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Kaneko T, Okita Y, Kato Y, Narazaki M, Kumanogoh A. Hypoglossal nerve palsy in IgG4-related disease. QJM 2024; 117:591-592. [PMID: 38539040 DOI: 10.1093/qjmed/hcae056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Indexed: 09/13/2024] Open
Affiliation(s)
- T Kaneko
- Department of Respiratory Medicine and Clinical Immunology, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Y Okita
- Department of Respiratory Medicine and Clinical Immunology, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Y Kato
- Department of Respiratory Medicine and Clinical Immunology, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita, Osaka 565-0871, Japan
| | - M Narazaki
- Department of Respiratory Medicine and Clinical Immunology, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita, Osaka 565-0871, Japan
| | - A Kumanogoh
- Department of Respiratory Medicine and Clinical Immunology, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita, Osaka 565-0871, Japan
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Sato K, Nasrun NE, Fujita K, Chieda K, Nagayasu H, Shimo T, Akizuki K. Unilateral hypoglossal nerve palsy following orthognathic surgery: A case report and literature review. Int J Surg Case Rep 2023; 111:108848. [PMID: 37776686 PMCID: PMC10556753 DOI: 10.1016/j.ijscr.2023.108848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 09/13/2023] [Accepted: 09/15/2023] [Indexed: 10/02/2023] Open
Abstract
INTRODUCTION Hypoglossal nerve palsy (HNP) can be caused by nerve damage from the central nerve to a peripheral nerve, and individuals with multiple factors could be predisposed to HNP. We report a case of isolated unilateral HNP after orthognathic surgery. CASE PRESENTATION A 56-year-old Japanese woman complained of jaw distortion and malocclusion. She had undergone a Le Fort I osteotomy and bilateral sagittal split ramus osteotomy (BSSRO) under general anesthesia in August 2021. On postoperative day 3, she experienced tongue motility, and when the tongue protruded forward, the tongue tip shifted to the right, and swelling of the right lateral pharyngeal wall was observed. An additional blood test revealed increased antibody titer levels (40×), cytomegalovirus IgG EIA titer (16.9 U/mL), HSV-IgG EIA titer (40 U/mL), and EBV-viral capsid antigen (VCA) IgG EIA titer (1.4 U/mL). We administered valacyclovir hydrochloride 1000 mg/day for 7 days, prednisolone (PSL) 60 mg/day, mecobalamin 1500 μg/day, and adenosine triphosphate (ATP) disodium hydrate 300 mg/day. A neurological examination revealed no central lesions, and we continued the patient's tongue-function training and oral hygiene guidance. The tongue apex deviation was resolved approx. 3 months postoperatively. DISCUSSION There are no major reports on the etiology of HNP after orthognathic surgery. The possibility of HNP triggered by endotracheal intubation or through packing gauze under general anesthesia and viral infection cannot be ruled out. CONCLUSION Clinicians should be aware of the possibility of unilateral HNP following orthognathic surgery.
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Affiliation(s)
- Koken Sato
- Matsuda Orthopedic Memorial Hospital, 1-35, Kita 18, Nishi 4, Kita-ku, Sapporo, Hokkaido 001-0018, Japan; Division of Orthodontics and Dentofacial Orthopedics, Department of Oral Growth and Development, School of Dentistry, Health Sciences University of Hokkaido, Hokkaido 061-0293, Japan
| | - Nisrina Ekayani Nasrun
- Division of Reconstructive Surgery for Oral and Maxillofacial Region, Department of Human Biology and Pathophysiology, School of Dentistry, Health Sciences University of Hokkaido, Hokkaido 061-0293, Japan
| | - Keiko Fujita
- Matsuda Orthopedic Memorial Hospital, 1-35, Kita 18, Nishi 4, Kita-ku, Sapporo, Hokkaido 001-0018, Japan
| | - Kazumi Chieda
- Apple Pediatric and Orthodontic Clinic, 2 Chome 3-1, Kiba-cho, Tomakomai, Hokkaido 053-0033, Japan
| | - Hiroki Nagayasu
- Division of Oral and Maxillofacial Surgery, Department of Human Biology and Pathophysiology, School of Dentistry, Health Sciences University of Hokkaido, Hokkaido 061-0293, Japan
| | - Tsuyoshi Shimo
- Division of Reconstructive Surgery for Oral and Maxillofacial Region, Department of Human Biology and Pathophysiology, School of Dentistry, Health Sciences University of Hokkaido, Hokkaido 061-0293, Japan.
| | - Kazuki Akizuki
- Matsuda Orthopedic Memorial Hospital, 1-35, Kita 18, Nishi 4, Kita-ku, Sapporo, Hokkaido 001-0018, Japan.
