The hypoglossal nerve cn xii is the motor nerve of the tongue. Note the proximity of the cisternal portion of the hypoglossal nerve to the vertebral artery. The hypoglossal nerve is the twelfth and last cranial nerve and supplies the tongue with motor control. The hypoglossal nerve is used for daily functions most people take for granted, like eating and speech. The clinical examination is the principal method by which hypoglossal nerve palsy can be detected, but imaging studies, either computed tomography or magnetic. In four patients, no cause was found and the outcome was excellent. Isolated unilateral hypoglossal nerve palsy hnp is uncommon with only a few casereports and two case series in literature. Hypoglossal dural arteriovenous fistula is a rare cause of unilateral hypoglossal nerve palsy, which involves the anterior condylar confluence or venous plexus of hypoglossal canal. What type of nerve fibers are contained within the nerves to the thyrohyoid and geniohyoid. 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.
Hypoglossal nerve palsy or twelve nerve palsy, march 15, 20. Hypoglossal nerve palsy in the presence of a branchial cyst. Hypoglossal nerve cranial nerve 12 cn xii the hypoglossal nerve supplies motor fibres to all of the muscles of the tongue ie there is no sensory function except the palatoglossus muscle, which is innervated by the vagus nerve cranial nerve 10 cn x or according to some classifications, by fibres from the glossopharyngeal nerve cranial nerve 9 cn. Hypoglossal nerve definition of hypoglossal nerve by. Hypoglossal nerve disorders brain, spinal cord, and nerve.
Hypoglossal rootlets project ventrally through the medulla to emerge in the preolivary sulcus. The hypoglossal nerve is one of the least injured nerves in head injury. Apr 15, 2015 the hypoglossal nerve plays an important role in the oral phase. Case of isolated hypoglossal nerve palsy is an extremely rare condition. The trigeminal nerve is the largest of your cranial nerves and has both sensory and motor functions the trigeminal nerve has three divisions, which are.
The nerve arises from the hypoglossal nucleus in the medulla as a number of small rootlets, passes through the. The hypoglossal nerve cn xii course motor teachmeanatomy. The rootlets lie posterolateral to the vertebral arteries in the premedullary cistern, they enter the hypoglossal canal and merge to. If there is hypoglossal nerve palsy, the tongue will point toward the palsy side. The hypoglossal nerve is the motor supply to the tongue muscles and may be damaged in its intracranial or extracranial course. Scullys medical problems in dentistry seventh edition, 2014.
The hypoglossal nerve is the twelfth cranial nerve. Study of this area aids in the diagnosis of a variety of tumors found at the base of the skull, including. Hypoglossal nerve definition of hypoglossal nerve by the. There are 12 pairs of nerves cranial nerves that control most of the functions of the head and neck. Vertebrobasilar dolichoectasia with hypoglossal nerve palsy 40. 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. Cases of this finding in patients with epilepsy further make this. What is the only branch of the hypoglossal nerve that contains true hypoglossal nerve fibers. Removal of the impacted tooth resulted in the improvement of function of the.
The rootlets then merge to form the hypoglossal nerve within the hypoglossal anterior condylar canal of the cipital hone. It allows control of the tongue for such things as mixing food you have eaten into a ball. The hypoglossal nerve plays an important role in the oral phase. Description and physiology the hypoglossal nerve is chiefly a motor nerve responsible for innervating the muscles of the tongue. Disorders of the 12th cranial nerve hypoglossal nerve cause weakness or wasting atrophy of the tongue on the affected side. Having said that though, hypoglossal nerve palsy ie paralysis of the muscles supplied by the hypoglossal nerve is well recognised complication of. This cranial nerve is also responsible for the articulation of speech and the act of swallowing. The patients hypoglossal nerve palsy weakness improved with aspirin and warfarin, and there was no recurrence of her symptoms in the aftermath of the dissection. Isolated unilateral hypoglossal nerve palsy due to vertebral. 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. Hypoglossal nerve disorders may be caused by tumors, strokes, infections, injuries, or amyotrophic lateral sclerosis. Isolated unilateral hypoglossal nerve palsy request pdf. The hypoglossal nerve is found beneath the tongue as the word roots imply.
Persistent isolated unilateral hypoglossal nerve palsy. The fibers of the hypoglossal nerve arise in the hypoglossal nuclei, which extend through the medulla oblongata in a paramedian location. Toldo i, manara r, sartori s, suppiej a, drigo p 2009 unilateral hypoglossal nerve palsy due to neurovascular conflict in a child. Cases of persistent idiopathic isolated hypoglossal nerve palsy are extremely rare, one similar case documenting only one other documented case in the literature. Wolf md department of otolaryngology, thomas jefferson university hospital figure 1. Causes of hypoglossal nerve palsy may be divided according to location in relation to the course of the hypoglossal nerve. Hypoglossal nerve palsy hnp is a rare perioperative complication that has physical. This material will help you understand fourth nerve palsy and how it is treated. We present the case of a 74 year old man, without relevant medical history, who started with headache and difficulty to swallow. The rootlets lie posterolateral to thevertebralarteries inthepremedullary cistern, theyenter the hypoglossal canal and merge to form the hypoglossal nerve, which continues extracranially in the nasopharyn. Hypoglossal nerve cranial nerve xii palsy is uncommon. Is hypoglossal nerve palsy caused by craniocervical junction. The isolated unilateral palsy of the hypoglossal nerve is an unusual sign in daily medical practice. Causes of hypoglossal nerve palsy may be divided according to the location of the lesion in relation to the course of the hypoglossal nerve.
