Hypoglossal nerve monitoring, a potential application of intraoperative nerve monitoring in head and neck surgery

Abstract

BackgroundIntraoperative nerve monitoring (IONM) has many applications in different surgical fields. In head and neck surgery, IONM has been used to perform surgery of the parotid, thyroid and parathyroid glands, preserving the facial and recurrent nerves. However, hypoglossal nerve neuromonitoring has not been addressed with such relevance.Material and methodsA retrospective review of surgeries performed on patients with special tongue and floor of mouth conditions was undertaken to examine the indications that prompted its use. Particular attention was given to the pathology, intraoperative findings and the final outcome of each patient.ResultsFour patients, aged between 6 years and 68 years, with complex oral tongue and floor of mouth lesions were reviewed. Three patients were male, aged 22 years and younger, and two of these patients had oral tongue cancers with previous surgery. Oral tongue and neck conditions are challenging since the functions of the hypoglossal nerve are put at risk. The use of IONM technology allowed us to preserve nerve functions, speech and swallowing.ConclusionsAlthough IONM of the hypoglossal nerve is not a common indication in tongue and floor of mouth lesions, under special conditions its application can be extrapolated to challenging surgical cases, like the ones described.

Large Lipoma of the Mouth Floor

“…Though there are no guidelines to use neuromonitoring in these cases, it is becoming more commonly used by otolaryngologists to ensure the preservation of these nerves [ 8 ]. There is much literature on the protective effects of intraoperative facial and vagus nerve monitoring, but there is very little literature about hypoglossal nerve monitoring being performed [ 9 , 10 ]. However, in this case, neuromonitoring played a key role, helping to prevent intraoperative hypoglossal nerve damage.…”

The Feasibility of Anterior Occipital Condyle Screw for the Reconstruction of Craniovertebral Junction: A Digital Anatomical and Cadaveric Study of a Novel Technique

“…39 Moreover, intraoperative monitoring of hypoglossal nerve function can help anatomical localization of the hypoglossal triangle, and reflect whether there has been hypoglossal nerve injury during operation. 40 , 41 Therefore, correct preoperative diagnosis and radiological outcome analysis should be performed before anterior occipital condyle screw fixation.…”

Bilateral Hypoglossal Nerve Palsy After Occipitocervical Fusion

“…There have been reports of intraoperative hypoglossal nerve monitoring being beneficial during brain and head and neck surgery. 21 , 22 Intraoperative monitoring may help identify an early insult and potentially prevent or decrease the severity of injury. However, with this complication being such a very rare occurrence, the routine utilization of intraoperative monitoring would likely not be cost-effective.…”