Isolated hypoglossal nerve paralysis and hypoglossal. 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. Le journal canadien des sciences neurologiques 385. Note the proximity of the cisternal portion of the hypoglossal nerve to the vertebral artery. The clinical examination is the principal method by which hypoglossal nerve palsy can be detected, but imaging studies, either computed tomography or magnetic. Isolated unilateral hypoglossal nerve palsy hnp is uncommon with only a few casereports and two case series in literature. 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. These techniques are best suited to cases of facial paralysis less than 2 years in duration. 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. There are several causes that can be attributed to it. Is there any video or schema showing the location of the hypoglossal nerve relative to skin and not the skeleton. Vertebrobasilar dolichoectasia with hypoglossal nerve palsy 40.
The hypoglossal nerve is found beneath the tongue as the word roots imply. Hypoglossal nerve palsy hnp is a rare perioperative complication that has physical. Distinguishing ccj degenerative lesions from other hypoglossal. 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 is the twelfth paired cranial nerve its name is derived from ancient greek, hypo meaning under, and glossal meaning tongue. Damage to this nerve produces characteristic clinical manifestations, of which unilateral atrophy of the tongue musculature is the most. Hypoglossal nerve disorders may be caused by tumors, strokes, infections, injuries, or amyotrophic lateral sclerosis. 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. Isolated unilateral hypoglossal nerve palsy due to. Persistent isolated unilateral hypoglossal nerve palsy. Wolf md department of otolaryngology, thomas jefferson university hospital figure 1. In four patients, no cause was found and the outcome was excellent. Hypoglossal nerve definition of hypoglossal nerve by. Hypoglossal nerve palsy in the presence of a branchial cyst.
The hypoglossal nerve is used for daily functions most people take for granted, like eating and speech. Isolated unilateral hypoglossal nerve palsy request pdf. Jeanpierre barral, alain croibier, in manual therapy for the cranial nerves, 2009. Isolated hypoglossal nerve palsy after cervical manipulation at the dentist erin k.
Description and physiology the hypoglossal nerve is chiefly a motor nerve responsible for innervating the muscles of the tongue. 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. Damage to the hypoglossal nucleus or hypoglossal nerve can cause denervation atrophy of the tongue, as seen in this patient. Scullys medical problems in dentistry seventh edition, 2014.
Cases of persistent idiopathic isolated hypoglossal nerve palsy are extremely rare, one similar case documenting only one other documented case in the literature. What is the only branch of the hypoglossal nerve that contains true hypoglossal nerve fibers. Hypoglossal nerve palsy hypoglossal nerve disorder. Causes of hypoglossal nerve palsy may be divided according to location in relation to the course of the hypoglossal nerve. Is hypoglossal nerve palsy caused by craniocervical. This cranial nerve is also responsible for the articulation of speech and the act of swallowing.
The isolated unilateral palsy of the hypoglossal nerve is an unusual sign in daily medical practice. This material will help you understand fourth nerve palsy and how it is treated. Bilateral hypoglossal nerve palsy due to brainstem infarction. Hypoglossal nerve transfer for facial paralysis surgery. Unilateral or bilateral nerve damage occupies an important place among these complications. Our study is the largest case series including12 patients. Hypoglossal nerve cranial nerve xii palsy is uncommon. The hypoglossal nerve cn xii course motor teachmeanatomy.
There are 12 pairs of nerves cranial nerves that control most of the functions of the head and neck. Is hypoglossal nerve palsy caused by craniocervical junction. Causes of hypoglossal nerve palsy may be divided according to the location of the lesion in relation to the course of the hypoglossal nerve. The rootlets of the hypoglossal nerve lie posterolateral to the vertebral artery within the premedullary cistern. The hypoglossal nerve innervates certain muscles that control movement of the tongue. Cases of this finding in patients with epilepsy further make this. 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. Therefore, deficits in the oral phase may suggest damage to the hypoglossal nerve. Idiopathic isolated unilateral hypoglossal nerve palsy is a rarely observed finding in clinical practice. What type of nerve fibers are contained within the nerves to the thyrohyoid and geniohyoid. A rare presentation of presumed pyogenic meningitis.
If there is hypoglossal nerve palsy, the tongue will point toward the palsy side. Mar 15, 20 hypoglossal nerve palsy or twelve nerve palsy. 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. Also known as hypoglossal facial anastomosis, the hypoglossal nerve transfer is performed less frequently these days as more awareness now exists about other options. Emerging from the hypoglossal canal, the hypoglossal nerve enters the nasopharyngeal carotid space. 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. 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.