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Mourad F, Milella C, Lullo G, Zangari F, Meroni R, Taylor A, Kerry R, Hutting N, Maselli F. Recognition of Prodromal Hypoglossal Nerve Palsy Presenting with Neck Pain as Primary Complaint: Findings from a Rare Case Report in Direct Access Physiotherapy during the COVID-19 Pandemic. Healthcare (Basel) 2023; 11:healthcare11091342. [PMID: 37174884 PMCID: PMC10178515 DOI: 10.3390/healthcare11091342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 05/01/2023] [Accepted: 05/04/2023] [Indexed: 05/15/2023] Open
Abstract
Neck pain (NP) is the second most common musculoskeletal disorder. Spinal cysts (SCs) are cystic dilatations of the synovial sheaths in joints and tendons. SCs are extremely rare in the cervical spine. Typically, patients are unaware of having an SC due to its asymptomatic nature; however, when cervical SC extends, its volume could compress the surrounding structures, such as the hypoglossal nerve. Isolated hypoglossal nerve palsy (HNP) is very rare and typically presents with unilateral atrophy of the musculature of the tongue and contralateral tongue deviation. Often, patients with HNP also report occipital/neck pain. A 75-year-old man with occipital/neck pain as a primary complaint. Although difficult to observe because of the filtering facepiece two mask, difficulties in articulation and sialorrhea during the interview were noticed. These latter were cues to consider CN examination that revealed CN XII palsy. This prompted a referral for further examination that revealed an SC compressing the right hypoglossal canal. The patient was not considered a surgical candidate and was managed conservatively. This case report outlines the relevant findings relating to the triage of a rare isolated hypoglossal nerve palsy from the physiotherapist's perspective within a complex setting because of the COVID-19 pandemic. Although referred with a diagnosis of cervical radiculopathy, our case highlights that skilled physiotherapists may play a fundamental role in both the recognition and, when applicable, subsequent novel management of a non-musculoskeletal presentation.
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Affiliation(s)
- Firas Mourad
- Department of Physiotherapy, LUNEX International University of Health, Exercise and Sports, 4671 Differdange, Luxembourg
- Luxembourg Health & Sport Sciences Research Institute A.s.b.l., 50, Avenue du Parc des Sports, 4671 Differdange, Luxembourg
| | - Claudia Milella
- Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy
| | - Graziana Lullo
- Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy
| | - Francesco Zangari
- Radiology Service, Azienda Socio Sanitaria Territoriale della Franciacorta, Viale Mazzini 4, 25032 Chiari, Italy
| | - Roberto Meroni
- Department of Physiotherapy, LUNEX International University of Health, Exercise and Sports, 4671 Differdange, Luxembourg
- Luxembourg Health & Sport Sciences Research Institute A.s.b.l., 50, Avenue du Parc des Sports, 4671 Differdange, Luxembourg
| | - Alan Taylor
- Faculty of Medicine and Health Sciences, School of Health Sciences, Division of Physical Therapy and Sport Rehabilitation, University of Nottingham, Nottingham NG5 1PB, UK
| | - Roger Kerry
- Faculty of Medicine and Health Sciences, School of Health Sciences, Division of Physical Therapy and Sport Rehabilitation, University of Nottingham, Nottingham NG5 1PB, UK
| | - Nathan Hutting
- Department of Occupation and Health, School of Organisation and Development, HAN University of Applied Sciences, 6503 GL Nijmegen, The Netherlands
| | - Filippo Maselli
- Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy
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Chen X, Yi J, Liu S, Chen W, Guan J, Pan C. Yin-Yang tongue sign: An imaging clue of lesions involving the skull base segment in the hypoglossal pathway. Dentomaxillofac Radiol 2023; 52:20220201. [PMID: 36168971 PMCID: PMC9793452 DOI: 10.1259/dmfr.20220201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 09/18/2022] [Accepted: 09/21/2022] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE To investigate the diagnostic value of the Yin-Yang tongue sign in patients with tongue deviation. METHODS According to the presence of the Yin-Yang tongue sign on CT/MR, 107 patients with tongue deviation were divided into a positive group and a negative group. The involvement categories of the hypoglossal canal (HC) in the positive group were evaluated and classified as HC dilation and HC erosion. The correlations between HC involvement categories and the presence of the sign were analysed. RESULTS There were 55 cases (55/107, 51.4%) in the positive group and 52 cases (52/107, 48.6%) in the negative group. Hypoglossal nerve (HN) involvement mainly occurred in the skull base (61.8%), skull base and carotid space (10.9%), and carotid space segment (12.7%). Neurogenic (50.9%), squamous cell carcinoma (14.5%), and metastases (12.7%) were the predominant aetiologies. The sensitivity, specificity, and accuracy of this sign for suggesting skull base lesions around HC were 72.4%, 80.8%, and 76.6%, respectively. In the positive group, HC dilation was seen in 21 patients (21/55, 38.2%) and 21 cases were all benign. HC erosion were noted in 19 patients (19/55, 34.5%), of whom 12 cases were malignant. CONCLUSION The Yin-Yang tongue sign is formed by unilateral tongue atrophy and fat infiltration caused by lesions in the HN pathway, especially compressive or invasive lesions involving the skull base segment.
