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Ragittaran J, Kamalasanan A, White RD, Sudarshan T. Imaging of hypoglossal palsy: a pictorial synopsis. Clin Radiol 2025; 81:106754. [PMID: 39721320 DOI: 10.1016/j.crad.2024.106754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Revised: 11/13/2024] [Accepted: 11/15/2024] [Indexed: 12/28/2024]
Abstract
Palsy of the hypoglossal nerve, the 12th cranial nerve, is rare and presents with specific clinical features depending on the anatomical location of the underlying pathology. As such, knowledge of clinical presentation and detailed anatomy of the nerve is vital to aid in localisation and identification of the pathology. This pictorial review details the anatomy of the nerve, including innervation, segments, and branches, with particular reference to magnetic resonance imaging (MRI). The role of clinical examination and multimodality imaging in differentiating between types of hypoglossal palsy is highlighted. Key pathologies affecting the different nerve segments are described and illustrated on multimodality imaging.
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Affiliation(s)
- J Ragittaran
- Ninewells Hospital, James Arrott Drive, Ninewells, Dundee, Scotland, DD1 9SY, UK.
| | | | - R D White
- Cardiff and Wales University Health Board, Cardiff, UK.
| | - T Sudarshan
- Ninewells Hospital, James Arrott Drive, Ninewells, Dundee, Scotland, DD1 9SY, UK.
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Gennaro P, Ramieri V, Gabriele G, Catarzi L. Hypoglossal Nerve Palsy Misdiagnosed as Tongue Tumor: A Rare Case of Calcified Hypoglossal Schwannoma. Indian J Otolaryngol Head Neck Surg 2024; 76:1240-1243. [PMID: 38440576 PMCID: PMC10909057 DOI: 10.1007/s12070-023-04239-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 09/18/2023] [Indexed: 03/06/2024] Open
Abstract
The authors hereby present a case of a calcified schwannoma of the hypoglossal nerve, which led to hypoglossal nerve palsy initially misinterpreted as a tongue tumor. This paper reviews the presentation of schwannoma of the hypoglossal nerve and offers a novel perspective on this rare condition. Diagnostic pitfalls and the diagnostic-therapeutic value are also discussed.
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Affiliation(s)
- Paolo Gennaro
- Department of Maxillofacial Surgery, University of Siena, Via Banchi di Sotto n° 55, Siena, Italy
| | - Valerio Ramieri
- Department of Maxillofacial Surgery, University of Siena, Via Banchi di Sotto n° 55, Siena, Italy
| | - Guido Gabriele
- Department of Maxillofacial Surgery, University of Siena, Via Banchi di Sotto n° 55, Siena, Italy
| | - Lisa Catarzi
- Department of Maxillofacial Surgery, University of Siena, Via Banchi di Sotto n° 55, Siena, Italy
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Chen F, Jen YM, He K, Yin ZS, Lee JC, Huang WY, Tang YH. Hypoglossal nerve delineation in nasopharyngeal carcinoma patients may reduce the radiation dose and damage to the nerve. Med Dosim 2023; 49:102-108. [PMID: 37858458 DOI: 10.1016/j.meddos.2023.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 07/03/2023] [Accepted: 09/20/2023] [Indexed: 10/21/2023]
Abstract
This study aims to establish a delineation guideline for the contouring of the hypoglossal nerve by dividing the nerve into different segments, and to test the possibility of a radiation dose reduction to the hypoglossal nerve in NPC patients receiving radiotherapy. Twenty NPC patients were selected arbitrarily. The hypoglossal nerves were delineated using anatomic landmarks and divided into the cisternal, intracanalicular, carotid, and transverse segments. The tumor coverage by radiation and dose-volume parameters of the nerve with and without various dose constraints to the hypoglossal nerve were compared. The hypoglossal nerve, which is invisible on CT images, can be delineated accurately with the assistance of several anatomic landmarks. Without a dose constraint to the hypoglossal nerve, the carotid space, intracanalicular, and transverse segments had high radiation dose-volumes. The dose-volume to the nerve, however, can be reduced when the nerve was defined and a dose constraint was given. The delineation of the hypoglossal nerve with its different segments is feasible. The carotid space, intracanalicular, and transverse segments received the highest dose, where the nerve damage was most likely located. The dose to the nerve can be reduced to less than 70 Gy using the intensity-modulated radiotherapy technique.
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Affiliation(s)
- Fen Chen
- Radiotherapy Center, Chenzhou No. 1 People's Hospital, Chenzhou, Hunan Province, China
| | - Yee-Min Jen
- Department of Radiation Oncology, Yee Zen General Hospital, Taoyuan City, Taiwan.
| | - Kui He
- Radiotherapy Center, Chenzhou No. 1 People's Hospital, Chenzhou, Hunan Province, China
| | - Zhao-Sheng Yin
- Radiotherapy Center, Chenzhou No. 1 People's Hospital, Chenzhou, Hunan Province, China
| | - Jih-Chin Lee
- Department of Otolaryngology Head & Neck Surgery, Tri-Service General Hospital, Taipei, Taiwan
| | - Wen-Yen Huang
- Department of Radiation Oncology, Tri-Service General Hospital, Taipei, Taiwan
| | - Yong-Hong Tang
- Radiotherapy Center, Taoyuan Chinese Medicine Hospital, Changde, Hunan Province, China
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Evli C, Kolsuz ME, Orhan K. Retrospective evaluation of the morpometric and morphological anatomy of the occipital condyle, hypoglossal canal and foramen magnum in Turkish populaton with CBCT. Surg Radiol Anat 2023:10.1007/s00276-023-03153-4. [PMID: 37133538 DOI: 10.1007/s00276-023-03153-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 04/20/2023] [Indexed: 05/04/2023]
Abstract
PURPOSE The aim of this study is to morphometrically and morphologically examine the occipital condyle, which is an important anatomical region in terms of surgery and forensic medicine, and its surrounding structures, to evaluate the change in mean values according to gender and age, and to evaluate the correlation of the measurements obtained. METHODS 180 (90 men, 90 women) CBCT images selected from the archive of Ankara University Faculty of Dentistry. Occipital Condyle length and width, Hypoglossal Canal-Basion distance, Hypoglossal Canal-Opistion distance, Hypoglossal Canal-Occipital Condyle anterior and posterior border distance, Occipital Condyle thickness, Hypoglossal Canal length, the widest diameter of Hypoglossal Canal, the narrowest diameter of the Hypoglossal Canal, the length of the Jugular Tubercle, the width of the Jugular Tubercle, the anterior intercondylar distance, the posterior intercondylar distance, and the Foramen Magnum index were measured. At the same time, the presence of septum or spicule in the hypoglossal canal and protrusion of the occipital condyle were evaluated. The relationship of age, gender, anterior and posterior intercondylar distance, and foramen magnum index measurements with all measurements were examined. RESULTS In our study, all measurements were repeated 1 month after the first measurements to evaluate the intra-observer agreement, and the agreement between the obtained measurements and the first measurements was evaluated by calculating the intraclass correlation coefficient and 95% confidence intervals. Men's measurements were found to be significantly higher than women's measurements. When the coefficients of concordance in all measurements were examined, it was observed that there was a perfect concordance. CONCLUSION When the results of the study are evaluated, it is seen that the values obtained are generally close to the studies related to CT. Considering this, an idea can be gained as to whether CBCT, which has a lower dose and less cost, can be used as an alternative to CT in studies to be conducted with more comprehensive and different methods in skull base surgical planning.
