TRIGEMINAL,
GLOSSOPHARYNGEAL
AND HYPOGLOSSAL NERVES
PRESENTED BY
MANTHRU NAIK
1ST YEAR PG
GUIDED BY
Dr. K. SUREKHA MDS
PRO...
NERVEINORDER
Cranial Nerve I - Olfactory
Cranial Nerve II - Optic
Cranial Nerve III - Occulomotor
Cranial Nerve IV - Troch...
ELEMENTARYSTRUCTUREOFA TYPICALNEURON
TYPES OF NEURON
1-UNIPOLAR
2-BIPOLAR
3-MULTIPOLAR
4-PSEUDOUNIPOLAR
TRIGEMINALNERVE
EMBRYOLOGYOFTRIGEMINALNERVE
Trigeminal nerve is derived from 1st pharyngeal arch
NUCLEI OFTRIGEMINALNERVE
1) Mesencephalic nuclei
2) Main sensory nuclei
3) Spinal nuclei
4) Motor nuclei
sensory
FUNCTIONAL PATHWAYS OFTRIGEMINAL NERVE
TOUCH PATHWAYFROM THE HEAD
PAIN & TEMPERATURE PATHWAY
ATTACHMENT OFTRIGEMINAL
NERVE TO BRAIN
TRIGEMINAL GANGLION
RELATIONS OF TRIGEMINAL GANGLION
Foramen lacerum
Medial relations
TRIGEMINAL NERVE
THE OPHTHALMIC DIVISION
COURSE
BRANCHES
GANGLIAASSOCIATEDWITH THE TRIGEMINALNERVE
CILIARY GANGLION
a- occulomotor nerve
b- internal carotid plexus
c- nasociliary ...
OPHTHALMIC NERVE NUT
SHELL
SUPRAORBITAL
SUPRATROCHLEAR
LACRIMAL
REGION OF
NASOCILLIARY
AREA OF DISTRIBUTION
COURSE
MAXILLARY DIVISION
CRANIUM
PTERYGOPALATINE
FOSSA
INFRAORBITAL
CANAL
FACE
BRANCHES
SUPERIORALVEOLAR NERVES
PTERYGOPALATINEGANGLION
ROOTS
BRANCHES
NASOPALTINE AND GREATER PALATINE NERVES
2) Nasopalatine nerve 4) Greater palatine nerve
5) Lesser palatine nerve
ZYGOMATIC
REGION
SUPERIOR
ALVELOLAR
REGION
INFRAORBITAL
REGION
AREA OF DISTRIBUTION
MAXILLARY NERVE NUT SHELL
COURSE
MANDIBULAR DIVISION
BRANCHES OF MAIN TRUNK
(2)
BRANCHES OF ANTERIOR DIVISION
BRANCHES OF POSTERIOR DIVISION
(2 )
LINGUALNERVE
INFERIOR ALVEOLAR NERVE
INFERIORALVEOLAR
NERVE
LINGUAL NERVE
INFERIORALVEOLAR
ARTERY
SPHENOMANDIBULAR
LIGAMENT
BRANCHES
Mylohyoid nerve
OTIC GANGLION
Preganglionic
parasympathetic fibers
Inferior salivatory nucleus
in medulla
glossopharyngeal N.jugular foramen
Glossophary...
SUBMANDIBULAR GANGLION
SECRETOMOTOR PATHWAYTO SUBMANDIBULAR
AND SUBLINGUALGLAND
AREA OF DISTRIBUTION
AURICULO-
TEMPORAL
BRANCHESOF
BUCCAL
INFERIOR ALVEOLAR AND
MENTAL
MOTOR ROOT OF TRIGEMINALNERVE
MANDIBULAR NERVE NUT SHELL
OVERALLDISTRIBUTION OF TRIGEMINALNERVE
EXAMINATION OF TRIGEMINAL NERVE
SENSORY FUNCTION
MOTOR FUNCTION
V1
V2 V3
BULK OF MASSETER STRENGTH OF JAW OPENING
TRIGEMINAL REFLEXES
CORNEAL REFLEX JAW JERK REFLEX
CLINICAL APPLICATIONS OFTRIGEMINAL NERVE
TRIGEMINAL GANGLION
Trigeminal neuralgia (tic douloureux)
The paratrigeminal synd...
