Surgical anatomy of the cervical segment of the hypoglossal nerve

Salame, Khalil; Masharawi, Youssef; Rochkind, S.; Arensburg, Baruch

doi:10.1002/ca.20141

Cited by 20 publications

(20 citation statements)

References 12 publications

(13 reference statements)

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“…Dissecting from the carotid bifurcation in a rostral direction, one will find the hypoglossal nerve at a mean distance of 15 mm superior to the bifurcation and, in a minority of cases, it may lie on the bifurcation itself. 35 The hypoglossal nerve is gently dissected along its course and retracted superiorly. The carotid artery is retracted laterally, and the pharyngeal constrictor muscles are retracted medially.…”

Section: Anatomical Considerationsmentioning

confidence: 99%

Submandibular approach to the C2–3 disc level: microsurgical anatomy with clinical application

Russo

Albanese

Quiroga

et al. 2009

SPI

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Object Approaching the C2–3 disc level is challenging because of its location behind the mandible and the vital neurovascular structures overlying the area. The purpose of this study was to illustrate in a stepwise fashion the microsurgical anatomy of the submandibular approach to the C2–3 disc. Methods Ten adult formalin-fixed cadaveric specimens (20 sides) were studied. Particular attention was paid to the structures limiting the exposure. The authors measured the distance between the inferior border of the mandible and the marginal mandibular branch of the facial nerve running inferior to the mandible, the distance between the horizontal segment of the hypoglossal nerve and the hyoid bone, and the distance between the horizontal segment of the hypoglossal nerve and the mandible. They compared the location of the superior laryngeal nerve with regard to the submandibular and the standard Smith-Robinson approaches. A clinical case illustrating the usefulness of the surgical technique in this region is presented. Results The mean distance between the inferior border of the mandible and the lowest point of the marginal mandibular branch of the facial nerve was 6.7 ± 1.69 mm. The hypoglossal nerve's mean distance above the hyoid bone was 8.4 ± 1.78 mm and below the mandible was 19.6 ± 6.39 mm. The internal branch of the superior laryngeal nerve, with respect to the cervical spine, always entered the thyrohyoid membrane just inferior to the C-3 vertebral body. The superior laryngeal nerve was found to be an impediment to approaching the C2–3 disc through the standard Smith-Robinson approach. Conclusions The submandibular approach provides excellent exposure, with a perpendicular view of the C2–3 disc level. This approach is one of the options to be considered when dealing with high cervical pathologies.

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Section: Anatomical Considerationsmentioning

confidence: 99%

Submandibular approach to the C2–3 disc level: microsurgical anatomy with clinical application

Russo

Albanese

Quiroga

et al. 2009

SPI

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“…Previous studies reported the distance of hypoglossal nerve from CC bifurcation was variable ranging from immediately above the bifurcation to anterior belly of digastric or rarely directly overlying the bifurcation. [13][14][15] The variable intimate relationship of this nerve to carotid arterial system makes it vulnerable to damage during carotid endarterectomy, different neck surgeries including anterior approaches to cervical vertebrae or craniovertebral structures. [13][14][15] We found the variation of anterior branches of ECA was quite common (26.53%) among which the linguo-facial trunk was the commonest (15.3%).…”

Section: Discussionmentioning

confidence: 99%

Variations, relations and clinical significance of carotid arterial system in anterior neck: a cadaveric study

2019

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Background: The common carotid, internal and external carotid arteries and their branches serve as major source of blood supply in head-neck region of human and are often encountered during numerous surgical and clinical interventions of neck.Methods: We dissected and examined both sides of neck in 49 well embalmed cadavers (98 sides). We recorded the following anatomical parameters of carotid arterial system-level of bifurcation, the relation between internal and external carotid arteries, branching pattern of anterior branches of external carotid artery, tortuosity in carotid arterial system, and relation of hypoglossal nerve with the carotid arteries.Results: In 56.16 % cases, the common carotid arterial bifurcation took place at the upper border of thyroid cartilage though high bifurcation was quite common (43.88%). The external carotid artery was located antero-medial to internal carotid artery in most cases (93.87%). Abnormal tortuosity of carotid arterial system was detected in 2.04% cases only. In 86.73% cases, the hypoglossal nerve crossed the internal and external carotid artery superior to carotid bifurcation above the level of hyoid bone while in 1 case it crossed immediately inferior to carotid bifurcation. In branching pattern, following variations were observed- linguo-facial trunk in 15.3% cases, thyro-lingual trunk in 5.1% cases, origin of superior thyroid artery from common carotid in 10.02% cases and origin of superior thyroid from internal carotid in one case (1.02%).Conclusions: The carotid arterial system has complex and variable anatomy in neck and this information should be kept in mind to avoid unwanted damage during surgical procedures of neck.

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“…The hypoglossal nerve courses superiorly or inferiorly to the origin of the occipital artery, or at the same level as it (Nathan and Levy, 1982;Weinstein and May, 1990). The hypoglossal nerve crosses the lingual artery or passes inferiorly to it (Salame et al, 2006). In addition, the hypoglossal nerve were rarely hooked by the small vessel to the thyrohyoid or sternocleidomastoid (Imparato et al, 1972;Nathan and Levy, 1982;Weinstein and May, 1990).…”

Section: Discussionmentioning

confidence: 99%

Morphological Features of the Branching Pattern of the Hypoglossal Nerve

Sakamoto

2018

The Anatomical Record

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The hypoglossal or twelfth cranial nerve is the motor nerve to the extrinsic and intrinsic muscles of the tongue, and the superior root of the ansa cervicalis and the thyrohyoid and geniohyoid branches are delivered through the nerve. This study investigated the muscular branches of the hypoglossal nerve to clarify their spatial relationships with the muscles of the tongue and the neighboring structures. The muscles and the nerve were gross anatomically examined in 42 cadavers. The superior root and the thyrohyoid branch left the nerve near the occipital and lingual arteries, respectively. The extrinsic muscles consisted of some components, and the geniohyoid branch and the lingual branches arose on the hyoglossus. The ascending lingual branches formed a plexus on the anterior part of the hyoglossus and were divided into the proximal and distal groups. They supplied the two parts of the hyoglossus, the three bundles of the styloglossus and the superior and inferior longitudinal muscles and communicated with the lingual nerve. The descending lingual branches supplied the inferior part of the genioglossus, and the terminal branches gave intramuscular twigs to its main part and the transverse and vertical muscles. The findings indicated that the branching pattern of the hypoglossal nerve is characterized by the positional relationships to the components of the extrinsic muscles. The hyoid bone can be an effective marker to identify the branches and affected position if it was used in combination with the morphology of the extrinsic muscles, and the knowledge of their variations is also beneficial. Anat Rec, 2018. © 2018 Wiley Periodicals, Inc.

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Surgical anatomy of the cervical segment of the hypoglossal nerve

Cited by 20 publications

References 12 publications

Submandibular approach to the C2–3 disc level: microsurgical anatomy with clinical application

Submandibular approach to the C2–3 disc level: microsurgical anatomy with clinical application

Variations, relations and clinical significance of carotid arterial system in anterior neck: a cadaveric study

Morphological Features of the Branching Pattern of the Hypoglossal Nerve

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