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Affiliation(s)
- Cengiz Evli
- Department of Dentomaxillofacial Radiology, Ankara University, Ankara, Turkey.
| | - Mehmet Eray Kolsuz
- Department of Dentomaxillofacial Radiology, Ankara University, Ankara, Turkey
| | - Kaan Orhan
- Department of Dentomaxillofacial Radiology, Ankara University, Ankara, Turkey
- Department of Dental and Maxillofacial Radiodiagnostics, Medical University of Lublin, Lublin, Poland
- Ankara University Medical Design Application and Research Center (MEDITAM), Ankara, Turkey
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Chen X, Yi J, Liu S, Chen W, Guan J, Pan C. Yin-Yang tongue sign: An imaging clue of lesions involving the skull base segment in the hypoglossal pathway. Dentomaxillofac Radiol 2023; 52:20220201. [PMID: 36168971 PMCID: PMC9793452 DOI: 10.1259/dmfr.20220201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 09/18/2022] [Accepted: 09/21/2022] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE To investigate the diagnostic value of the Yin-Yang tongue sign in patients with tongue deviation. METHODS According to the presence of the Yin-Yang tongue sign on CT/MR, 107 patients with tongue deviation were divided into a positive group and a negative group. The involvement categories of the hypoglossal canal (HC) in the positive group were evaluated and classified as HC dilation and HC erosion. The correlations between HC involvement categories and the presence of the sign were analysed. RESULTS There were 55 cases (55/107, 51.4%) in the positive group and 52 cases (52/107, 48.6%) in the negative group. Hypoglossal nerve (HN) involvement mainly occurred in the skull base (61.8%), skull base and carotid space (10.9%), and carotid space segment (12.7%). Neurogenic (50.9%), squamous cell carcinoma (14.5%), and metastases (12.7%) were the predominant aetiologies. The sensitivity, specificity, and accuracy of this sign for suggesting skull base lesions around HC were 72.4%, 80.8%, and 76.6%, respectively. In the positive group, HC dilation was seen in 21 patients (21/55, 38.2%) and 21 cases were all benign. HC erosion were noted in 19 patients (19/55, 34.5%), of whom 12 cases were malignant. CONCLUSION The Yin-Yang tongue sign is formed by unilateral tongue atrophy and fat infiltration caused by lesions in the HN pathway, especially compressive or invasive lesions involving the skull base segment.
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Affiliation(s)
| | - Jingru Yi
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Simin Liu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Weiwei Chen
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jian Guan
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Chu Pan
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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de Sousa Costa R, Ventura N, de Andrade Lourenção Freddi T, da Cruz LCH, Corrêa DG. The Hypoglossal nerve. Semin Ultrasound CT MR 2022; 44:104-114. [PMID: 37055141 DOI: 10.1053/j.sult.2022.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The hypoglossal nerve is the 12th cranial nerve, exiting the brainstem in the preolivary sulcus, passing through the premedullary cistern, and exiting the skull through the hypoglossal canal. This is a purely motor nerve, responsible for the innervation of all the intrinsic tongue muscles (superior longitudinal muscle, inferior longitudinal muscle, transverse muscle, and vertical muscle), 3 extrinsic tongue muscles (styloglossus, hyoglossus, and genioglossus), and the geniohyoid muscle. Magnetic resonance imaging (MRI) is the best imaging exam to evaluate patients with clinical signs of hypoglossal nerve palsy, and computed tomography may have a complementary role in the evaluation of bone lesions affecting the hypoglossal canal. A heavily T2-weighted sequence, such as fast imaging employing steady-state acquisition (FIESTA) or constructive interference steady state (CISS) is important to evaluate this nerve on MRI. There are multiple causes of hypoglossal nerve palsy, being neoplasia the most common cause, but vascular lesions, inflammatory diseases, infections, and trauma can also affect this nerve. The purpose of this article is to review the hypoglossal nerve anatomy, discuss the best imaging techniques to evaluate this nerve and demonstrate the imaging aspect of the main diseases that affect it.
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de Sousa Costa R, Ventura N, de Andrade Lourenção Freddi T, da Cruz LCH, Corrêa DG. The Glossopharyngeal, Vagus and Accessory nerves: Anatomy and Pathology. Semin Ultrasound CT MR 2022; 44:95-103. [PMID: 37055144 DOI: 10.1053/j.sult.2022.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The glossopharyngeal, vagus, and accessory nerves are discussed in this article, given their intimate anatomical and functional associations. Abnormalities of these lower cranial nerves may be intrinsic or extrinsic due to various disease processes. This article aims to review these nerves' anatomy and demonstrates the imaging aspect of the diseases which most commonly affect them.
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Murphy ER, Thompson R, Osman KL, Haxton C, Brothers M, Lee L, Warncke K, Smith CL, Keilholz AN, Hamad A, Golzy M, Bunyak F, Ma L, Nichols NL, Lever TE. A Strength Endurance Exercise Paradigm Mitigates Deficits in Hypoglossal-Tongue Axis Function, Strength, and Structure in a Rodent Model of Hypoglossal Motor Neuron Degeneration. Front Neurosci 2022; 16:869592. [PMID: 35844238 PMCID: PMC9279620 DOI: 10.3389/fnins.2022.869592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 05/23/2022] [Indexed: 11/18/2022] Open
Abstract
The tongue plays a crucial role in the swallowing process, and impairment can lead to dysphagia, particularly in motor neuron diseases (MNDs) resulting in hypoglossal-tongue axis degeneration (e.g., amyotrophic lateral sclerosis and progressive bulbar palsy). This study utilized our previously established inducible rodent model of dysphagia due to targeted degeneration of the hypoglossal-tongue axis. This model was created by injecting cholera toxin B conjugated to saporin (CTB-SAP) into the genioglossus muscle of the tongue base for retrograde transport to the hypoglossal (XII) nucleus via the hypoglossal nerve, which provides the sole motor control of the tongue. Our goal was to investigate the effect of high-repetition/low-resistance tongue exercise on tongue function, strength, and structure in four groups of male rats: (1) control + sham exercise (n = 13); (2) control + exercise (n = 10); (3) CTB-SAP + sham exercise (n = 13); and (4) CTB-SAP + exercise (n = 12). For each group, a custom spout with adjustable lick force requirement for fluid access was placed in the home cage overnight on days 4 and 6 post-tongue injection. For the two sham exercise groups, the lick force requirement was negligible. For the two exercise groups, the lick force requirement was set to ∼40% greater than the maximum voluntary lick force for individual rats. Following exercise exposure, we evaluated the effect on hypoglossal-tongue axis function (via videofluoroscopy), strength (via force-lickometer), and structure [via Magnetic Resonance Imaging (MRI) of the brainstem and tongue in a subset of rats]. Results showed that sham-exercised CTB-SAP rats had significant deficits in lick rate, swallow timing, and lick force. In exercised CTB-SAP rats, lick rate and lick force were preserved; however, swallow timing deficits persisted. MRI revealed corresponding degenerative changes in the hypoglossal-tongue axis that were mitigated by tongue exercise. These collective findings suggest that high-repetition/low-resistance tongue exercise in our model is a safe and effective treatment to prevent/diminish signs of hypoglossal-tongue axis degeneration. The next step is to leverage our rat model to optimize exercise dosing parameters and investigate corresponding treatment mechanisms of action for future translation to MND clinical trials.