TRIGEMINAL NEURALGIA
PAIN
sudden ,usually ,unilateral ,severe ,
brief ,stabbing , lancinating ,
stereotyped and recurring ...
SYMPTOMS
TRIGGER POINTS
TYPES OF TRIGEMINAL NEURALGIA
CLASSI TN
SYMPTOMATIC TN
AETIOLOGY
Usually idiopathic
Other etiological factors include
COMMON PATTERNS OF VASCULAR
COMPRESSION OF TRIGEMINALNERVE
(JANNETA, 1967)
Intra cranial tumors - cerebellopontine angle
tumors
Postherpetic neuralgia
Multiple sclerosis (MS)
Infections
PATHOGENESIS
Demyelination
Hyperactivity or abnormal discharge of impluses
(ignition hypothesis - Devor et al )
Ephaptic c...
Ephaptic cross- talk between fibres
Touching trigger points causes pain
DIAGNOSIS
Sweet diagnostic criteria
1. Pain is paroxysmal
2. The pain may be provoked by light touch to the face
(trigger ...
DIFFERENTIAL DIAGNOSIS
Differentiation from atypical facial pain
TREATMENT
Medical treatment
Surgical treatment
Peripheral injections(anaesthetic agent or
95% absolute alcohol)
Peripheral...
TREATMENT ALGORITHAM
MEDICALTREATMENT
HOWADRUG FOR SEIZURES IS
USEFUL IN THE TREATMENT OF
NEUROPATHIC PAIN ?
MICROVASCULAR DECOMPRESSION
Craniotomy Vascular compression
Teflon sponge placed Fixation of Ti plate
SURGICAL TREATMENT
RHIZOTOMY PROCEDURES
Percutaneous glycerol rhizotomy Balloon compression rhizotomy
Stereotactic Radiosurgery (Gamma Knife)
Attachment of a frame Beams of cobalt radiation are precisely
focused
Percutaneous stereotactic radiofrequency
rhizotomy (PSR)
Preparation of the patient Insertion of electrode
Identification ...
Peripheral Rhizotomies Microsurgical Rhizotomy
Wallenberg syndrome
OPHTHALMIC DIVISION
Ethmoid tumours
Nasal fractures
Supraorbital injuries
Bilateral cleft lip and palate
Herpes zoster oph...
MANDIBULAR DIVISION
Lingual nerve
Inferior alveolar nerve
Mental nerve neuralgia
Mumps
Submandibular duct
Superficial temp...
THEAURICULOTEMPRAL NERVE
SYNDROME(FREYSYNDROME)
Mechanism of frey’s syndrome
Sweating and flushing in area supplied
by aur...
GLOSSOPHARYNGEAL NERVE
Glossopharyngeal nerve nuclei
FUNCTIONAL MODALITIES: SVE, GVE, GVA, SVA, GSA
Am - Nucleus ambiguus I s - Inferior salivary...
COURSE
BRANCHES
TYMPANIC BRANCH
OUTLINE OF GLOSSOPHARYNGEAL NERVE
Effects of Damage and Clinical Test
 Gag reflex
 Ask the patient to swallow or cough
 Test the posterior one-third of t...
CLINICALIMPLICATIONS
GLOSSOPHARYNGEALNEURALGIA
DRUGS
TEGRETOL
NEURONTIN
(GABAPENTIN)DILANTIN
LIORESAL
(BACLOFEN)
Diagnosti...
