Manual Therapy and Exercise for a Patient With Neck-Tongue Syndrome: A Case Report

The anterolateral cervicoatlantooccipital plexus: A novel finding with application to skull base and spine surgery and pain disorders of the head and neck

INTRODUCTION

A novel nerve plexus of the upper neck is described. By exploring how the individual components of this specific anterolateral nerve plexus communicate with each other, patient care may be improved in regard to preoperative diagnosis, intraoperative navigation, and minimally invasive treatments.

MATERIALS AND METHODS

Using a surgical microscope, 11 adult cadaveric heads (22 sides) were dissected. The region of the junction between the atlantooccipital and craniocervical junctions was explored, specifically, the innervation of this region via adjacent nerve connections. Branches from these regional nerve sources were analyzed for interconnections and when found, these branches were documented and measured.

RESULTS

A delicate nerve plexus was found overlying the anterolateral C1-C2 junction in all specimens. The plexus was contributed by the sympathetic trunk, vagus nerve, hypoglossal nerve, and C1 and C2 ventral rami. We termed this plexus the anterolateral cervicoatlantooccipital plexus (ALCAO plexus). On all but two sides (91%), the C2 ventral ramus provided the most input into the plexus with 1 to 2 branches. On two sides, the C1 ventral ramus was the primary contribution and on average, this nerve contributed 1 to 2 branches to the plexus. Interestingly, on eight sides (36.4%), the C1 fibers that are known to travel with the hypoglossal nerve and to be distributed to the geniohyoid and thyrohyoid muscles arose from C1 nerve fibers that first traversed the ALCAO plexus. The sympathetic trunk contributed 1 to 4 lateral branches with the majority of these arising superiorly from the superior cervical ganglion. The vagus nerve contributed 1-2 lateral branches and the hypoglossal nerve contributed 1 to 2 anteromedial branches. This plexus was located more or less lateral to the sympathetic trunk and superior cervical ganglion and medial to the transverse process of C1 and C2. The plexus innervated the rectus capitis lateralis, rectus capitis anterior, lateral atlantooccipital joint and on four sides, the atlantoaxial joint. Additionally, small branches were seen traveling to the anterior atlantoaxial and anterior atlantooccipital membranes on 55% and 77.2% of sides, respectively. On six sides, very small branches from the ALCAO plexus ended in the periosteum over the anterolateral aspect of the anterior arch and transverse process of the C1 vertebra.

CONCLUSION

It is important to recognize that the course of these interneural connections are variable and may pose unforeseen complications during surgical procedures. A comprehensive knowledge of these neural connections is useful when surgery and pathology of the neck and skull base are considered.

A Systematic Review of Case Reports on the Neck-Tongue Syndrome

Background and Objectives: Neck-tongue syndrome (NTS) is rare, and characterized by unilateral upper neck or occipital pain and paresthesia in the ipsilateral hemisphere of the tongue due to neck movement. Treatment for NTS is mainly conservative, but the symptoms, causes, and rationale for treatment remain controversial. This study aimed to provide a framework for NTS treatment in clinical practice based on recent treatment directions. Materials and Methods: Case reports published from the past 20 years to August 2021 were searched through MEDLINE, EMBASE, and PEDro databases. Since there is no established management for NTS, the search terms were neck-tongue syndrome and case reports. The Critical Appraisal Checklist for Case Reports was used for the quality assessment of case reports. Through descriptive analysis, NTS symptoms, interventions, and results were reviewed. Results: Among the 16 studies searched, six case reports were selected and analyzed based on eight criteria. Symptoms included neck pain and ipsilateral tongue paralysis when the head was turned. As an intervention, six and four studies showed immediate symptom relief through manual therapy and exercise, respectively. Conclusions: Based on the reviewed evidence, management through physical therapy and chiropractic therapy with conservative methods such as manual therapy and exercise for patients with neck-tongue syndrome is recommended.

Neck-tongue syndrome

Neck–tongue syndrome (NTS) is a rarely reported disorder characterised by paroxysmal episodes of intense pain in the upper cervical or occipital areas associated with ipsilateral hemiglossal dysaesthesia brought about by sudden neck movement. The most likely cause of this clinical entity is a temporary subluxation of the lateral atlantoaxial joint with impaction of the C2 ventral ramus against the articular processes on head rotation. NTS is an under-recognised condition that can be debilitating for patients and challenging for the treating physicians. Here, we report a 47-year-old man who fulfilled the International Classification of Headache Disorders, third edition criteria for a diagnosis of NTS was treated successfully with a chiropractic approach. There are currently no consensus guidelines for dealing with this disorder. Reassuringly, chiropractic care for uncomplicated NTS appears highly effective.

Chiropractic Management of a Patient With Neck-Tongue Syndrome: A Case Report

OBJECTIVE

The purpose of this case report was to describe the chiropractic management of a patient with neck-tongue syndrome (NTS).

CLINICAL FEATURES

A 34-year-old female patient sought treatment at a chiropractic clinic for symptoms involving neck pain associated with left-sided paresthesia of the tongue that had persisted for >2 years. A diagnosis of NTS was made.

INTERVENTION AND OUTCOME

The patient was treated with spinal manipulation, myofascial release, and home exercises. After 2 weeks, she was symptom free. At the 2-year follow-up, the patient remained free of symptoms.

CONCLUSION

This patient with NTS responded favorably to a course of chiropractic care.