Hypoglossal nerve injury associated with laryngeal mask airway lma is a rare complication but can cause severe symptoms such as dysarthria and dysphasia. Hypoglossal nerve palsy secondarytocraniocervicaljunctionccjjuxtaarticularsynovial and ganglion cysts28 and osteophytes9,10 has been described in isolated case reports. Facial palsy is a devastating psychological and social condition. An external file that holds a picture, illustration, etc. However, isolated hypoglossal nerve palsy is relatively rare and considered a diagnostic challenge. Hypoglossal nerve disorders may be caused by tumors, strokes, infections, injuries, or amyotrophic lateral sclerosis.
Persistent isolated unilateral hypoglossal nerve palsy. One of the most common procedures for diminishing the consequences of facial palsy is hypoglossalfacial anastomosis. 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. It allows control of the tongue for such things as mixing food you have eaten into a ball. These techniques are best suited to cases of facial paralysis less than 2 years in duration. 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. Pdf hypoglossal nerve paralysis revealing type 2 diabetes.
Hypoglossal rootlets project ventrally through the medulla to emerge in the preolivary sulcus. Jeanpierre barral, alain croibier, in manual therapy for the cranial nerves, 2009. 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. The slight bulge into the fourth ventricle is termed the hypoglossal eminence. This material will help you understand fourth nerve palsy and how it is treated. Hypoglossal nerve an overview sciencedirect topics. At the moment after 18 months of follow up the patient is asymptomatic with totally normal systemic and neurological examination. Isolated hypoglossal nerve paralysis the american journal of. Distinguishing ccj degenerative lesions from other hypoglossal. The procedure involves transferring all or part of the hypoglossal nerve to the stump of the facial nerve. Hypoglossal nerve transfer treatment facial paralysis institute. Removal of the impacted tooth resulted in the improvement of function of the.
The nerve arises from the hypoglossal nucleus in the medulla as a number of small rootlets, passes through the. Vertebrobasilar dolichoectasia with hypoglossal nerve palsy 40. Hypoglossal nerve definition and meaning collins english. Scullys medical problems in dentistry seventh edition, 2014. An unusual case of isolated hypoglossal nerve palsy secondary to. Hypoglossal nerve palsy is a diagnostic problem due to the extensive list of known causes table 2.
Also known as hypoglossal facial anastomosis, the hypoglossal nerve transfer is performed less frequently these days as more awareness now exists about other options. Two exceptional causes were chiari malformation in one case. Damage to the hypoglossal nucleus or hypoglossal nerve can cause denervation atrophy of the tongue, as seen in this patient. Isolated hypoglossal nerve palsy is quite rare and very few cases have been reported in. In conclusion, patients with hypoglossal schwannomas can present with muscle atrophy of the tongue, but they can also be asymptomatic initially11. Note the proximity of the cisternal portion of the hypoglossal nerve to the vertebral artery.
Early diagnosis can be achieved after a detailed neurological examination. Our study is the largest case series including12 patients. Hypoglossal facial nerve transfer in patients with longterm facial paralysis who are older than 55, crossfacial nerve grafts have not produced great results. Transient unilateral combined paresis of the hypoglossal nerve and. To our knowledge, eight cases of hypoglossal nerve palsy after use of the lma have previously been reported 18. 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. Robaina bordon and others published isolated hypoglossal nerve palsy find, read and cite all the research you need on researchgate. Hypoglossal palsy complicating of infectious mononucleosis j.
Bells palsy and partial hypoglossal to facial nerve. The authors report two patients with isolated unilateral tongue atrophy. However, bergin 1960, suggested that an allergic neurotaxitis similar to that found in the encephalitis of. 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. 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. Isolated hypoglossal nerve palsy is uncommon, and underlying craniocervical junction degenerative disease. Temporary unilateral hypoglossal nerve palsy secondary to. Hypoglossal facial nerve sidetoend anastomosis is an effective and reliable technique with consis tent and satisfying results. The most commonly reported causes include an intracranial or extracranial space. An unusual case of peripheral hypoglossal nerve palsy.
Original article sidetoend hypoglossalfacial nerve. Damage to the hypoglossal nerve produces characteristic clinical and radiological. I have a lisp, eating is difficult, speech is difficult, saliva. They account for 1015% of intracranial arteriovenous malformations.
Jan 17, 2011 hypoglossal nerve injury from tube inhibation chickadee1955 ive been searching all over online for someone else that has gone through this. Hypoglossal schwannoma presenting as hemiatrophy of the. 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. Hypoglossal schwannoma presenting as hemiatrophy of the tongue. The clinical examination is the principal method by which hypoglossal nerve palsy can be detected, but imaging studies, either. I thought it was swollen, but turns out that the intubation for anesthesia caused damage to my hypoglossal nerve that innervates the tongue. 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. Mri appearance of the normal and diseased hypoglossal nerve. It is a multietiological condition, and may occur secondary to infectious mononucleosis. Isolated unilateral hypoglossal nerve palsy request pdf.
Hypoglossal nerve transfer treatment facial paralysis. Is hypoglossal nerve palsy caused by craniocervical junction. Damage to this nerve produces characteristic clinical manifestations, of which unilateral atrophy of the tongue musculature is the most important. A rare cause of unilateral hypoglossal nerve palsy. The hypoglossal nerve is used for daily functions most people take for granted, like eating and speech.