HYPOGLOSSALNERVE
HYPOGLOSSALNUCLEUS
Segments of the hypoglossal nerve
Hypoglossal
nerve
Vertebral arteries
COURSE
Hypoglossal nucleus, medullary & cisternal segments
Suprahyoid carotid space segment
Sublingual segment
BRANCHES OFHYPOGLOSSALNERVE
Hypoglossal nerve nut shell
EXAMINING THE HYPOGLOSSAL NERVE
HYPOGLOSSALPALSY
 Unilateral palsy is merely troublesome, resulting
in difficulty with speech, tongue biting during
masti...
IATROGENIC INJURIES OFHYPOGLOSSALNERVE
During
 Dissection of floor of submandibular triangle
 Blind application of hemos...
 The use of transverse neck incisions has probably
served to increase the number of injuries to the
hypoglossal nerve and...
DISSECTION IN SUBMANDIBULAR TRIANGLE
First Surgical Plane: The Roof of the Submandibular Triangle
•Composed of skin, super...
Second Surgical Plane:The Contents of theSubmandibular
Triangle
 Structures of the second surgical plane, from superficia...
Contents of submandibular triangle
Third SurgicalPlane:The Floorof the SubmandibularTriangle
 Structures of the third surgical plane, from superficial to de...
Fourth Surgical Plane: The Basement of the
SubmandibularTriangle
 Deep portion of the submandibular gland
 Submandibular...
The Basement of the Submandibular Triangle
RANINE VEIN
 Ranine vein is vena comitans of hypoglossal nerve which
begins below the tip of the tongue.
 Inadvertent cl...
HIGHEXPOSURE OFINTERNALCAROTIDARTERY
DURING CAROTID ENDARTERECTOMY
 The hypoglossal nerve, because of its intimate relati...
STRUCTURESTETHERING HYPOGLOSSALNERVE
Sternocleidomastoid artery
and vein
Occipital artery
Descends hypoglossi
Digastric mu...
METHODS OFATRAUMATIC MOBILISATION OF
HYPOGLOSSALNERVE
By dividing sternocleidomastoid artery
By dividing occipital artery, descendens hypoglossi, digastric muscle
By mandibular subluxation
A – orotracheal intubation
B - nasotracheal intubation
C – mandibular subluxation
CONDITIONSAFFECTING HYPOGLOSSAL
NERVE
REFERENCES
 GRAY’S ANATOMY- 39TH EDITION
 NETTER’S- COLOUR ATLAS OF ANATOMY
 B.D.CHAURASIA’S HUMAN ANATOMY- VOL 3
 CRA...
Trigeminal nerve, Glossopharyngeal and Hypoglossal nerves
Trigeminal nerve, Glossopharyngeal and Hypoglossal nerves
Trigeminal nerve, Glossopharyngeal and Hypoglossal nerves
Trigeminal nerve, Glossopharyngeal and Hypoglossal nerves
Trigeminal nerve, Glossopharyngeal and Hypoglossal nerves
Trigeminal nerve, Glossopharyngeal and Hypoglossal nerves
Trigeminal nerve, Glossopharyngeal and Hypoglossal nerves
Trigeminal nerve, Glossopharyngeal and Hypoglossal nerves
Trigeminal nerve, Glossopharyngeal and Hypoglossal nerves
Trigeminal nerve, Glossopharyngeal and Hypoglossal nerves
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Trigeminal nerve, Glossopharyngeal and Hypoglossal nerves

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Trigeminal nerve, Glossopharyngeal and Hypoglossal nerves

  1. 1. TRIGEMINAL, GLOSSOPHARYNGEAL AND HYPOGLOSSAL NERVES PRESENTED BY MANTHRU NAIK 1ST YEAR PG GUIDED BY Dr. K. SUREKHA MDS PROF. & HEAD Dr. G. SUDHAKAR MDS ASST. PROF.