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Affiliation(s)
- Erika R. Murphy
- Department of Speech, Language and Hearing Sciences, School of Health Professions, University of Missouri, Columbia, MO, United States
| | - Rebecca Thompson
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, University of Missouri, Columbia, MO, United States
- Department of Biomedical Sciences, College of Veterinary Medicine, University of Missouri, Columbia, MO, United States
| | - Kate L. Osman
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, University of Missouri, Columbia, MO, United States
| | - Chandler Haxton
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, University of Missouri, Columbia, MO, United States
| | - Margaret Brothers
- Department of Speech, Language and Hearing Sciences, School of Health Professions, University of Missouri, Columbia, MO, United States
| | - Li Lee
- Department of Radiology, School of Medicine, University of Missouri, Columbia, MO, United States
- Research Division, Biomolecular Imaging Center, Harry S. Truman Memorial Veterans’ Hospital, Columbia, MO, United States
| | - Kristen Warncke
- Department of Radiology, School of Medicine, University of Missouri, Columbia, MO, United States
- Research Division, Biomolecular Imaging Center, Harry S. Truman Memorial Veterans’ Hospital, Columbia, MO, United States
| | - Catherine L. Smith
- Department of Biomedical Sciences, College of Veterinary Medicine, University of Missouri, Columbia, MO, United States
| | - Amy N. Keilholz
- Department of Biomedical Sciences, College of Veterinary Medicine, University of Missouri, Columbia, MO, United States
| | - Ali Hamad
- Department of Electrical Engineering and Computer Science, University of Missouri, Columbia, MO, United States
| | - Mojgan Golzy
- Biostatistics Unit, Department of Family and Community Medicine, University of Missouri, Columbia, MO, United States
| | - Filiz Bunyak
- Department of Electrical Engineering and Computer Science, University of Missouri, Columbia, MO, United States
| | - Lixin Ma
- Department of Radiology, School of Medicine, University of Missouri, Columbia, MO, United States
- Research Division, Biomolecular Imaging Center, Harry S. Truman Memorial Veterans’ Hospital, Columbia, MO, United States
| | - Nicole L. Nichols
- Department of Biomedical Sciences, College of Veterinary Medicine, University of Missouri, Columbia, MO, United States
- Dalton Cardiovascular Research Center, University of Missouri, Columbia, MO, United States
- *Correspondence: Nicole L. Nichols,
| | - Teresa E. Lever
- Department of Speech, Language and Hearing Sciences, School of Health Professions, University of Missouri, Columbia, MO, United States
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, University of Missouri, Columbia, MO, United States
- Department of Biomedical Sciences, College of Veterinary Medicine, University of Missouri, Columbia, MO, United States
- Teresa E. Lever,
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Expert's Comment concerning Grand Rounds Case entitled "Permanent twelfth nerve palsy secondary to C0 and C1 fracture in patient with craniocervical pneumatisation" (R. Kaiser and H. Mehdian, Eur Spine J; 2014: DOI 10.1007/s00586-014-3360-5) : An otorhinolaryngological approach to the assessment and management of a hypoglossal nerve palsy. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2021; 30:385-388. [PMID: 27465239 DOI: 10.1007/s00586-016-4705-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Olesen C, Groen MB, Forsberg J, Antulov R. Persistent idiopathic unilateral isolated hypoglossal nerve palsy – a report of two cases. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2020. [DOI: 10.1186/s41983-020-00216-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Introduction
Isolated unilateral hypoglossal nerve palsy is an infrequent condition that usually appears in connection to an underlying disease. Rarely, the cause cannot be determined, and there is no symptom remission.
Case description
We report two cases of male patients who developed persistent idiopathic isolated unilateral hypoglossal nerve palsy. The younger patient complained of involuntary movements of the tongue, while the older patient developed dysarthria. In both cases, the symptoms lasted for several weeks before the initial clinical examination, and after comprehensive clinical, laboratory, and imaging investigations, no underlying cause was detected. Both patients did not show remission of symptoms on the follow-up examinations done after several months.
Discussion
Idiopathic isolated unilateral hypoglossal nerve palsy is an underreported condition, most likely due to the expected reversible nature of the disease. In the case of persistence of symptoms, extensive medical assessment is needed before postulating a diagnosis of persistent idiopathic isolated unilateral hypoglossal nerve palsy. There are no treatment guidelines for this condition, but oral steroids were reported as a treatment option. Therefore, physicians should use a systematic approach to exclude serious underlying pathology or identify a treatable condition.
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Geng C, Lu Z, Xuan L, Yin H, Yang X, Yang L, Xia X, Chu W. Hypoglossal Nerve Lesions: The Role of a 3D IR-Prepped Fast SPGR High-Resolution 3T MRI Sequence. J Neuroimaging 2020; 31:180-185. [PMID: 32730672 DOI: 10.1111/jon.12762] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 07/01/2020] [Accepted: 07/03/2020] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND AND PURPOSE To assess a 3D high-resolution IR-prepped fast SPGR high-resolution MRI sequence for evaluating hypoglossal nerve lesions. METHODS The clinical data of 8 patients with hypoglossal nerve lesions admitted from December 2011 to February 2016 were retrospectively analyzed. MRI included contrast-enhanced conventional sequences and a 3D IR-prepped fast SPGR high-resolution T1-weighted (BRAVO) MRI sequence at 3T. RESULTS Eight patients had hypoglossal lesions detected by MRI. Conventional enhanced scanning could not clearly display the hypoglossal nerve and canal, while the enhanced 3D high-resolution sequence could. In addition, multiple planar reconstruction clearly displayed the hypoglossal nerve, hypoglossal canal, and lesions in multiple planes. CONCLUSIONS Compared with conventional MRI, we show superior results from an advanced sequence to improve image quality in characterizing hypoglossal nerve lesions.