If the symptoms are accompanied by acute pain, a possible cause may be dissection of the internal carotid artery. Isolated hypoglossal nerve palsy due to infected impacted. Hypoglossal nerve definition of hypoglossal nerve by the. Discussion the hypoglossal nerve is a pure motor nerve innervating intrinsic as well as extrinsic tongue muscles. These functions includeeye movements, swallowing, facial sensation, and other facial movements. Hypoglossal nerve palsy exits the medulla oblongata, extends through the skull base, and traverses the suprahyoid neck before ramifying to supply the tongue musculature. Hypoglossal nerve disorders brain, spinal cord, and nerve. Study of this area aids in the diagnosis of a variety of tumors found at the base of the skull, including. Hypoglossal nerve palsy medigoo health medical tests. This symptom is the key to the diagnosis of a hypoglossal nerve injury. 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.
Cisternal hypoglossal schwannoma with tongue atrophy 42. Two exceptional causes were chiari malformation in one case. The rootlets lie posterolateral to the vertebral arteries in the premedullary cistern, they enter the hypoglossal canal and merge to. 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. The slight bulge into the fourth ventricle is termed the hypoglossal eminence. Isolated hypoglossal palsy caused by synovial cyst 43. Isolated unilateral hypoglossal nerve palsy article in the canadian journal of neurological sciences. These join to form two roots, and passing anteriorly. 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 or twelve nerve palsy, march 15, 20. 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.
Hypoglossal nerve definition and meaning collins english. Transient unilateral combined paresis of the hypoglossal. Hypoglossal nerve palsy secondarytocraniocervicaljunctionccjjuxtaarticularsynovial and ganglion cysts28 and osteophytes9,10 has been described in isolated case reports. On the physical examination, he had isolated hypoglossal nerve palsy. Other articles where hypoglossal nerve is discussed. We report nine patients with hypoglossal nerve palsy as the sole neurological manifestation, without simultaneous involvement of other cranial nerves or longtract signs.
No tongue atrophy was seen at one month figure 3a or at her three month followup appointments figure 3b. For claims with a date of service on or after october 1, 2015, use an equivalent icd10cm code or codes. Hypoglossal nerve an overview sciencedirect topics. Toldo i, manara r, sartori s, suppiej a, drigo p 2009 unilateral hypoglossal nerve palsy due to neurovascular conflict in a child. Hypoglossal nerve palsy as a complication of an anterior. The hypoglossal nerve cranial nerve xii supplies motor innervation to the muscles of the tongue. Case of isolated hypoglossal nerve palsy is an extremely rare condition. The hypoglossal nerve is one of the least injured nerves in head injury. The nerve emerges from the medulla laterally, between the pyramid and the olive as a number of rootlets.
Isolated hypoglossal nerve palsy due to infected impacted tooth. 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. 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. The hypoglossal nerve plays an important role in the oral phase. Hypoglossal nerve palsy or twelve nerve palsy, march 15. Hypoglossal nerve palsy after general anesthesia is rare but there have been several reports showing an association with oropharyngeal manipulation such as intubation, bronchoscopy, and laryngeal. Pdf hypoglossal nerve palsy in the presence of a branchial cyst. It allows control of the tongue for such things as mixing food you have eaten into a ball. The procedure involves transferring all or part of the hypoglossal nerve to the stump of the facial nerve. The hypoglossal nerve cn xii is the motor nerve of the tongue.
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. Unilateral hypoglossal nerve palsy due to neurovascular conflict in a child. The hypoglossal nerve is the twelfth and last cranial nerve and supplies the tongue with motor control. Apr 15, 2015 the hypoglossal nerve plays an important role in the oral phase. The fibers of the hypoglossal nerve arise in the hypoglossal nuclei, which extend through the medulla oblongata in a paramedian location. Having said that though, hypoglossal nerve palsy ie paralysis of the muscles supplied by the hypoglossal nerve is well recognised complication of. The next common cause proved to be metastatic disease at the base of the skull in three patients. Disorders of the 12th cranial nerve hypoglossal nerve cause weakness or wasting atrophy of the tongue on the affected side. 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. Hypoglossal rootlets project ventrally through the medulla to emerge in the preolivary sulcus. We present the case of a 74 year old man, without relevant medical history, who started with headache and difficulty to swallow.
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