  2. 2. NERVEINORDER Cranial Nerve I - Olfactory Cranial Nerve II - Optic Cranial Nerve III - Occulomotor Cranial Nerve IV - Trochlear Cranial Nerve V - Trigeminal Cranial Nerve VI - Abducens Cranial Nerve VII - Facial Cranial Nerve VIII- Vestibulocochlear Cranial Nerve IX - Glossopharyngeal Cranial Nerve X - Vagus Cranial Nerve XI - Spinal Accessory Cranial Nerve XII - Hypoglossal CLASSIFICATION OF CRANIAL NERVES Sensory cranial nerves(special sensory fibers ): I, II, VIII Motor cranial nerves(somatic efferent nerves ): III, IV, VI, XI, XII Mixed nerves (branchiomeric nerves ): V, VII, IX, X FUNCTIONAL COMPONENTS OF NERVES 1) General Somatic Afferent (GSA) 2) General Visceral Afferent (GVA) 3) General Visceral Efferent (GVE) 4) General Somatic Efferent (GSE) 5) Special Somatic Afferents (SSA) 6) Special Visceral Afferents (SVA) 7) Special Visceral Efferents (SVE) INTRODUCTION
  3. 3. ELEMENTARYSTRUCTUREOFA TYPICALNEURON
  4. 4. TYPES OF NEURON 1-UNIPOLAR 2-BIPOLAR 3-MULTIPOLAR 4-PSEUDOUNIPOLAR
  5. 5. TRIGEMINALNERVE
  6. 6. EMBRYOLOGYOFTRIGEMINALNERVE Trigeminal nerve is derived from 1st pharyngeal arch
  7. 7. NUCLEI OFTRIGEMINALNERVE 1) Mesencephalic nuclei 2) Main sensory nuclei 3) Spinal nuclei 4) Motor nuclei sensory
  8. 8. FUNCTIONAL PATHWAYS OFTRIGEMINAL NERVE
  9. 9. TOUCH PATHWAYFROM THE HEAD
  10. 10. PAIN & TEMPERATURE PATHWAY
  11. 11. ATTACHMENT OFTRIGEMINAL NERVE TO BRAIN
  12. 12. TRIGEMINAL GANGLION
  13. 13. RELATIONS OF TRIGEMINAL GANGLION Foramen lacerum
  14. 14. Medial relations
  15. 15. TRIGEMINAL NERVE
  16. 16. THE OPHTHALMIC DIVISION COURSE
  17. 17. BRANCHES
  18. 18. GANGLIAASSOCIATEDWITH THE TRIGEMINALNERVE CILIARY GANGLION a- occulomotor nerve b- internal carotid plexus c- nasociliary nerve n- inferior oblique muscle
  19. 19. OPHTHALMIC NERVE NUT SHELL
  20. 20. SUPRAORBITAL SUPRATROCHLEAR LACRIMAL REGION OF NASOCILLIARY AREA OF DISTRIBUTION
  21. 21. COURSE MAXILLARY DIVISION
  22. 22. CRANIUM PTERYGOPALATINE FOSSA INFRAORBITAL CANAL FACE BRANCHES
  23. 23. SUPERIORALVEOLAR NERVES
  24. 24. PTERYGOPALATINEGANGLION ROOTS
  25. 25. BRANCHES
  26. 26. NASOPALTINE AND GREATER PALATINE NERVES 2) Nasopalatine nerve 4) Greater palatine nerve 5) Lesser palatine nerve
  27. 27. ZYGOMATIC REGION SUPERIOR ALVELOLAR REGION INFRAORBITAL REGION AREA OF DISTRIBUTION
  28. 28. MAXILLARY NERVE NUT SHELL
  29. 29. COURSE MANDIBULAR DIVISION
  30. 30. BRANCHES OF MAIN TRUNK (2)
  31. 31. BRANCHES OF ANTERIOR DIVISION
  32. 32. BRANCHES OF POSTERIOR DIVISION (2 )
  33. 33. LINGUALNERVE
  34. 34. INFERIOR ALVEOLAR NERVE INFERIORALVEOLAR NERVE LINGUAL NERVE INFERIORALVEOLAR ARTERY SPHENOMANDIBULAR LIGAMENT