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Affiliation(s)
- Chengjun Geng
- Department of Medical Imaging, Wuxi Medical College of Anhui Medical University, Wuxi, Jiangsu, China
| | - Zehua Lu
- Department of Medical Imaging, Wuxi Medical College of Anhui Medical University, Wuxi, Jiangsu, China
| | - Lulu Xuan
- Department of Medical Imaging, Wuxi Medical College of Anhui Medical University, Wuxi, Jiangsu, China
| | - Huikang Yin
- Department of Medical Imaging, Wuxi Medical College of Anhui Medical University, Wuxi, Jiangsu, China
| | - Xiaoliang Yang
- Department of Medical Imaging, Wuxi Medical College of Anhui Medical University, Wuxi, Jiangsu, China
| | - Liyue Yang
- Department of Medical Imaging, Wuxi Medical College of Anhui Medical University, Wuxi, Jiangsu, China
| | - Xiaoliang Xia
- Department of Medical Imaging, Wuxi Medical College of Anhui Medical University, Wuxi, Jiangsu, China
| | - Wei Chu
- Department of Radiology, Wuxi Huishan People's Hospital, Wuxi, Jiangsu, China
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Curcean AD, Rusu GM, Dudea SM. Ultrasound appearance of peripheral nerves in the neck: vagus, hypoglossal and greater auricular. Med Pharm Rep 2020; 93:39-46. [PMID: 32133445 PMCID: PMC7051821 DOI: 10.15386/mpr-1273] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 07/31/2019] [Accepted: 09/06/2019] [Indexed: 12/02/2022] Open
Abstract
Background and aim Information in ultrasonography about reference values of nerves, particularly of those located in the neck is limited. The aim of the study is to demonstrate the feasibility of direct visualization of the vagus, hypoglossal and greater auricular nerves, testing the method on healthy volunteers and estimate the reference values for two perpendicular diameters and cross-sectional area (CSA). Methods A prospective study was carried out on 21 healthy volunteers (12 women and 9 men), recording their demographic characteristics. A 13 MHz transducer was used on a Hitachi EUB-8500 machine. The vagus nerve was measured at the bifurcation of common carotid artery (CCA) and at the intersection of the internal jugular vein with omohyoid muscle. The hypoglossal nerve was identified as it crosses the posterolateral border of the mylohyoid muscle in the submandibular space. The auricular nerve was identified on the superficial surface of the sternocleidomastoid muscle at 1 cm from its posterior margin. The mean CSA on axial scans, nerve width and thickness were determined. The side-to-side and gender differences of the estimated reference values and their correlations with the weight, height, and body mass index (BMI) were evaluated. Results The mean ultrasound-estimated CSA was measured for the vagus nerve at CCA bifurcation (2.14 ± 0.79 on the left 2.86 ± 1.27 on the right), vagus nerve at the level of omohyoid muscle (2.10 ± 0.06 on the left and 2.43 ± 0.08 on the right), hypoglossal nerve (1.71 ± 0.08 on the left, 1.24 ± 0.06 on the right) and greater auricular nerve (0.90 ± 0.53 on the left and 0.79 ± 0.71 on the right). The vagus nerve was significantly larger on the right side compared to the left side. Larger hypoglossal nerve was observed in men compared to women. Significant correlations were observed between weight and CSA of the greater auricular nerve. Conclusion Direct visualization of the vagus, greater auricular nerve and hypoglossal nerves is feasible. Reference values for the size of the studied nerves at specific anatomic landmarks were established. Side, gender and body weight differences of the nerves CSA were noted.
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Affiliation(s)
- Andra Diana Curcean
- Radiology Department, Academic Emergency County Hospital, Cluj-Napoca, Romania
| | | | - Sorin Marian Dudea
- Radiology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
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The intracanalicular segment of the hypoglossal nerve: An anatomical study using magnetic resonance imaging. J Clin Neurosci 2019; 68:295-301. [PMID: 31326283 DOI: 10.1016/j.jocn.2019.07.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 07/06/2019] [Indexed: 11/22/2022]
Abstract
Few studies have documented the morphology of the intracanalicular segment of the hypoglossal nerve (CSHN). Therefore, the aim of this study was to characterize the CSHN using magnetic resonance imaging (MRI). In total, 95 patients underwent thin-sliced, contrast MRI. The axial and coronal images were used for analysis. The CSHNs were bilaterally identified in 97% and 94% of the 95 patients on the axial and serial coronal images, respectively. On axial images, length of the hypoglossal canal was measured as 8.2 ± 1.66 mm on the right and 8.4 ± 1.71 mm on the left. The CSHN was delineated as a slightly tortuous, linear structure with variable length. The CSHN course in the hypoglossal canal could be classified into the ventral, central, and ventrodorsal types, with the ventral type most predominant and found in 65% on the right side and 43% on the left. The angle formed by the CSHN and perpendicular line was highly variable. On serial coronal images, the CSHN course in the hypoglossal canal was also variable and could be found in the any part of the canal. The CSHN is a distinct structure characterized by morphological variability, which can influence the type of hypoglossal neuropathy arising from the CSHN.
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Guarnizo A, Glikstein R, Torres C. Imaging Features of isolated hypoglossal nerve palsy. J Neuroradiol 2019; 47:136-150. [PMID: 31034896 DOI: 10.1016/j.neurad.2019.04.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 04/10/2019] [Accepted: 04/11/2019] [Indexed: 10/26/2022]
Abstract
The hypoglossal nerve gives motor innervation to the intrinsic and extrinsic muscles of the tongue. Pathology of this nerve affects the balanced action of the genioglossus muscle causing tongue deviation toward the weak side. Clinically, hypoglossal nerve palsy manifests with difficulty chewing, swallowing and with dysarthric speech herein, we review the anatomy of the hypoglossal nerve as well as common and infrequent lesions that can affect this nerve along its course.
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Affiliation(s)
- Angela Guarnizo
- Neuroradiology Fellow, University of Ottawa - The Ottawa Hospital, Ottawa, Canada
| | - Rafael Glikstein
- Neuroradiologist, University of Ottawa - The Ottawa Hospital, Ottawa, Canada.
| | - Carlos Torres
- Neuroradiologist, University of Ottawa - The Ottawa Hospital, Ottawa, Canada
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Hypoglossal Nerve Palsy as a Cause of Severe Dysphagia along with the Oropharyngeal Stenosis due to Occipitocervical Kyphosis. Case Rep Orthop 2019; 2019:7982847. [PMID: 30963014 PMCID: PMC6431363 DOI: 10.1155/2019/7982847] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Accepted: 02/15/2019] [Indexed: 11/27/2022] Open
Abstract
Hypoglossal nerve palsy (HNP) is a potential cause of dysphagia. A 66-year-old man presented to our hospital with dysphagia and neck pain. One year prior to his first visit, he had been diagnosed with upper cervical tuberculosis and had undergone posterior C1-2 fixation. The physical examination led to the diagnosis of dysphagia with HNP, and he had severe weight loss. Radiographic examination revealed that the O-C kyphosis had been exacerbated and that the deformity was likely the primary cause of HNP. To restore the swallowing function, O-C fusion surgery was performed. Postoperatively, the patient showed immediate improvement of dysphagia with gradual recovery of hypoglossal nerve function. In the last follow-up evaluation, swallowing function was confirmed with no signs of HNP. Our results indicate that HNP could be more prevalent in cases with severe cervical kyphosis, being underdiagnosed due to the more apparent signs of the oropharyngeal narrowing.
