Vertebrobasilar dolichoectasia with hypoglossal nerve palsy 40. Iatrogenic hypoglossal nerve palsy practical neurology. When it is damaged, or functions improperly, the result is loss of tongue muscle function. When a disorder of hypoglossal nerve exists, the corresponding half of the tongue becomes paralyzed, and the tongue muscles atrophy. Isolated unilateral hypoglossal nerve palsy due to vertebral. I did not have full movement and it draws to the left. Following thorough investigation it became apparent that this was the first presentation of widespread metastasis. Microsurgical anatomy of the hypoglossal nerve request pdf. The hypoglossal nerve provides motor innervation to the extrinsic hyoglossus, styloglossus, and genioglossus and intrinsic muscles of the tongue.
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. Hypoglossal nerve palsy medigoo health medical tests. Isolated hypoglossal nerve palsy hnp, or neurapraxia, a rare postoperative. A rare case of hypoglossal nerve palsy complicating a head injury. It allows control of the tongue for such things as mixing food you have eaten into a ball.
The hypoglossal nerve is the motor supply to the tongue muscles and may be damaged in its intracranial or extracranial course. Hypoglossal to facial nerve transfer for treating bells palsy, a very. The patient had a boggy tongue with a deviation to the right side but an otherwise normal neurological examination. Any of these can lead to a problem with speaking, chewing. Isolated hypoglossal palsy caused by synovial cyst 43. Bilateral hypoglossal nerve palsy due to brainstem infarction. 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.
Recognition of internal carotid artery dissection is critical for appropriate treatment and to minimise the risk of thromboembolicischaemic complications. Hypoglossal nerve palsy after airway management for. Hypoglossal nerve palsy due to internal carotid artery. 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 presentation of hypoglossal nerve palsy could be the harbinger of a more sinister underlying pathology. A 74yearold woman was referred with dysphagia, dysarthria and hoarseness. Jan 17, 2011 when i had my tissue expanders implanted in november i came out of the anesthesia with a problem with my tongue. Hypoglossal nerve palsy exits the medulla oblongata, extends through the skull base, and traverses the suprahyoid neck before ramifying to supply the tongue musculature. Also known as hypoglossal facial anastomosis, the hypoglossal nerve transfer is performed less frequently these days as more awareness now exists about other options. 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 msd manual consumer version. The nerve then crosses the lingual artery a little above the greater cornu. Pdf isolated hypoglossal nerve palsy hnp, or neurapraxia, a rare postoperative complication after airway.
The hypoglossal nerve is one of the least injured nerves in head injury. The 12th cranial nerve makes it possible to move the tongue muscles. If you continue browsing the site, you agree to the use of cookies on this website. Persistent idiopathic unilateral isolated hypoglossal. The hypoglossal nerve cranial nerve xii supplies motor innervation to the muscles of the tongue. The hypoglossal nerve is used for daily functions most people take for granted, like eating and speech. Nerve and plexus surgery program, division of neurosurgery, university of. Isolated hypoglossal nerve palsy as a result of metastatic. The median duration of facial paralysis prior to treatment was 11.
Cases of persistent idiopathic isolated hypoglossal nerve palsy are extremely rare, one similar case documenting only one other documented case in the literature. Isolated hypoglossal nerve palsy after cervical manipulation. There are several causes that can be attributed to it. Our study is the largest case series including12 patients. The reasons for its infrequency include anatomy, clinical presentation, and mechanism of injury. Jeanpierre barral, alain croibier, in manual therapy for the cranial nerves, 2009.
The nerve arises from the hypoglossal nucleus in the medulla as a number of small rootlets, passes through the. The procedure involves transferring all or part of the hypoglossal nerve to the stump of the facial nerve. Damage to this nerve produces characteristic clinical manifestations, of which unilateral atrophy of the tongue musculature is the most important. Hypoglossal nerve injury an overview sciencedirect topics. Hypoglossal nerve cranial nerve xii palsy is uncommon. Damage to this nerve produces characteristic clinical manifestations, of which unilateral atrophy of the tongue musculature is the most impo. People with hypoglossal nerve disorder have difficulty speaking, chewing, and swallowing. Descriptors are arranged in a hierarchical structure, which enables searching at various levels of specificity. We visualized the pathology and the affected hypoglossal nerve. A rare presentation of presumed pyogenic meningitis. We report an isolated unilateral hypoglossal nerve palsy in a 59 year old gentleman. Hypoglossal nerve injury caused by halosuspension traction. At the moment after 18 months of follow up the patient is asymptomatic with totally normal systemic and neurological examination. We will also cover some of the effects of damage to this system, including.