  35. 35. BRANCHES Mylohyoid nerve
  36. 36. OTIC GANGLION
  37. 37. Preganglionic parasympathetic fibers Inferior salivatory nucleus in medulla glossopharyngeal N.jugular foramen Glossopharyngeal n. tympanic branch of IX tympanic plexus lesser petrosal nerveotic ganglion postganglionic parasympathetic fibers otic ganglion auriculotemporal branch (CN V)parotid gland
  38. 38. SUBMANDIBULAR GANGLION
  39. 39. SECRETOMOTOR PATHWAYTO SUBMANDIBULAR AND SUBLINGUALGLAND
  40. 40. AREA OF DISTRIBUTION AURICULO- TEMPORAL BRANCHESOF BUCCAL INFERIOR ALVEOLAR AND MENTAL
  41. 41. MOTOR ROOT OF TRIGEMINALNERVE
  42. 42. MANDIBULAR NERVE NUT SHELL
  43. 43. OVERALLDISTRIBUTION OF TRIGEMINALNERVE
  44. 44. EXAMINATION OF TRIGEMINAL NERVE SENSORY FUNCTION MOTOR FUNCTION V1 V2 V3 BULK OF MASSETER STRENGTH OF JAW OPENING
  45. 45. TRIGEMINAL REFLEXES CORNEAL REFLEX JAW JERK REFLEX
  46. 46. CLINICAL APPLICATIONS OFTRIGEMINAL NERVE TRIGEMINAL GANGLION Trigeminal neuralgia (tic douloureux) The paratrigeminal syndrome Wallenberg syndrome
  47. 47. TRIGEMINAL NEURALGIA PAIN sudden ,usually ,unilateral ,severe , brief ,stabbing , lancinating , stereotyped and recurring pain
  48. 48. SYMPTOMS
  49. 49. TRIGGER POINTS
  50. 50. TYPES OF TRIGEMINAL NEURALGIA CLASSI TN SYMPTOMATIC TN
  51. 51. AETIOLOGY Usually idiopathic Other etiological factors include
  52. 52. COMMON PATTERNS OF VASCULAR COMPRESSION OF TRIGEMINALNERVE (JANNETA, 1967)
  53. 53. Intra cranial tumors - cerebellopontine angle tumors Postherpetic neuralgia Multiple sclerosis (MS) Infections
  54. 54. PATHOGENESIS Demyelination Hyperactivity or abnormal discharge of impluses (ignition hypothesis - Devor et al ) Ephaptic cross- talk between fibres
  55. 55. Ephaptic cross- talk between fibres Touching trigger points causes pain
  56. 56. DIAGNOSIS Sweet diagnostic criteria 1. Pain is paroxysmal 2. The pain may be provoked by light touch to the face (trigger zones) 3. The pain is confined to the trigeminal distribution 4. The pain is unilateral 5. The clinical sensory examination is normal DIAGNOSTIC MRI SCANNING
  57. 57. DIFFERENTIAL DIAGNOSIS
  58. 58. Differentiation from atypical facial pain
  59. 59. TREATMENT Medical treatment Surgical treatment Peripheral injections(anaesthetic agent or 95% absolute alcohol) Peripheral neurectomy Cryotherapy Peripheral radiofrequency Neurolysis(thermocoagulation) Gasserian ganglion procedures
  60. 60. TREATMENT ALGORITHAM
  61. 61. MEDICALTREATMENT
  62. 62. HOWADRUG FOR SEIZURES IS USEFUL IN THE TREATMENT OF NEUROPATHIC PAIN ?
