These techniques are best suited to cases of facial paralysis less than 2 years in duration. I thought it was swollen, but turns out that the intubation for anesthesia caused damage to my hypoglossal nerve that innervates the tongue. Isolated unilateral hypoglossal nerve palsy due to. Isolated hypoglossal palsy caused by synovial cyst 43. Pdf the hypoglossal nerve receives only brief mention in most textbooks and compared with other cranial nerve palsies, 12th nerve palsy is. Discussion the hypoglossal nerve is a pure motor nerve innervating intrinsic as well as extrinsic tongue muscles. One of the most common procedures for diminishing the consequences of facial palsy is hypoglossalfacial anastomosis. We report nine patients with hypoglossal nerve palsy as the sole neurological manifestation, without simultaneous involvement of other cranial nerves or longtract signs. Damage to this nerve produces characteristic clinical manifestations, of which unilateral atrophy of the tongue musculature is the most important.
This material will help you understand fourth nerve palsy and how it is treated. The nerve emerges from the medulla laterally, between the pyramid and the olive as a number of rootlets. A 63yearold man had a 5week history of a constant rightsided pulsating headache that was initially temporoparietal but migrated to the suboccipital area. Hypoglossal nerve transfer treatment facial paralysis. Isolated unilateral hypoglossal nerve palsy request pdf. Thepathologicalexplanation forthis neurological complication is presumably a local virus infection around the hypoglossal nerve nucleus.
Is hypoglossal nerve palsy caused by craniocervical junction. I had a hip surgery and woke up with this hypoglossal nerve injury. 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. 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. Unilateral hypoglossal nerve palsy after use of the. Hypoglossal definition and meaning collins english dictionary.
Hypoglossal nerve paresis secondary to anterior approach of upper cervical spine followed by spontaneous recovery. Isolated hypoglossal nerve palsy is uncommon, and underlying craniocervical junction degenerative disease has rarely been reported as an underlying cause. Descriptors are arranged in a hierarchical structure, which enables searching at various levels of specificity. Isolated unilateral hypoglossal nerve palsy hnp is uncommon with only a few casereports and two case series in literature.
The hypoglossal nerve cranial nerve xii supplies motor innervation to the muscles of the tongue. Hypoglossal nerve palsy hypoglossal nerve disorder. Tongue paralysis due to isolated palsy of xii cranial nerve is uncommon neurological finding. Original article sidetoend hypoglossalfacial nerve. 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 hypoglossal canal and down through the. Cases of persistent idiopathic isolated hypoglossal nerve palsy are extremely rare, one similar case documenting only one other documented case in the literature. Idiopathic isolated unilateral hypoglossal nerve palsy is a rarely observed finding in clinical practice. Media in category hypoglossal nerve palsy the following 3 files are in this category, out of 3 total. Neither the severity of the lesion nor duration of facial palsy has an adverse effect on. The semeiological observation of a sectorial and not uniform distribution. Hypoglossal schwannoma presenting as hemiatrophy of the tongue. The most commonly reported causes include an intracranial or extracranial space. It was only on examination that we discovered she had an abnormal tongue.
Cisternal hypoglossal schwannoma with tongue atrophy 42. Isolated unilateral hypoglossal nerve palsy article in the canadian journal of neurological sciences. A rare combination of facial and hypoglossal nerve palsies following post traumatic internal carotid artery dissection. 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 disorders brain, spinal cord, and nerve. A rare combination of facial and hypoglossal nerve palsies following. Hypoglossal nerve disorders merck manuals consumer version. An unusual case of peripheral hypoglossal nerve palsy, caused by lateral position of the. The hypoglossal nerve is used for daily functions most people take for granted, like eating and speech. Removal of the impacted tooth resulted in the improvement of function of the. Hypoglossal nerve transfer for facial paralysis surgery. The hypoglossal nerve receives only brief mention in most textbooks and compared with other cranial nerve palsies, 12th nerve palsy is much less common.