From the hypoglossal nucleus in the medulla oblongata, general somatic efferent fibres exit the cranial cavity through the hypoglossal canal and enter the neck in close proximity. Also known as hypoglossalfacial anastomosis, the hypoglossal nerve transfer is performed less frequently these days as more awareness now exists about other options. Hypoglossal nerve palsy secondarytocraniocervicaljunctionccjjuxtaarticularsynovial and ganglion cysts28 and osteophytes9,10 has been described in isolated case reports. Isolated unilateral hypoglossal nerve palsy article in the canadian journal of neurological sciences. Therefore, deficits in the oral phase may suggest damage to the hypoglossal nerve. Isolated hypoglossal nerve palsy after cervical manipulation at the dentist erin k. Damage to this nerve produces characteristic clinical manifestations, of which unilateral atrophy of the tongue musculature is the most. Hypoglossal nerve palsy exits the medulla oblongata, extends through the skull base, and traverses the suprahyoid neck before ramifying to supply the tongue musculature. The next common cause proved to be metastatic disease at the base of the skull in three patients. At the moment after 18 months of follow up the patient is asymptomatic with totally normal systemic and neurological examination.
I kind of know where the hypoglossal nerve is located when i look at the diagram, but id like to know how far is the nerve from the skin and where is the closest area to the skin before and right after its branching. These functions includeeye movements, swallowing, facial sensation, and other facial movements. Hypoglossal nerve an overview sciencedirect topics. These techniques are best suited to cases of facial paralysis less than 2 years in duration. Damage to the hypoglossal nerve is a relatively uncommon cranial nerve palsy. Hypoglossal nerve transfer for facial paralysis surgery. Le journal canadien des sciences neurologiques 385. Isolated hypoglossal nerve palsy due to infected impacted. No tongue atrophy was seen at one month figure 3a or at her three month followup appointments figure 3b. Bilateral hypoglossal nerve palsy due to brainstem infarction. 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. Mar 15, 20 hypoglossal nerve palsy or twelve nerve palsy. Hypoglossal nerve disorders msd manual consumer version. Damage to this nerve produces characteristic clinical manifestations, of which unilateral atrophy of the tongue musculature is the most important.
Isolated hypoglossal nerve palsy due to infected impacted tooth. The hypoglossal nerve is the twelfth paired cranial nerve its name is derived from ancient greek, hypo meaning under, and glossal meaning tongue. Atrophy of left hemitongue with associated deviation. A rare presentation of presumed pyogenic meningitis. The nerve emerges from the medulla laterally, between the pyramid and the olive as a number of rootlets. Hypoglossal nerve disorders brain, spinal cord, and. Our study is the largest case series including12 patients.
Hypoglossal nerve definition and meaning collins english. Is hypoglossal nerve palsy caused by craniocervical. Hypoglossal nerve palsy hypoglossal nerve disorder. These join to form two roots, and passing anteriorly. The slight bulge into the fourth ventricle is termed the hypoglossal eminence. Unilateral hypoglossal nerve palsy due to neurovascular conflict in a child. Isolated hypoglossal palsy caused by synovial cyst 43. Transient unilateral combined paresis of the hypoglossal. Pdf hypoglossal nerve palsy in the presence of a branchial cyst. On the physical examination, he had isolated hypoglossal nerve palsy. Hypoglossal nerve palsy or twelve nerve palsy, march 15.
Cisternal hypoglossal schwannoma with tongue atrophy 42. 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. Isolated hypoglossal nerve paralysis and hypoglossal. Vascular, inflammatory, traumatic, or spaceoccupying lesions can affect the cn xii anywhere in its course, from the nucleus in the caudal medulla, through the intracranial extramedullary portion of the nerve, across the hypoglossal canal, or into its extracranial termination.
This symptom is the key to the diagnosis of a hypoglossal nerve injury. Emerging from the hypoglossal canal, the hypoglossal nerve enters the nasopharyngeal carotid space. The nerve has a purely somatic motor function, innervating all the extrinsic and intrinsic muscles of the tongue except the palatoglossus, innervated by vagus nerve in this article, we shall look at the anatomy of the hypoglossal. 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. Unilateral or bilateral nerve damage occupies an important place among these complications. Nerve transfers are indicated when the main trunk of the facial nerve is damaged or unavailable but the distal nerve branches and facial muscles remain viable. We report nine patients with hypoglossal nerve palsy as the sole neurological manifestation, without simultaneous involvement of other cranial nerves or longtract signs. The hypoglossal nerve cranial nerve xii supplies motor innervation to the muscles of the tongue. There are several causes that can be attributed to it.
If the symptoms are accompanied by acute pain, a possible cause may be dissection of the internal carotid artery. Other articles where hypoglossal nerve is discussed. Jeanpierre barral, alain croibier, in manual therapy for the cranial nerves, 2009. Isolated unilateral hypoglossal nerve palsy due to. Hypoglossal nerve palsy medigoo health medical tests. The rootlets of the hypoglossal nerve lie posterolateral to the vertebral artery within the premedullary cistern. Two exceptional causes were chiari malformation in one case. For claims with a date of service on or after october 1, 2015, use an equivalent icd10cm code or codes. The hypoglossal canal is formed during the embryological stage of development in mammals, sometimes leading to the presence of more than two canals as the occipital bone is formed.
Idiopathic isolated unilateral hypoglossal nerve palsy is a rarely observed finding in clinical practice. Hypoglossal nerve palsy as a complication of an anterior. Distinguishing ccj degenerative lesions from other hypoglossal. The hypoglossal nerve innervates certain muscles that control movement of the tongue. Is there any video or schema showing the location of the hypoglossal nerve relative to skin and not the skeleton. Also known as hypoglossal facial anastomosis, the hypoglossal nerve transfer is performed less frequently these days as more awareness now exists about other options.
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