Bells palsy and partial hypoglossal to facial nerve transfer. We report a rare case of hypoglossal nerve palsy after anterior cervical spine surgery. Hypoglossal nerve palsy hypoglossal nerve disorder. 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. Structures supplied by the hypoglossal nerve are indicated by solid lines, whereas those supplied by fibers of cervical origin are indicated by dashed lines. Isolated and unilateral hypoglossal nerve palsy secondary to head and neck trauma is uncommon. Hypoglossal nerve an overview sciencedirect topics. The meei facegram software detected a significant increase in. Cisternal hypoglossal schwannoma with tongue atrophy 42. Kelli sullivan introducing students to cranial nerve xii in the human body. Pdf hypoglossal nerve palsy after airway management for.
Multiple factors have been postulated to contribute to its occurrence. The hypoglossal nerve may be impacted by several things, such as tumors at the base of the skull, strokes, infections, or neck injuries. 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. In the setting of an ischemic stroke, lower cranial nerve palsy could also be due to. The hypoglossal nerve is the twelfth cranial nerve and controls movements of the tongue.
Isolated unilateral hypoglossal nerve palsy hnp is uncommon with only a few casereports and two case series in literature. 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. The path of the nerve starts in the hypoglossal nucleus of the brainstem, which is located near the midline. 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. 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. Persistent isolated unilateral hypoglossal nerve palsy. 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. Removal of the impacted tooth resulted in the improvement of function of the. Hypoglossal nerve disorders brain, spinal cord, and nerve. The fibers of the hypoglossal nerve arise in the hypoglossal nuclei, which extend through the medulla oblongata in a paramedian location.
It is rarely injured unless intentionally sacrificed as part of a tumor resection. Hypoglossal nerve diseases article about hypoglossal nerve. Hypoglossal nerve palsy due to carotid artery dissection. Having said that though, hypoglossal nerve palsy ie paralysis of the muscles supplied by the hypoglossal nerve is well recognised complication of. Hypoglossal nerve palsy hnp is a rare complication of airway management. Damage to the hypoglossal nucleus or hypoglossal nerve can cause denervation atrophy of the tongue, as seen in this patient. Despite considerable manipulation, dissection, and retraction, the hypoglossal nerve usually retains its function. Isolated hypoglossal nerve palsy due to infected impacted tooth. Cases of this finding in patients with epilepsy further make this.
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. Discussion the hypoglossal nerve is a pure motor nerve innervating intrinsic as well as extrinsic tongue muscles. 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. 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 can be transected during trauma or surgery but there are also several reports in the otolaryngology, anesthesia, and neurology literature concerning.
Idiopathic isolated unilateral hypoglossal nerve palsy is a rarely observed finding in clinical practice. 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. This lesson covers the function and structure of the hypoglossal nerve. Hypoglossal nerve conduction findings in obstructive sleep. Hypoglossal nerve diseases is a descriptor in the national library of medicines controlled vocabulary thesaurus, mesh medical subject headings. The hypoglossal nerve cranial nerve xii supplies the extrinsic and intrinsic muscles of the tongue. Clinicians should be suspicious in such circumstances and. Hypoglossal nerve palsy as a complication of an anterior.
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 clinical examination is the principal method by which hypoglossal nerve palsy can be detected, but imaging studies, either computed tomography or magnetic. Scullys medical problems in dentistry seventh edition, 2014. Isolated hypoglossal nerve palsy is uncommon and upon presentation should be treated with a high level of suspicion. Check out our website link below for additional anatomy. 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. Hypoglossal definition of hypoglossal by medical dictionary. I thought it was swollen, but turns out that the intubation for anesthesia caused damage to my hypoglossal nerve that innervates the tongue. Hypoglossal nerve definition of hypoglossal nerve by.
A 53yearold woman presenting a spontaneous complete. Hypoglossal nerve palsy caused by a large vagal paraganglioma. 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. Case of isolated hypoglossal nerve palsy is an extremely rare condition. Hypoglossal nerve definition of hypoglossal nerve by the. Hypoglossal nerve dr hytham nafady slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. Introduction the hypoglossal nerve is the 12th cranial nerve which is primarily motor in nature, supplying the extrinsic and intrinsic muscles of the tongue.
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