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Chhabra A, Bajaj G, Wadhwa V, Quadri RS, White J, Myers LL, Amirlak B, Zuniga JR. MR Neurographic Evaluation of Facial and Neck Pain: Normal and Abnormal Craniospinal Nerves below the Skull Base. Radiographics 2018; 38:1498-1513. [DOI: 10.1148/rg.2018170194] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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17
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Khaku A, Patel V, Zacharia T, Goldenberg D, McGinn J. Guidelines for radiographic imaging of cranial neuropathies. EAR, NOSE & THROAT JOURNAL 2018; 96:E23-E39. [PMID: 29121382 DOI: 10.1177/0145561317096010-1106] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Disruption of the complex pathways of the 12 cranial nerves can occur at any site along their course, and many, varied pathologic processes may initially manifest as dysfunction and neuropathy. Radiographic imaging (computed topography or magnetic resonance imaging) is frequently used to evaluate cranial neuropathies; however, indications for imaging and imaging method of choice vary considerably between the cranial nerves. The purpose of this review is to provide an analysis of the diagnostic yield and the most clinically appropriate means to evaluate cranial neuropathies using radiographic imaging. Using the PubMed MEDLINE NCBI database, a total of 49,079 articles' results were retrieved on September 20, 2014. Scholarly articles that discuss the etiology, incidence, and use of imaging in the context of evaluation and diagnostic yield of the 12 cranial nerves were evaluated for the purposes of this review. We combined primary research, guidelines, and best practice recommendations to create a practical framework for the radiographic evaluation of cranial neuropathies.
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Affiliation(s)
- Aliasgher Khaku
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, The Pennsylvania State University College of Medicine, 500 University Dr., MC H091, Hershey, PA 17033-0850, USA
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Gurung B, Chaudhry IA, Karim N, Nanda U. Case of idiopathic isolated unilateral hypoglossal nerve palsy with spontaneous recovery. BMJ Case Rep 2018; 2018:bcr-2017-223968. [DOI: 10.1136/bcr-2017-223968] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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High-Resolution Isotropic Three-Dimensional MR Imaging of the Extraforaminal Segments of the Cranial Nerves. Magn Reson Imaging Clin N Am 2018; 26:101-119. [DOI: 10.1016/j.mric.2017.08.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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20
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Ai CJ, Jabar NA, Lan TH, Ramli R. Mandibular Canal Enlargement: Clinical and Radiological Characteristics. J Clin Imaging Sci 2017; 7:28. [PMID: 28781925 PMCID: PMC5523564 DOI: 10.4103/jcis.jcis_28_17] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 05/29/2017] [Indexed: 11/25/2022] Open
Abstract
Enlargement of the mandibular canal is a rare radiological finding. Clinically, it may or may not be associated with sensory deficits. We report four cases of widening of the mandibular canal observed with various methods of imaging with different clinical characteristics. We describe this unique radiological finding and elaborate the importance of quality assessment of the imaging that is vital for accurate diagnosis and treatment planning. Clinicians should be mindful when assessing the imaging whenever the size of the mandibular canal is implicated. The case ranged from a benign tumor to malignancy, radiological errors, and artifacts. A more superior imaging or treatment modality was necessary to ascertain the diagnosis.
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Affiliation(s)
- Chong Jun Ai
- Department of Oral Diagnostic and Surgical Sciences, Faculty of Dentistry, International Medical University, Kuala Lumpur, Malaysia
| | - Nazimi Abd Jabar
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, UKM and UKM Medical Centre, Kuala Lumpur, Malaysia
| | - Tan Huann Lan
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, UKM and UKM Medical Centre, Kuala Lumpur, Malaysia
| | - Roszalina Ramli
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, UKM and UKM Medical Centre, Kuala Lumpur, Malaysia
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Panikkar S, Tol G, Siddique I. Iatrogenic bilateral hypoglossal palsy following spinal surgery. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2017; 27:314-317. [PMID: 28698964 DOI: 10.1007/s00586-017-5214-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 06/29/2017] [Accepted: 07/05/2017] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Bilateral hypoglossal palsy is a rare complication during airway management in surgery. CASE PRESENTATION Isolated bilateral hypoglossal palsy was noted post-operatively in a patient who underwent multiple spinal surgeries associated with prone anaesthesia. DISCUSSION Risk factors include difficult, multiple intubations, prolonged surgical time, throat pack, and hyperextension of the neck during intubation. CONCLUSION We aim to create awareness about this complication which has a significant morbidity and negative effect on patient outcomes.
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Affiliation(s)
- Shrijit Panikkar
- Department of Spinal Surgery, Salford Royal NHS Foundation Trust, Stott Lane, Salford, Manchester, M6 8HD, UK.
| | - Govind Tol
- Department of Anaesthesia, Salford Royal NHS Foundation Trust, Stott Lane, Salford, Manchester, M6 8HD, UK
| | - Irfan Siddique
- Department of Spinal Surgery, Salford Royal NHS Foundation Trust, Stott Lane, Salford, Manchester, M6 8HD, UK
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Ekuma ME, Goto T, Hanaoka Y, Kanaya K, Horiuchi T, Hongo K, Ohaegbulam SC. Unilateral isolated hypoglossal nerve palsy due to pathologically adherent PICA fusiform aneurysm - A case report. Surg Neurol Int 2017; 8:114. [PMID: 28680733 PMCID: PMC5482208 DOI: 10.4103/sni.sni_279_16] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 03/21/2017] [Indexed: 12/02/2022] Open
Abstract
Background: Isolated hypoglossal nerve palsy due to mechanical compression by a vascular lesion is rare. Case Description: We report the case of a 72-year-old man who presented with a 4-year history of swallowing disturbance and subsequently progressively worsening left-sided tongue atrophy. He was referred to our department by a neurologist due a magnetic resonance imaging detected left vertebral artery compression of the medulla. Neurological examination was unremarkable except for left hypoglossal nerve dysfunction, which presented as left-sided atrophy and impaired movement of the tongue. Three-dimensional computed tomography angiography showed proximal left posterior inferior cerebellar artery (PICA) origin fusiform aneurysm. Microvascular decompression was done through a left transcondylar fossa approach. Intraoperative findings were thickened arachnoid around the lower cranial nerves, fusiform aneurysm of the left PICA at its origin from the left vertebral artery which was severely adherent to and compressing the left hypoglossal nerve rootlets. Conclusion: The PICA has a very close relationship to the hypoglossal nerve, and its fusiform dilatation could cause isolated hypoglossal nerve dysfunction. Pathological adhesions between hypoglossal rootlets and the PICA aneurysm wall could be a possible contributor in the development and progression of hypoglossal nerve palsy.
