossal nerve dr hytham nafady slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. The fibers of the hypoglossal nerve arise in the hypoglossal nuclei, which extend through the medulla oblongata in a paramedian location. Hypoglossal nerve an overview sciencedirect topics. Hypoglossal nerve cranial nerve xii palsy is uncommon. The hypoglossal nerve is the motor supply to the tongue muscles and may be damaged in its intracranial or extracranial course. Iatrogenic hypoglossal nerve palsy practical neurology.
Hypoglossal nerve palsy exits the medulla oblongata, extends through the skull base, and traverses the suprahyoid neck before ramifying to supply the tongue musculature. Scullys medical problems in dentistry seventh edition, 2014. Hypoglossal nerve palsy hnp is an uncommon cranial nerve palsy comparing to other commoner cranial nerves such as 3rd, 6th, and 7th cranial nerves 4. Kelli sullivan introducing students to cranial nerve xii in the human body. 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. The hypoglossal nerve cranial nerve xii supplies motor innervation to the muscles of the tongue.
Hypoglossal nerve diseases article about hypoglossal nerve. The hypoglossal nerve is intimately associated with other critical structures of the neck and skull base, making isolated injury difficult to achieve. I thought it was swollen, but turns out that the intubation for anesthesia caused damage to my hypoglossal nerve that innervates the tongue. In the setting of an ischemic stroke, lower cranial nerve palsy could also be due to. People with hypoglossal nerve disorder have difficulty speaking, chewing, and swallowing. A 53yearold woman presenting a spontaneous complete. Isolated hypoglossal nerve palsy as a result of metastatic. Hypoglossal nerve palsy hypoglossal nerve disorder. We report a rare case of hypoglossal nerve palsy after anterior cervical spine surgery. Hypoglossal nerve palsy caused by a large vagal paraganglioma.
The hypoglossal nerve may be impacted by several things, such as tumors at the base of the skull, strokes, infections, or neck injuries. Apart from a case series of 100 subjects in 1996 and several small cohorts, there have been no large retrospective series of cranial nerve xii cn xii palsy. Damage to this nerve produces characteristic clinical manifestations, of which unilateral atrophy of the tongue musculature is the most important. When it is damaged, or functions improperly, the result is loss of tongue muscle function. Also known as hypoglossal facial anastomosis, the hypoglossal nerve transfer is performed less frequently these days as more awareness now exists about other options.
We present a case where a patient presented herself with swelling on the right side of her cheek extending to the floor of the mouth, with unilateral right hypoglossal nerve palsy. Disorders of the 12th cranial nerve hypoglossal nerve cause weakness or wasting atrophy of the tongue on the affected side. After leaving the skull, the hypoglossal nerve forms an arch and, at the anterior end of the hyoglossal muscle, branches into terminal branches, which innervate the musculature of the tongue. Radiologists must be aware of the radiological appearance of hypoglossal nerve palsy and maintain a high index of suspicion for internal carotid artery dissection when this finding is present. Nerve and plexus surgery program, division of neurosurgery, university of. Cisternal hypoglossal schwannoma with tongue atrophy 42. Damage to this nerve produces characteristic clinical manifestations, of which unilateral atrophy of the tongue musculature is the most impo. There are several causes that can be attributed to it. Isolated unilateral hypoglossal nerve palsy hnp is uncommon with only a few casereports and two case series in literature. The hypoglossal nerve is the twelfth cranial nerve and controls movements of the tongue. Our study is the largest case series including12 patients. Persistent idiopathic unilateral isolated hypoglossal. Multiple factors have been postulated to contribute to its occurrence. Only four of these cases recalled history of intermittent low grade fever and dull headache 20 to 45 days prior to presentation.
Apr 15, 2015 however, a hypoglossal nerve injury is only known as a complication after soft tissue surgery in the upper anterior aspect of the neck by anterior retropharyngeal approach, but not as a complication of a cervical spine surgery. The hypoglossal nerve originates from the hypoglossal nuclei in the medulla at the inferior aspect of the fourth ventricle. Check out our website link below for additional anatomy. Jeanpierre barral, alain croibier, in manual therapy for the cranial nerves, 2009.
The most common presentation was cn deficits, with the most common hypoglossal nerve involvement in the form of tongue fasciculation and atrophy 12 patients 85. This lesson covers the function and structure of the hypoglossal nerve. If you continue browsing the site, you agree to the use of cookies on this website. I did not have full movement and it draws to the left. A 74yearold woman was referred with dysphagia, dysarthria and hoarseness. Hypoglossal nerve palsy due to internal carotid artery. Isolated hypoglossal nerve palsy after cervical manipulation. Cases of this finding in patients with epilepsy further make this. The 12th cranial nerve makes it possible to move the tongue muscles. Structures supplied by the hypoglossal nerve are indicated by solid lines, whereas those supplied by fibers of cervical origin are indicated by dashed lines. Bilateral hypoglossal nerve palsy due to brainstem infarction. Hypoglossal nerve injury an overview sciencedirect topics. Isolated and unilateral hypoglossal nerve palsy secondary to head and neck trauma is uncommon.
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