Isolated hypoglossal nerve palsy is quite rare and very few cases have been reported in. On examination, there was deviation of the tongue to the right, and the rightside had a wasted surface appearance, despite what he described as wavelike prominence when looking at. Files are available under licenses specified on their description page. The hypoglossal canal contains the canalicular segment of the 12th cranial nerve, a branch of the ascending pharyngeal artery, and the anterior condylar venous plexus. An unusual case of peripheral hypoglossal nerve palsy. However, bergin 1960, suggested that an allergic neurotaxitis similar to that found in the encephalitis of. Intraneural ganglion cyst of the hypoglossal nerve jeremie oliver, bs ba 1, vijay agarwal, md 2, jeffrey janus, md 3, jamie van gompel, md 2,3 1 mayo clinic school of medicine. Disorders of the 12th cranial nerve hypoglossal nerve cause weakness or wasting atrophy of the tongue on the affected side. 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 paralysis revealing type 2 diabetes mellitus. They account for 1015% of intracranial arteriovenous malformations. The nerve arises from the hypoglossal nucleus in the medulla as a number of small rootlets, passes through the.
Isolated unilateral hypoglossal nerve palsy due to vertebral. 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. It allows control of the tongue for such things as mixing food you have eaten into a ball. Early diagnosis can be achieved after a detailed neurological examination. Hypoglossal nerve palsy secondarytocraniocervicaljunctionccjjuxtaarticularsynovial and ganglion cysts28 and osteophytes9,10 has been described in isolated case reports. I have a lisp, eating is difficult, speech is difficult, saliva. The procedure involves transferring all or part of the hypoglossal nerve to the stump of the facial nerve. Mri appearance of the normal and diseased hypoglossal nerve. In four patients, no cause was found and the outcome was excellent. To improve understanding of this entity, we present a retrospective series of 18 patients with hypoglossal palsy in whom twelfth cranial nerve compression within the premedullary cistern or hypoglossal canal, or both, was found. Damage to the hypoglossal nucleus or hypoglossal nerve can cause denervation atrophy of the tongue, as seen in this patient. Persistent isolated unilateral hypoglossal nerve palsy. It is a multietiological condition, and may occur secondary to infectious mononucleosis.
Transient unilateral combined paresis of the hypoglossal nerve and. Cases of this finding in patients with epilepsy further make this. The slight bulge into the fourth ventricle is termed the hypoglossal eminence. Hypoglossal palsy from an atlantoaxial synovial cyst.
Hypoglossal facial nerve transfer in patients with longterm facial paralysis who are older than 55, crossfacial nerve grafts have not produced great results. 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. Scullys medical problems in dentistry seventh edition, 2014. Pdf hypoglossal nerve paralysis revealing type 2 diabetes. The clinical examination is the principal method by which hypoglossal nerve palsy can be detected, but imaging studies, either. Isolated hypoglossal nerve paralysis the american journal of. Hypoglossal nerve palsy medigoo health medical tests. The clinical examination is the principal method by which hypoglossal nerve palsy can be detected, but imaging studies, either computed tomography or magnetic. Previous studies suggested that an enlarged canalicular venous plexus may be responsible for the hypoglossal nerve palsy 5, 6. Robaina bordon and others published isolated hypoglossal nerve palsy find, read and cite all the research you need on researchgate. Hypoglossal nerve injury associated with laryngeal mask airway lma is a rare complication but can cause severe symptoms such as dysarthria and dysphasia. Hypoglossal facial nerve sidetoend anastomosis is an effective and reliable technique with consis tent and satisfying results. In conclusion, patients with hypoglossal schwannomas can present with muscle atrophy of the tongue, but they can also be asymptomatic initially11.
A rare cause of unilateral hypoglossal nerve palsy. Hypoglossal schwannoma presenting as hemiatrophy of the. Hypoglossal nerve cranial nerve xii palsy is uncommon. 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. However, combined injury of the lingual and hypoglossal nerves following intubation anesthesia is a much rarer condition. There are several causes that can be attributed to it. 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 procedure has a high rate of success, and even though it was described more than a century ago, variations of the original technique have helped to. Everything i have read says it is self resolving, usually within a few days. Temporary unilateral hypoglossal nerve palsy secondary to. Hypoglossal rootlets project ventrally through the medulla to emerge in the preolivary sulcus.