Patients with paralysis associated with other cranial nerve abnormalities, including olfactory nerve, glossopharyngeal nerve, vagus nerve, and hypoglossal nerve. Hypoglossal nerve paresis secondary to anterior approach of upper cervical spine followed by spontaneous recovery. There are several causes that can be attributed to it. We report nine patients with hypoglossal nerve palsy as the sole neurological manifestation, without simultaneous involvement of other cranial nerves or longtract signs. Pdf the hypoglossal nerve receives only brief mention in most textbooks and compared with other cranial nerve palsies, 12th nerve palsy is. The nerve emerges from the medulla laterally, between the pyramid and the olive as a number of rootlets. Descriptors are arranged in a hierarchical structure, which enables searching at various levels of specificity. The next common cause proved to be metastatic disease at the base of the skull in three patients. Case of isolated hypoglossal nerve palsy is an extremely rare condition. 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. Hypoglossal nerve palsy or twelve nerve palsy, march 15.
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. The hypoglossal nerve cranial nerve xii supplies motor innervation to the muscles of the tongue. Media in category hypoglossal nerve palsy the following 3 files are in this category, out of 3 total. The hypoglossal nerve receives only brief mention in most textbooks and compared with other cranial nerve palsies, 12th nerve palsy is much less common. 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 palsy caused by synovial cyst 43. Cisternal hypoglossal schwannoma with tongue atrophy 42. Hypoglossal nerve paresis secondary to anterior approach. Idiopathic isolated unilateral hypoglossal nerve palsy is a rarely observed finding in clinical practice. Neither the severity of the lesion nor duration of facial palsy has an adverse effect on. Isolated hypoglossal nerve palsy is uncommon, and underlying craniocervical junction degenerative disease has rarely been reported as an underlying cause. 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 palsy as a complication of an anterior approach for cervical spine surgery. However, combined injury of the lingual and hypoglossal nerves following intubation anesthesia is a much rarer condition.
Unilateral hypoglossal nerve palsy after use of the. Discussion the hypoglossal nerve is a pure motor nerve innervating intrinsic as well as extrinsic tongue muscles. The clinical examination is the principal method by which hypoglossal nerve palsy can be detected, but imaging studies, either computed tomography or magnetic. Is hypoglossal nerve palsy caused by craniocervical. Hypoglossal nerve paralysis revealing type 2 diabetes mellitus.
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 innervates all the extrinsic and intrinsic muscles of the tongue, except for the palatoglossus which is innervated by the vagus nerve. In four patients, no cause was found and the outcome was excellent. 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 nerve transfer for facial paralysis surgery. Isolated unilateral hypoglossal nerve palsy due to vertebral. Everything i have read says it is self resolving, usually within a few days. Hypoglossal nerve palsy exits the medulla oblongata, extends through the skull base, and traverses the suprahyoid neck before ramifying to supply the tongue musculature. Patient with paralysis limited to a specific branch, or branches, of the facial nerve. I had a hip surgery and woke up with this hypoglossal nerve injury. A rare combination of facial and hypoglossal nerve palsies following post traumatic internal carotid artery dissection. Isolated hypoglossal nerve palsy due to infected impacted. Hypoglossal nerve palsy medigoo health medical tests. Hypoglossalfacial nerve transfer in patients with longterm facial paralysis who are older than 55, crossfacial nerve grafts have not produced great results.
An unusual case of peripheral hypoglossal nerve palsy, caused by lateral position of the. Thepathologicalexplanation forthis neurological complication is presumably a local virus infection around the hypoglossal nerve nucleus. It was only on examination that we discovered she had an abnormal tongue. Previous studies suggested that an enlarged canalicular venous plexus may be responsible for the hypoglossal nerve palsy 5, 6.
Any information contained in this pdf file is automatically generated from. Cases of this finding in patients with epilepsy further make this. These functions includeeye movements, swallowing, facial sensation, and other facial movements. Hypoglossal nerve paresis secondary to anterior approach of. Isolated unilateral hypoglossal nerve palsy due to. Hypoglossal palsy from an atlantoaxial synovial cyst. Azizzadeh likes to utilize the hypoglossal nerve or trigeminal nerve as the neural supply for the gracilis muscle transplant see gracilis muscle section. 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. 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. Tongue paralysis due to isolated palsy of xii cranial nerve is uncommon neurological finding. There are 12 pairs of nerves cranial nerves that control most of the functions of the head and neck. Hypoglossal nerve cranial nerve xii palsy is uncommon. Hypoglossal nerve disorders merck manuals consumer version. 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 hypoglossal nerve disorder. Hypoglossal definition and meaning collins english dictionary. Hypoglossal palsy complicating of infectious mononucleosis. 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. A rare combination of facial and hypoglossal nerve palsies following.
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. Hypoglossal nerve disorders brain, spinal cord, and nerve. Hypoglossal nerve diseases is a descriptor in the national library of medicines controlled vocabulary thesaurus, mesh medical subject headings. Well, its about 7 weeks and my improvement has plateaued. Files are available under licenses specified on their description page.
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 semeiological observation of a sectorial and not uniform distribution. The hypoglossal nerve cn xii is the motor nerve of the tongue. Isolated hypoglossal nerve palsy from internal carotid. Bells palsy and partial hypoglossal to facial nerve transfer. Isolated unilateral hypoglossal nerve palsy article in the canadian journal of neurological sciences. The fibers of the hypoglossal nerve arise in the hypoglossal nuclei, which extend through the medulla oblongata in a paramedian location. Isolated hypoglossal nerve palsy due to infected impacted tooth. The hypoglossal nerve is the twelfth and last cranial nerve and supplies the tongue with motor control. Hypoglossal nerve disorders msd manual consumer version. Hypoglossal definition and meaning collins english. 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.
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