I thought it was swollen, but turns out that the intubation for anesthesia caused. The hypoglossal nerve is one of the least injured nerves in head injury. Isolated unilateral hypoglossal nerve palsy canadian. An uncommon cause of isolated hypoglossal nerve palsy. Previous studies suggested that an enlarged canalicular venous plexus may.
Isolated hypoglossal nerve palsy can present in any clinical situation, either as a complaint or incidental finding. The injury to the nerve can occur from its origin to the tongue itself. A 26yearold female developed a unilateral hypoglossal nerve palsy in association with tuberculosis of the first cervical vertebra. Having said that though, hypoglossal nerve palsy ie paralysis of the muscles supplied by the hypoglossal nerve is well recognised complication of. Damage to the hypoglossal nucleus or hypoglossal nerve can cause denervation atrophy of the tongue, as seen in this patient. Cases of persistent idiopathic isolated hypoglossal nerve palsy are extremely rare, one similar case documenting only one other documented case in the literature. Solitary hypoglossal nerve palsy hnp after airway management during general anesthesia is a rare complication that may occur after a variety of surgeries. Second, nerve ischaemia caused by compromised blood supply. Hypoglossal nerve disorders may be caused by tumors, strokes, infections, injuries, or amyotrophic lateral sclerosis. Idiopathic isolated unilateral hypoglossal nerve palsy. 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 keep the interest in it, prompting many recent. Hypoglossal nerve an overview sciencedirect topics. Isolated hypoglossal nerve palsy is an uncommon cranial neuropathy, which usually presents with dysarthria and mild impairment in tongue movements and swallowing. This report describes a new surgical technique to improve the results of conventional hypoglossal facial nerve anastomosis that does not necessitate the use of.
Hypoglossalfacial nerve transfer in patients with longterm facial paralysis who are older than 55, crossfacial nerve grafts have not produced great results. The clinical examination is the principal method by which hypoglossal nerve palsy can be detected, but imaging studies, either computed tomography or magnetic. These join to form two roots, and passing anteriorly. Idiopathic isolated unilateral hypoglossal nerve palsy is a rarely observed finding in clinical practice. There are 12 pairs of nerves cranial nerves that control most of the functions of the head and neck. We report a 52yearold woman who presented with rightsided headaches for over a year. Icad induced hypoglossal nerve palsy is rare, two mechanisms with the consensus are as follows, first, mechanical compression or stretching of the nerve by the expanded dissected arterial wall with the subadventitial hematoma. A rare cause of unilateral hypoglossal nerve palsy. 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 is a pure motor nerve supplying the lingual muscles and part of the pharyngeal musculature 6. She had wasting and fasciculations on the right side of her tongue, which was. The procedure involves transferring all or part of the hypoglossal nerve to the stump of the facial nerve.
Yuguang chen, md, mingshen dai, md, phd, chingliang ho, md, tzuchuan huang, md. Twelfthnerve palsies have frequently been reported in association with the following conditions. The hypoglossal nerve receives only brief mention in most textbooks and compared with other cranial nerve palsies, 12th nerve palsy is much less common. We present the case of a 74 year old man, without relevant medical history, who started with headache and difficulty to swallow. The nerve emerges from the medulla laterally, between the pyramid and the olive as a number of rootlets. Using the postdescendens hypoglossal nerve in hypoglossal. Hypoglossal nerve palsy after airway management for. Intraoperative neural monitoring performed on cnx, xi, and. Iatrogenic hypoglossal nerve palsy practical neurology. Present case series includes 12 patients of isolated unilateral hypoglossal nerve palsy due to different etiologies, making it the largest case series till date, to the best of our knowledge.
Unilateral isolated hypoglossal nerve palsy due to. This study also challenges the long held belief that isolated unilateral hypoglossal nerve palsy almost always heralds a malignancy. Facial palsy is a devastating psychological and social condition. 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 transfer treatment facial paralysis. Unilateral isolated hypoglossal nerve palsy associated. We will also cover some of the effects of damage to this system, including. Hypoglossal nerve disorders may be caused by tumors, strokes, infections, injuries, or. The nerve then crosses the lingual artery a little above the greater cornu. The facial and hypoglossal nerves were exposed bilaterally in 10 sides of 5 cadaveric heads.
A previous study suggested that icad patients with local signs were associated with a benign clinical course and a favourable outcome 8. You can manage this and all other alerts in my account. Isolated hypoglossal nerve paralysis is an uncommon cranial nerve palsy. Hypoglossal nerve cranial nerve xii palsy is uncommon. Hypoglossal nerve palsy following chiropractic neck. Hypoglossal nerve palsy is a rare occurrence usually associated with other cranial nerve palsies and long tract signs. Hypoglossal nerve disorders msd manual consumer version.
Case of isolated hypoglossal nerve palsy is an extremely rare condition. There are several causes that can be attributed to it. Therefore, hypoglossal nerve palsy caused by sever ing the hypoglossal nerve leads to lingual dyskinesia. It highlights the importance of detecting subtle intraoral clinical changes, the use of appropriate imaging, and. Nonetheless, injury is serious, and early recognition is essential for initiating appropriate management.
Hypoglossal nerve exits the medulla oblongata, extends through the skull base, and traverses the suprahyoid neck before ramifying to supply the tongue musculature. The hypoglossal nerve originates from the hypoglossal nuclei in the medulla at the inferior aspect of the fourth ventricle. These techniques are best suited to cases of facial paralysis less than 2 years in duration. We emphasize the need of an extensive diagnostic workup and correct and timely diagnosis of potentially treatable etiologies in cases of isolated hnp. Anatomically, it leaves the medulla and passes along the base of the skull to the hypoglossal canal. Isolated hypoglossal nerve palsy due to infected impacted. The isolated unilateral palsy of the hypoglossal nerve is an unusual sign in daily medical practice.