  63. 63. MICROVASCULAR DECOMPRESSION Craniotomy Vascular compression Teflon sponge placed Fixation of Ti plate SURGICAL TREATMENT
  64. 64. RHIZOTOMY PROCEDURES Percutaneous glycerol rhizotomy Balloon compression rhizotomy
  65. 65. Stereotactic Radiosurgery (Gamma Knife) Attachment of a frame Beams of cobalt radiation are precisely focused
  66. 66. Percutaneous stereotactic radiofrequency rhizotomy (PSR) Preparation of the patient Insertion of electrode Identification of site of pain Application of heat
  67. 67. Peripheral Rhizotomies Microsurgical Rhizotomy
  68. 68. Wallenberg syndrome
  69. 69. OPHTHALMIC DIVISION Ethmoid tumours Nasal fractures Supraorbital injuries Bilateral cleft lip and palate Herpes zoster ophthalmicus MAXILLARY DIVISION Infraorbital injuries (malar fractures) Maxillary antrum tumours Maxillary sinus infections Maxillary teeth abscesses Anaesthetic nerve blocks Sphenopalatine ganglioneuralgia( brain freeze) Dendritic fluoresceine uptake from HZO
  70. 70. MANDIBULAR DIVISION Lingual nerve Inferior alveolar nerve Mental nerve neuralgia Mumps Submandibular duct Superficial temporal artery biopsy
  71. 71. THEAURICULOTEMPRAL NERVE SYNDROME(FREYSYNDROME) Mechanism of frey’s syndrome Sweating and flushing in area supplied by auriculotemporal nerve
  72. 72. GLOSSOPHARYNGEAL NERVE
  73. 73. Glossopharyngeal nerve nuclei FUNCTIONAL MODALITIES: SVE, GVE, GVA, SVA, GSA Am - Nucleus ambiguus I s - Inferior salivary nucleus Sol - Nucleus tractus salitarius spT - Spinal tract ofV nerve
  74. 74. COURSE
  75. 75. BRANCHES
  76. 76. TYMPANIC BRANCH
  77. 77. OUTLINE OF GLOSSOPHARYNGEAL NERVE
  78. 78. Effects of Damage and Clinical Test  Gag reflex  Ask the patient to swallow or cough  Test the posterior one-third of the tongue with bitter and sour substances.
  79. 79. CLINICALIMPLICATIONS GLOSSOPHARYNGEALNEURALGIA DRUGS TEGRETOL NEURONTIN (GABAPENTIN)DILANTIN LIORESAL (BACLOFEN) Diagnostic test
  80. 80. HYPOGLOSSALNERVE
  81. 81. HYPOGLOSSALNUCLEUS
  82. 82. Segments of the hypoglossal nerve
  83. 83. Hypoglossal nerve Vertebral arteries COURSE Hypoglossal nucleus, medullary & cisternal segments
  84. 84. Suprahyoid carotid space segment
  85. 85. Sublingual segment
  86. 86. BRANCHES OFHYPOGLOSSALNERVE
  87. 87. Hypoglossal nerve nut shell
  88. 88. EXAMINING THE HYPOGLOSSAL NERVE
  89. 89. HYPOGLOSSALPALSY  Unilateral palsy is merely troublesome, resulting in difficulty with speech, tongue biting during mastication of food, and difficulties in swallowing for as long as four months postoperatively  Bilateral palsy can pose a life-threatening situation by producing upper airway obstruction  Hypoglossal palsy can be due to iatrogenic injuries to hypoglossal nerve or due to lesions affecting it.
  90. 90. IATROGENIC INJURIES OFHYPOGLOSSALNERVE During  Dissection of floor of submandibular triangle  Blind application of hemostats and monopolar coagulation to ranine veins  Dissection in level I and II during RND  carotid endarterectomy  High exposure of internal carotid artery
  91. 91.  The use of transverse neck incisions has probably served to increase the number of injuries to the hypoglossal nerve and the marginal mandibular nerve.  The incision is close to, and parallels, the course of both nerves.