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Affiliation(s)
- Mike E Ekuma
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan.,Memfys Hospital for Neurosurgery, Enugu, Nigeria
| | - Tetsuya Goto
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Yoshiki Hanaoka
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Kohei Kanaya
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Tetsuyoshi Horiuchi
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Kazuhiro Hongo
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan
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Patel VA, Zacharia TT, Goldenberg D, McGinn JD. End-organ radiographic manifestations of cranial neuropathies: A concise review. Clin Imaging 2017; 44:5-11. [PMID: 28364580 DOI: 10.1016/j.clinimag.2017.03.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Revised: 02/02/2017] [Accepted: 03/22/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Cranial neuropathies are a spectrum of disorders associated with dysfunction of one or more of the twelve cranial nerves and the subsequent anatomic structures they innervate. OBJECTIVE The purpose of this article is to review radiographic imaging findings of end-organ aberrations secondary to cranial neuropathies. METHOD All articles related to cranial neuropathies were retrieved through the PubMed MEDLINE NCBI database from January 1, 1991 to August 31, 2014. These manuscripts were analyzed for their relation to cranial nerve end-organ disease pathogenesis and radiographic imaging. RESULTS The present review reveals detectable end-organ changes on CT and/or MRI for the following cranial nerves: olfactory nerve, optic nerve, oculomotor nerve, trochlear nerve, trigeminal nerve, abducens nerve, facial nerve, vestibulocochlear nerve, glossopharyngeal nerve, vagus nerve, accessory nerve, and hypoglossal nerve. CONCLUSION Radiographic imaging can assist in the detailed evaluation of end-organ involvement, often revealing a corresponding cranial nerve injury with high sensitivity and diagnostic accuracy. A thorough understanding of the distal manifestations of cranial nerve disease can optimize early pathologic detection as well as dictate further clinical management.
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Affiliation(s)
- Vijay A Patel
- Department of Surgery, Division of Otolaryngology - Head and Neck Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA, USA
| | - Thomas T Zacharia
- Department of Radiology, The Pennsylvania State University, College of Medicine, Hershey, PA, USA
| | - David Goldenberg
- Department of Surgery, Division of Otolaryngology - Head and Neck Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA, USA
| | - Johnathan D McGinn
- Department of Surgery, Division of Otolaryngology - Head and Neck Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA, USA.
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Iwanaga J, Fisahn C, Alonso F, DiLorenzo D, Grunert P, Kline MT, Watanabe K, Oskouian RJ, Spinner RJ, Tubbs RS. Microsurgical Anatomy of the Hypoglossal and C1 Nerves: Description of a Previously Undescribed Branch to the Atlanto-Occipital Joint. World Neurosurg 2017; 100:590-593. [PMID: 28109859 DOI: 10.1016/j.wneu.2017.01.038] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 01/07/2017] [Accepted: 01/10/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Distal branches of the C1 nerve that travel with the hypoglossal nerve have been well investigated but relationships of C1 and the hypoglossal nerve near the skull base have not been described in detail. Therefore, the aim of this study was to investigate these small branches of the hypoglossal and first cervical nerves by anatomic dissection. METHODS Twelve sides from 6 cadaveric specimens were used in this study. To elucidate the relationship among the hypoglossal, vagus, and first and cervical nerve, the mandible was removed and these nerves were dissected under the surgical microscope. RESULTS A small branch was found to always arise from the dorsal aspect of the hypoglossal nerve at the level of the transverse process of the atlas and joined small branches from the first and second cervical nerves. The hypoglossal and C1 nerves formed a nerve plexus, which gave rise to branches to the rectus capitis anterior and rectus capitis lateralis muscles and the atlanto-occipital joint. CONCLUSIONS Improved knowledge of such articular branches might aid in the diagnosis and treatment of patients with pain derived from the atlanto-occipital joint. We believe this to be the first description of a branch of the hypoglossal nerve being involved in the innervation of this joint.
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Affiliation(s)
- Joe Iwanaga
- Seattle Science Foundation, Seattle, Washington, USA; Department of Anatomy, Kurume University School of Medicine, Kurume, Fukuoka, Japan; Dental and Oral Medical Center, Kurume University School of Medicine, Kurume, Fukuoka, Japan.
| | - Christian Fisahn
- Seattle Science Foundation, Seattle, Washington, USA; Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USA
| | - Fernando Alonso
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USA
| | - Daniel DiLorenzo
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USA
| | - Peter Grunert
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USA
| | | | - Koichi Watanabe
- Department of Anatomy, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Rod J Oskouian
- Seattle Science Foundation, Seattle, Washington, USA; Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USA
| | - Robert J Spinner
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - R Shane Tubbs
- Seattle Science Foundation, Seattle, Washington, USA; Department of Anatomical Sciences, St. George's University, West Indies, Grenada
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Noble DJ, Scoffings D, Ajithkumar T, Williams MV, Jefferies SJ. Fast imaging employing steady-state acquisition (FIESTA) MRI to investigate cerebrospinal fluid (CSF) within dural reflections of posterior fossa cranial nerves. Br J Radiol 2016; 89:20160392. [PMID: 27636022 DOI: 10.1259/bjr.20160392] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE There is no consensus approach to covering skull base meningeal reflections-and cerebrospinal fluid (CSF) therein-of the posterior fossa cranial nerves (CNs VII-XII) when planning radiotherapy (RT) for medulloblastoma and ependymoma. We sought to determine whether MRI and specifically fast imaging employing steady-state acquisition (FIESTA) sequences can answer this anatomical question and guide RT planning. METHODS 96 posterior fossa FIESTA sequences were reviewed. Following exclusions, measurements were made on the following scans for each foramen respectively (left, right); internal acoustic meatus (IAM) (86, 84), jugular foramen (JF) (83, 85) and hypoglossal canal (HC) (42, 45). A protocol describes measurement procedure. Two observers measured distances for five cases and agreement was assessed. One observer measured all the remaining cases. RESULTS IAM and JF measurement interobserver variability was compared. Mean measurement difference between observers was -0.275 mm (standard deviation 0.557). IAM and JF measurements were normally distributed. Mean IAM distance was 12.2 mm [95% confidence interval (CI) 8.8-15.6]; JF was 7.3 mm (95% CI 4.0-10.6). The HC was difficult to visualize on many images and data followed a bimodal distribution. CONCLUSION Dural reflections of posterior fossa CNs are well demonstrated by FIESTA MRI. Measuring CSF extension into these structures is feasible and robust; mean CSF extension into IAM and JF was measured. We plan further work to assess coverage of these structures with photon and proton RT plans. Advances in knowledge: We have described CSF extension beyond the internal table of the skull into the IAM, JF and HC. Oncologists planning RT for patients with medulloblastoma and ependymoma may use these data to guide contouring.