A rare case of hypoglossal nerve palsy nathan chan mb bchir mrcs introduction dural arteriovenous fistulas davfs are shunts connecting dural arteries to dural venous sinuses, meningeal veins or cortical veins. Note the proximity of the cisternal portion of the hypoglossal nerve to the vertebral artery. Azizzadeh likes to utilize the hypoglossal nerve or trigeminal nerve as the neural supply for the gracilis muscle transplant see gracilis muscle section. Hypoglossal nerve disorders may be caused by tumors, strokes, infections, injuries, or amyotrophic lateral sclerosis. Case of isolated hypoglossal nerve palsy is an extremely rare condition. Is hypoglossal nerve palsy caused by craniocervical. Patient with paralysis limited to a specific branch, or branches, of the facial nerve. Hypoglossal nerve palsy as a complication of an anterior approach for cervical spine surgery. Isolated hypoglossal nerve palsy due to infected impacted. To improve understanding of this entity, we present a retrospective series of 18 patients with hypoglossal palsy in whom twelfth cranial nerve compression within the premedullary cistern. Hypoglossal palsy complicating of infectious mononucleosis j.
Damage to the hypoglossal nerve produces characteristic clinical and radiological. Two exceptional causes were chiari malformation in one case. Bells palsy and partial hypoglossal to facial nerve transfer. At the moment after 18 months of follow up the patient is asymptomatic with totally normal systemic and neurological examination. 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. Till date isolated hnp was considered an ominous clinical sign indicatingan underlying malignancy, however,in the present case series treatable causessuch as tubercular central nervous system infection33%and. Vertebrobasilar dolichoectasia with hypoglossal nerve palsy 40. These functions includeeye movements, swallowing, facial sensation, and other facial movements. Hypoglossal palsy complicating of infectious mononucleosis. Hypoglossalfacial nerve transfer in patients with longterm facial paralysis who are older than 55, crossfacial nerve grafts have not produced great results. Hypoglossal nerve paresis secondary to anterior approach. Facial palsy is a devastating psychological and social condition.
However, isolated hypoglossal nerve palsy is relatively rare and considered a diagnostic challenge. Isolated hypoglossal nerve palsy is uncommon, and underlying craniocervical junction degenerative disease. Hypoglossal nerve disorders msd manual consumer version. Hypoglossal nerve an overview sciencedirect topics. Patients with paralysis associated with other cranial nerve abnormalities, including olfactory nerve, glossopharyngeal nerve, vagus nerve, and hypoglossal nerve. Hypoglossal nerve definition and meaning collins english. Any information contained in this pdf file is automatically generated from.
The next common cause proved to be metastatic disease at the base of the skull in three patients. The authors report two patients with isolated unilateral tongue atrophy. The fibers of the hypoglossal nerve arise in the hypoglossal nuclei, which extend through the medulla oblongata in a paramedian location. Hypoglossal nerve palsy is a diagnostic problem due to the extensive list of known causes table 2. To our knowledge, eight cases of hypoglossal nerve palsy after use of the lma have previously been reported 18. The hypoglossal nerve is the motor supply to the tongue muscles and may be damaged in its intracranial or extracranial course. We report a 52yearold woman who presented with rightsided headaches for over a year. Hypoglossal nerve diseases is a descriptor in the national library of medicines controlled vocabulary thesaurus, mesh medical subject headings. The hypoglossal nerve cn xii is the motor nerve of the tongue. An external file that holds a picture, illustration, etc. Isolated hypoglossal nerve palsy from internal carotid. Magnetic resonance imaging mri of the brain stem and angiomri demonstrated a dolichovertebral artery with an abnormal course compressing the medulla oblongata at the emergence of the hypoglossal rootlets. Distinguishing ccj degenerative lesions from other hypoglossal. In all these cases, lmas which have silicone cuffs e.
Hypoglossal nerve transfer treatment facial paralysis institute. Our study is the largest case series including12 patients. Hypoglossal nerve palsy or twelve nerve palsy, march 15. Bells palsy and partial hypoglossal to facial nerve. The hypoglossal nerve is the twelfth and last cranial nerve and supplies the tongue with motor control.
Well, its about 7 weeks and my improvement has plateaued. Hypoglossal nerve paresis secondary to anterior approach of. There are 12 pairs of nerves cranial nerves that control most of the functions of the head and neck. An unusual case of isolated hypoglossal nerve palsy secondary to. Jan 17, 2011 hypoglossal nerve injury from tube inhibation chickadee1955 ive been searching all over online for someone else that has gone through this.
Isolated hypoglossal nerve palsy due to infected impacted tooth. Le journal canadien des sciences neurologiques 385. Hypoglossal definition and meaning collins english. Hypoglossal nerve disorders brain, spinal cord, and.
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