  92. 92. DISSECTION IN SUBMANDIBULAR TRIANGLE First Surgical Plane: The Roof of the Submandibular Triangle •Composed of skin, superficial fascia enclosing the platysma muscle and fat, and the underlying mandibular and cervical branches of the facial nerve (VII) The Roof of the Submandibular Triangle
  93. 93. Second Surgical Plane:The Contents of theSubmandibular Triangle  Structures of the second surgical plane, from superficial to deep, are facial (anterior facial) vein retromandibular (posterior facial) vein part of the facial (external maxillary) artery submental branch of the facial artery superficial layer of submaxillary fascia (deep cervical fascia) lymph nodes deep layer of submaxillary fascia (deep cervical fascia) hypoglossal nerve (XII)
  94. 94. Contents of submandibular triangle
  95. 95. Third SurgicalPlane:The Floorof the SubmandibularTriangle  Structures of the third surgical plane, from superficial to deep mylohyoid muscle with its nerve hyoglossus muscle middle constrictor muscle covering the lower part of the superior constrictor muscle part of the styloglossus muscle
  96. 96. Fourth Surgical Plane: The Basement of the SubmandibularTriangle  Deep portion of the submandibular gland  Submandibular (Wharton's) duct  Lingual nerve  Sublingual vein  Sublingual gland  Hypoglossal nerve (XII)  Submandibular ganglion
  97. 97. The Basement of the Submandibular Triangle
  98. 98. RANINE VEIN  Ranine vein is vena comitans of hypoglossal nerve which begins below the tip of the tongue.  Inadvertent clamping while controlling bleeding from plexus posterior and inferior to the posterior belly of digastric muscle can result in hypoglossal nerve injury
  99. 99. HIGHEXPOSURE OFINTERNALCAROTIDARTERY DURING CAROTID ENDARTERECTOMY  The hypoglossal nerve, because of its intimate relationship to the internal carotid artery, may limit exposure since it crosses the internal carotid artery at various levels in different individuals, from just above the carotid bifurcation to as high as the level of the anterior belly of the digastric muscle. It usually crosses the ICA and ECA approximately 2 to 4 cm above the carotid bifurcation  Frequently, in order to visualize the uppermost extent of carotid bifurcation plaques, to deal with internal carotid kinks or internal carotid aneurysms the hypoglossal nerve may be retracted, resulting in temporary paralysis of one-half of the tongue  Never attempt to separate the hypoglossal and vagus nerves if they fuse together
  100. 100. STRUCTURESTETHERING HYPOGLOSSALNERVE Sternocleidomastoid artery and vein Occipital artery Descends hypoglossi Digastric muscle Stylohyoid muscle
  101. 101. METHODS OFATRAUMATIC MOBILISATION OF HYPOGLOSSALNERVE By dividing sternocleidomastoid artery
  102. 102. By dividing occipital artery, descendens hypoglossi, digastric muscle
  103. 103. By mandibular subluxation A – orotracheal intubation B - nasotracheal intubation C – mandibular subluxation
  104. 104. CONDITIONSAFFECTING HYPOGLOSSAL NERVE
  105. 105. REFERENCES  GRAY’S ANATOMY- 39TH EDITION  NETTER’S- COLOUR ATLAS OF ANATOMY  B.D.CHAURASIA’S HUMAN ANATOMY- VOL 3  CRANIAL NERVES – FUNCTIONAL ANATOMY, STANLEY MONKHOUSE  Handbook of LOCAL ANESTHESIA- Stanley F. Malamed  Trigeminal neuralgia- Pathology & pathophysiology Seth Love & Hugh b. Coakham  Trigeminal nerve- Sashank prasad and Steven Galetta  INTERNET SOURCES  Vascular reconstructions : anatomy, exposures, and techniques amal J Hoballah

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