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Affiliation(s)
- David J Noble
- 1 Department of Oncology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, UK
| | - Daniel Scoffings
- 2 Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Thankamma Ajithkumar
- 1 Department of Oncology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, UK
| | - Michael V Williams
- 1 Department of Oncology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, UK
| | - Sarah J Jefferies
- 1 Department of Oncology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, UK
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Meng S, Reissig LF, Tzou CH, Meng K, Grisold W, Weninger W. Ultrasound of the Hypoglossal Nerve in the Neck: Visualization and Initial Clinical Experience with Patients. AJNR Am J Neuroradiol 2016; 37:354-9. [PMID: 26405084 DOI: 10.3174/ajnr.a4494] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 05/22/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The hypoglossal nerve, providing motor innervation for the tongue, can be affected in many diseases of the neck and skull base, leading to dysarthria, dysphagia, and ultimately atrophy of the tongue. We determined the feasibility of direct visualization of the hypoglossal nerve in the neck with ultrasound, testing this technique on healthy volunteers and evaluating it in clinical practice. MATERIALS AND METHODS The study consisted of 4 parts: first, ultrasound-guided perineural ink injections along the course of the hypoglossal nerve at 24 sides of 12 fresh, nonembalmed cadaver necks. Subsequently, the specimens were dissected to confirm the correct identification of the nerve. The second part was examination of healthy volunteers with ultrasound and measurement of cross-sectional areas for generating reference data. The third part was scanning of healthy volunteers by 2 resident physicians with little and intermediate experience in ultrasound. Fourth was examination with ultrasound of patients with motor symptoms of the tongue. RESULTS The hypoglossal nerve was correctly identified bilaterally in all cadaveric specimens (24/24) and all volunteers (33/33). The cross-sectional area ranged from 1.9 to 2.1 mm(2). The resident physicians were able to locate the nerve in 19 of 22 cases, demonstrating that locating the nerve is reproducible and feasible even with intermediate experience in ultrasound. Finally, alterations of the hypoglossal nerve in disease states could be depicted. CONCLUSIONS Direct, reliable, and reproducible visualization of the extracranial hypoglossal nerve with ultrasound is feasible.
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Affiliation(s)
- S Meng
- From the Departments of Radiology (S.M.) Center for Anatomy and Cell Biology (S.M., L.F.R., W.W.)
| | - L F Reissig
- Center for Anatomy and Cell Biology (S.M., L.F.R., W.W.)
| | - C-H Tzou
- Division of Plastic and Reconstructive Surgery (C.-H.T.), Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - K Meng
- Ear, Nose, and Throat Diseases (K.M.)
| | - W Grisold
- Neurology (W.G.), KFJ Hospital, Vienna, Austria
| | - W Weninger
- Center for Anatomy and Cell Biology (S.M., L.F.R., W.W.)
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Kanda T, Kiritoshi T, Osawa M, Toyoda K, Oba H, Kotoku J, Kitajima K, Furui S. The incidence of double hypoglossal canal in Japanese: evaluation with multislice computed tomography. PLoS One 2015; 10:e0118317. [PMID: 25706378 PMCID: PMC4338081 DOI: 10.1371/journal.pone.0118317] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Accepted: 01/14/2015] [Indexed: 11/19/2022] Open
Abstract
Background and Purpose Double hypoglossal canal, namely a hypoglossal canal bridging, is a normal variation of the hypoglossal canal. Racial differences in the prevalence of double hypoglossal canal have been reported. We evaluated the prevalence of double hypoglossal canal in a Japanese population with multidetector computed tomography (MDCT). Materials and Methods We reviewed five hundred and ninety consecutive patients (mean age, 61 years: range, 15–94 years: 254 men, 336 women) who underwent computed tomographic angiography (CTA) of the brain for a variety of CNS abnormalities. Two radiologists achieved consensus on the canal being single or double, and measured the sizes of single canals on CT images. Kappa statistics was used to test the reliability between the 2 investigators. A logistic regression was used to evaluate the prevalence of double hypoglossal canal and the following factors: sex, age, and laterality. Student’s t-test was used to evaluate the asymmetry of single hypoglossal canal diameters. Statistical significance was accepted at P < 0.05. Results Double hypoglossal canal was identified in 16.9% of the patients, and was bilateral in 2.2%. Double hypoglossal canal was significantly more frequent on the left side than right (P = 0.004, odds ratio = 1.79) and in males than females (P = 0.011, odds ratio = 1.67). A larger left or right-sided canal was found in 31.6% and 12.2% of the patients, respectively, following the same side preference as that of double hypoglossal canal. Almost perfect agreement was achieved between the two readers (k = 0.975). Conclusions In this Japanese population, the prevalence of a double hypoglossal canal was 16.9%, of which 2.2% were bilateral. Double hypoglossal canal was more frequent in males than females, and on the left side than right.
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Affiliation(s)
- Tomonori Kanda
- Department of Radiology, Teikyo University School of Medicine, Tokyo, Japan
- * E-mail:
| | - Tomoki Kiritoshi
- Department of Radiology, Teikyo University School of Medicine, Tokyo, Japan
| | - Marie Osawa
- Department of Radiology, Teikyo University School of Medicine, Tokyo, Japan
| | - Keiko Toyoda
- Department of Radiology, Teikyo University School of Medicine, Tokyo, Japan
| | - Hiroshi Oba
- Department of Radiology, Teikyo University School of Medicine, Tokyo, Japan
| | - Jun’ichi Kotoku
- Department of Radiological Technology Faculty of Medical Technology, Teikyo University School of Medicine, Tokyo, Japan
| | - Kazuhiro Kitajima
- Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Shigeru Furui
- Department of Radiology, Teikyo University School of Medicine, Tokyo, Japan
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Chen YG, Dai MS, Ho CL, Huang TC. Isolated hypoglossal nerve paralysis. Am J Med 2014; 127:926-7. [PMID: 24811553 DOI: 10.1016/j.amjmed.2014.03.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Revised: 03/26/2014] [Accepted: 03/26/2014] [Indexed: 10/25/2022]
Affiliation(s)
- Yu-Guang Chen
- Division of Hematology/Oncology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Ming-Shen Dai
- Division of Hematology/Oncology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Ching-Liang Ho
- Division of Hematology/Oncology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Tzu-Chuan Huang
- Division of Hematology/Oncology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC.
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Brea Álvarez B, Tuñón Gómez M. Diseminación perineural en tumores de cabeza y cuello. RADIOLOGIA 2014; 56:400-12. [DOI: 10.1016/j.rx.2014.04.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2013] [Revised: 03/20/2014] [Accepted: 04/13/2014] [Indexed: 01/08/2023]
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Patro SN, Torres C, Riascos R. An unusual case of isolated hypoglossal nerve palsy secondary to osteophytic projection from the atlanto-occipital joint. Neuroradiol J 2014; 27:361-4. [PMID: 24976205 DOI: 10.15274/nrj-2014-10039] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Accepted: 04/05/2014] [Indexed: 11/12/2022] Open
Abstract
We describe an unusual and rare case of isolated left hypoglossal nerve palsy secondary to compression from a prominent degenerative osteophyte from the left atlanto-occipital joint. The hypoglossal nerve is a purely motor cranial nerve innervating the tongue musculature. Palsy of the hypoglossal nerve is frequently associated with other cranial nerve palsies and can be related to vascular, neoplastic, infectious or traumatic conditions. Isolated hypoglossal nerve palsy is quite rare and very few cases have been reported in the literature to date.