Disorders of the 12th cranial nerve hypoglossal nerve cause weakness or wasting atrophy of the tongue on the affected side. Pdf physiotherapy management of peripheral unilateral isolated. Hypoglossal nerve palsy medigoo health medical tests. It was only on examination that we discovered she had an abnormal tongue. Tumors, predominantly malignant, produced nearly half of the palsies 49 cases, while gunshot wounds made. Although varying by etiology, hypoglossal nerve palsy generally has a poor prognosis, particularly if the nerve has been transected and is not immediately repaired. Isolated hypoglossal nerve palsy from internal carotid. On the physical examination, he had isolated hypoglossal nerve palsy. Acute onset of pain with tongue weakness points to dissection of the extracranial internal carotid artery, a medical emergency.
Hypoglossal nerve palsy tends to occur as a sign rather than a symptom and therefore warrants thorough investigation. Pathology of this nerve affects the balanced action of the genioglossus muscle causing tongue deviation toward the weak side. I did not have full movement and it draws to the left. Those cases with bilateral hypoglossal nerve palsies, involvement of con tiguous cranial nerves, hemiparesis or any other focal deficits were excluded from the. Isolated hypoglossal nerve palsy neurologia english edition. We describe a patient with an isolated hypoglossal nerve palsy caused by an ar.
He was referred to our department by a neurologist due a magnetic resonance imaging detected left. To describe the causes and characteristics of hypoglossal nerve palsy. Isolated hypoglossal palsy caused by synovial cyst 43. The extensive soft tissue and bony abnormalities were demonstrated only by computerized axial tomography. 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.
Isolated hypoglossal nerve palsy due to mechanical compression by a vascular lesion is rare. Vertebrobasilar dolichoectasia with hypoglossal nerve palsy 40. Physiotherapy management of peripheral unilateral isolated hypoglossal nerve palsy in a 53 year old woman. Hypoglossal nerve palsy as a complication of transoral intubation for general anesthesia you will receive an email whenever this article is corrected, updated, or cited in the literature. By the end of the first postoperative day, patients typically present with ipsilateral tongue deviation and may exhibit speech and swallowing difficulties. Azizzadeh likes to utilize the hypoglossal nerve or trigeminal nerve as the neural supply for. Hypoglossal nerve palsy as a complication of transoral. Hypoglossal nerve palsy hypoglossal nerve disorder. Hypoglossal nerve disorders brain, spinal cord, and. We report the case of a 72yearold man who presented with a 4year history of swallowing disturbance and subsequently progressively worsening leftsided tongue atrophy. A diagnosis of idiopathic isolated unilateral hypoglossal nerve palsy was made. This material will help you understand fourth nerve palsy and how it is treated.
When attending patients with hypoglossal nerve palsy, particularly if it is not associated with other neurological deficits, clinicians should focus on lesions of its peripheral. Surgical resection of the hypoglossal nerve lesion included a left suboccipital craniotomy and c1 laminectomy to facilitate the supracondylar far lateral leftsided approach. This lesson covers the function and structure of the hypoglossal nerve. Bilateral hypoglossal nerve damage due to the use of the harmonic focus. Cisternal hypoglossal schwannoma with tongue atrophy 42. Hypoglossal nerve palsy following chiropractic neck manipulation volume 46 issue 5 tommy lik hang chan, david dongkyung kim, manas sharma, mandar jog skip to main content accessibility help we use cookies to distinguish you from other users and to provide you with a better experience on our websites. One of the most common procedures for diminishing the consequences of facial palsy is hypoglossalfacial anastomosis. 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 causes of hypoglossal nerve palsy are well documented, but idiopathic, isolated nerve palsy that does not recover, is rare.
The hypoglossal nerve is the twelfth and last cranial nerve and supplies the tongue with motor control. Available formats pdf please select a format to send. The feasibility of a sidetoend ie, partial endtoend hfa with partial sectioning of the postdescendens hypoglossal nerve and the mobilized intratemporal facial nerve was assessed. Twelfthnerve palsies usually appear as signs rather than symptoms. 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 hypoglossalfacial anastomosis, the hypoglossal nerve transfer is performed less frequently these days as more awareness now exists about other options. The fibers of the hypoglossal nerve arise in the hypoglossal nuclei, which extend through the medulla oblongata in a paramedian location. When it presents in isolation it can be diagnostically challenging as was evident in this case. All structured data from the file and property namespaces is available under the. Structures supplied by the hypoglossal nerve are indicated by solid lines, whereas those supplied by fibers of cervical origin are indicated by dashed lines.
Persistent isolated unilateral hypoglossal nerve palsy. We describe a case of isolated idiopathic hypoglossal nerve palsy in a young male patient and discuss several of the aetiopathogenic mechanisms which may. Isolated unilateral hypoglossal neuropathy caused by dural. The hypoglossal nerve cranial nerve xii supplies motor innervation to the muscles of the tongue. The fibers of the hypoglossal nerve arise in the hypoglossal nuclei.
The hypoglossal nerve is the 12th cranial nerve and supplies motor innervation to the intrinsic and extrinsic muscles of the tongue. Hypoglossal nerve transfer for facial paralysis surgery. Imaging features of isolated hypoglossal nerve palsy sciencedirect. Isolated unilateral hypoglossal nerve palsy journal of neurology. Note the communication of the hypoglossal nerve with fibers from c1, the nodose ganglion of the vagus nerve, and the superior cervical sympathetic ganglion. Isolated bilateral paralysis of the hypoglossal nerve. We present a case where a patient presented herself with swelling on the right side of her cheek extending to the floor of the. We present the case of a 74 year old man, without relevant medical history, who started with.
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