Hypoglossal nerve

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Hypoglossal nerve

  1. 1. Hypoglossal nerve Dr / Hytham Nafady
  2. 2. Introduction <ul><li>hypoglossal nerve has only a somatic motor component (general somatic efferent) that supplies the extrinsic and intrinsic tongue muscles. </li></ul>
  3. 5. Anatomy
  4. 6. Segments of the hypoglossal nerve <ul><li>Hypoglossal nucleus. </li></ul><ul><li>Intracranial segments: </li></ul><ul><li>Medullary segment. </li></ul><ul><li>Cisternal segment. </li></ul><ul><li>Canalicular segment. </li></ul><ul><li>Extracranial segments: </li></ul><ul><li>Nasopharyngeal/oropharyngeal carotid space. </li></ul><ul><li>Sublingual segment. </li></ul>
  5. 8. Hypoglossal nucleus, medullary & cisternal segments
  6. 9. Hypoglossal nucleus <ul><li>Location: </li></ul><ul><li>Hypoglossal colliculus of the medulla oblongata. </li></ul>
  7. 11. Medullary segment <ul><li>The fibers of the hypoglossal nerve course anteriorly lateral to the medial leminscus & lateral to the olive. </li></ul><ul><li>The hypoglossal nerve exits the medulla at the pre-olivary sulcus. </li></ul>
  8. 13. Cisternal segment <ul><li>The hypoglossal nerve course laterally through the premedullary cistern, posterolateral to the vertebral artery. </li></ul>
  9. 14. PICA Hypoglossal nerve Vertebral arteries
  10. 15. Canalicular segment (hypoglossal canal)
  11. 16. Hypoglossal canal axial CT
  12. 17. Hypoglossal canal coronal CT
  13. 18. Persistent primitive hypoglossal artery
  14. 20. Interpeduncular cistern ICA Sigmoid sinus IJV Cn 12 Cn 10 Cn 9
  15. 21. Suprahyoid carotid space segment <ul><li>The hypoglossal nerve lies deep to the IJV , ICA & 9 & 10 cranial nerves. </li></ul><ul><li>It become superficial as it courses anteriorly. </li></ul><ul><li>At the level of angle of the mandible it loops anteriorly around the root of the occipital artery and lying deep to the posterior belly of digastric muscle. </li></ul>
  16. 22. Sublingual segment <ul><li>The hypoglossal nerve enters the sublingual space by crossing the lingual artery at the level of hyoid bone. </li></ul><ul><li>The hypoglossal nerve lies superfical to the hyoglossus muscle & deep to the myelohyoid muscle. </li></ul>
  17. 25. suprahyoid carotid space segment
  18. 31. platymsa base Intrinsic muscles GG GH
  19. 34. Action of genioglossus in sticking out the tongue
  20. 35. Tongue protrusion
  21. 36. Pushing the tongue into the cheek against resistance
  22. 37. Hypoglossal palsy
  23. 38. Medullary glioma
  24. 39. Vertebrobasilar dolichoectasia with hypoglossal nerve palsy
  25. 40. Meningioma
  26. 41. Cisternal hypoglossal schwannoma with tongue atrophy
  27. 42. Isolated hypoglossal palsy caused by synovial cyst
  28. 43. Hypoglossal schwannoma
  29. 44. Occipital condylar fracture
  30. 45. Skull base metastasis
  31. 46. Carotid artery dissection
  32. 48. Extracranial hypoglossal schwannoma with tongue hemiatrophy
  33. 49. Submandibular hypoglossal schwannoma
  34. 50. Thank you

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