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Affiliation(s)
- Satya Narayana Patro
- Department of Radiology, University of Ottawa, The Ottawa Hospital; Ottawa, ON, Canada -
| | - Carlos Torres
- Department of Radiology, University of Ottawa, The Ottawa Hospital; Ottawa, ON, Canada
| | - Roy Riascos
- Department of Radiology, The University of Texas Medical Branch; Galveston, TX, USA
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Emohare O, Peterson E, Slinkard N, Janus S, Morgan R. Occam paradox? A variation of tapia syndrome and an unreported complication of guidewire-assisted pedicle screw insertion. EVIDENCE-BASED SPINE-CARE JOURNAL 2014; 4:132-6. [PMID: 24436711 PMCID: PMC3836948 DOI: 10.1055/s-0033-1357355] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Accepted: 07/18/2013] [Indexed: 12/13/2022]
Abstract
Study Design Case report. Clinical Question The clinical aim is to report on a previously unknown association between guidewire-assisted pedicle screw insertion and neuropraxia of the recurrent laryngeal nerve (RLN), and how this may overlap with the signs of Tapia syndrome; we also report our approach to the clinical management of this patient. Methods A 17-year-old male patient with idiopathic scoliosis experienced Tapia syndrome after posterior instrumentation and arthrodesis at the level of T1-L1. After extubation, the patient had a hoarse voice and difficulty in swallowing. Imaging showed a breach in the cortex of the anterior body of T1 corresponding to the RLN on the right. Results Otolaryngological examination noted right vocal fold immobility, decreased sensation of the endolarynx, and pooling of secretions on flexible laryngoscopy that indicated right-sided cranial nerve X injury and left-sided tongue deviation. Aspiration during a modified barium swallow prompted insertion of a percutaneous endoscopic gastrostomy tube before the patient was sent home. On postoperative day 20, a barium swallow demonstrated reduced aspiration, and the patient reported complete resolution of symptoms. The feeding tube was removed, and the patient resumed a normal diet 1 month later. Tapia syndrome, or persistent unilateral laryngeal and hypoglossal paralysis, is an uncommon neuropraxia, which has previously not been observed in association with a breached vertebral body at T1 along the course of the RLN. Conclusion Tapia syndrome should be a differential diagnostic consideration whenever these symptoms persist postoperatively and spine surgeons should be aware of this as a potential complication of guidewires in spinal instrumentation.
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Affiliation(s)
- Osa Emohare
- Center for Spine and Spinal Cord Injury, Regions Hospital, St. Paul, Minnesota, United States ; Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota, United States
| | - Erik Peterson
- Center for Spine and Spinal Cord Injury, Regions Hospital, St. Paul, Minnesota, United States
| | - Nathaniel Slinkard
- Department of Orthopaedic Surgery, Henry Ford Health System, Detroit, Michigan, United States
| | - Seth Janus
- Department of Otolaryngology, Regions Hospital, St. Paul, Minnesota, United States ; Department of Otolaryngology, University of Minnesota, Minneapolis, Minnesota, United States
| | - Robert Morgan
- Center for Spine and Spinal Cord Injury, Regions Hospital, St. Paul, Minnesota, United States ; Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota, United States
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Abstract
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. The patient had a boggy tongue with a deviation to the right side but an otherwise normal neurological examination. Magnetic resonance angiography showed a narrow lumen of the right vertebral artery in the neck. After initially treating the patient with aspirin in the emergency room and later with warfarin for three months, there was complete recanalization of the right vertebral artery. Only one other case of vertebral artery dissection and twelfth nerve palsy has been reported before.
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Affiliation(s)
- Karthik Mahadevappa
- Department of Neurology, Quincy Medical Center/ Alzheimer’s Disease Center, Quincy, Massachusetts, USA
| | - Thomas Chacko
- Department of Radiology, Quincy Medical Center, Quincy, Massachusetts, USA
| | - Anil K. Nair
- Department of Neurology, Quincy Medical Center/ Alzheimer’s Disease Center, Quincy, Massachusetts, USA
- Corresponding Author: Anil K. Nair, MD, Chief of Neurology, Quincy Medical Center, Director, Alzheimer’s Disease Center, 114 Whitwell Street, 4th floor, Quincy, MA 02169, USA, Tel: (617) 302-6388, G.Voice: (617) 639-5006, Fax: (617) 934-2425,
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Anatomical landmarks for transoral robotic tongue base surgery: comparison between endoscopic, external and radiological perspectives. Surg Radiol Anat 2012; 35:3-10. [DOI: 10.1007/s00276-012-0983-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2011] [Accepted: 05/11/2012] [Indexed: 12/25/2022]
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Lorenzoni PJ, Scola RH, Kay CS, Novak FT, Cardoso EH, Scalcon MR, Rachid Filho A, Werneck LC. Isolated hypoglossal nerve palsy: an unusual rare presentation in systemic lupus erythematosus. ARQUIVOS DE NEURO-PSIQUIATRIA 2011; 69:843-4. [DOI: 10.1590/s0004-282x2011000600025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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HONG JT, TAKIGAWA T, SUGISAKI K, ORÍAS AAE, INOUE N, AN HS. Biomechanical and Morphometric Evaluation of Occipital Condyle for Occipitocervical Segmental Fixation. Neurol Med Chir (Tokyo) 2011; 51:701-6. [DOI: 10.2176/nmc.51.701] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Jae Taek HONG
- Department of Neurosurgery, Catholic University of Korea, St. Vincent's Hospital
- Department of Orthopedic Surgery, Rush University Medical Center
| | - Tomoyuki TAKIGAWA
- Department of Orthopedic Surgery, Kobe Red Cross Hospital
- Department of Orthopedic Surgery, Rush University Medical Center
| | - Keizo SUGISAKI
- Department of Orthopedic Surgery, Rush University Medical Center
| | | | - Nozomu INOUE
- Department of Orthopedic Surgery, Rush University Medical Center
| | - Howard S. AN
- Department of Orthopedic Surgery, Rush University Medical Center
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SAITOU NARUYA, KIMURA RYOSUKE, FUKASE HITOSHI, YOGI AKIRA, MURAYAMA SADAYUKI, ISHIDA HAJIME. Advanced CT images reveal nonmetric cranial variations in living humans. ANTHROPOL SCI 2011. [DOI: 10.1537/ase.100928] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- NARUYA SAITOU
- Division of Population Genetics, National Institute of Genetics, Mishima
| | - RYOSUKE KIMURA
- Transdisciplinary Research Organization for Subtropics and Island Studies, University of the Ryukyus, Okinawa
| | - HITOSHI FUKASE
- Department of Human Biology and Anatomy, Faculty of Medicine, University of the Ryukyus, Okinawa
| | - AKIRA YOGI
- Department of Radiology, Faculty of Medicine, University of the Ryukyus, Okinawa
| | - SADAYUKI MURAYAMA
- Department of Radiology, Faculty of Medicine, University of the Ryukyus, Okinawa
| | - HAJIME ISHIDA
- Department of Human Biology and Anatomy, Faculty of Medicine, University of the Ryukyus, Okinawa
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