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Affiliation(s)
| | - Jingru Yi
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Simin Liu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Weiwei Chen
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jian Guan
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Chu Pan
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Something Got Your Tongue? A Unique Cause of Hypoglossal Nerve Palsy. Case Rep Neurol Med 2022; 2022:2884145. [PMID: 36458134 PMCID: PMC9708331 DOI: 10.1155/2022/2884145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 09/19/2022] [Accepted: 10/14/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction The authors report a rare cause of isolated hypoglossal nerve palsy caused by a high cervical osteophyte. This case increases clinical knowledge of an underreported condition and teaches the clinician radiologic pearls in making the diagnosis. To their knowledge, this is the first case report showing surgical remediation of this condition. Symptoms and Clinical Findings. A 73-year-old female presented with several months of occipital headache, progressive dysarthria, dysphagia, and tongue deviation to the right. Her neurologic exam was significant for atrophy of the right hemitongue with tongue fasciculations. On protrusion, her tongue deviated rightward. Diagnosis and Therapeutic Intervention. Careful review of her initial head computed tomography (CT) imaging revealed that a high cervical osteophyte caused unilateral, isolated hypoglossal nerve palsy. Neurosurgery performed a right, far lateral approach for decompression of this osteophyte and over the ensuing months her symptoms improved. Conclusion High cervical osteophyte is an underrecognized cause of isolated hypoglossal nerve palsy. The imaging investigation should be systematic and focus on the skull base with magnetic resonance imaging (MRI) or CT. This is a rare occasion when high resolution CT of the skull base can actually be the more helpful imaging modality. As shown in this case, an osteoarthritic cause can be surgically ameliorated.
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de Sousa Costa R, Ventura N, de Andrade Lourenção Freddi T, da Cruz LCH, Corrêa DG. The Hypoglossal nerve. Semin Ultrasound CT MR 2022; 44:104-114. [PMID: 37055141 DOI: 10.1053/j.sult.2022.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The hypoglossal nerve is the 12th cranial nerve, exiting the brainstem in the preolivary sulcus, passing through the premedullary cistern, and exiting the skull through the hypoglossal canal. This is a purely motor nerve, responsible for the innervation of all the intrinsic tongue muscles (superior longitudinal muscle, inferior longitudinal muscle, transverse muscle, and vertical muscle), 3 extrinsic tongue muscles (styloglossus, hyoglossus, and genioglossus), and the geniohyoid muscle. Magnetic resonance imaging (MRI) is the best imaging exam to evaluate patients with clinical signs of hypoglossal nerve palsy, and computed tomography may have a complementary role in the evaluation of bone lesions affecting the hypoglossal canal. A heavily T2-weighted sequence, such as fast imaging employing steady-state acquisition (FIESTA) or constructive interference steady state (CISS) is important to evaluate this nerve on MRI. There are multiple causes of hypoglossal nerve palsy, being neoplasia the most common cause, but vascular lesions, inflammatory diseases, infections, and trauma can also affect this nerve. The purpose of this article is to review the hypoglossal nerve anatomy, discuss the best imaging techniques to evaluate this nerve and demonstrate the imaging aspect of the main diseases that affect it.
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de Sousa Costa R, Ventura N, de Andrade Lourenção Freddi T, da Cruz LCH, Corrêa DG. The Glossopharyngeal, Vagus and Accessory nerves: Anatomy and Pathology. Semin Ultrasound CT MR 2022; 44:95-103. [PMID: 37055144 DOI: 10.1053/j.sult.2022.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The glossopharyngeal, vagus, and accessory nerves are discussed in this article, given their intimate anatomical and functional associations. Abnormalities of these lower cranial nerves may be intrinsic or extrinsic due to various disease processes. This article aims to review these nerves' anatomy and demonstrates the imaging aspect of the diseases which most commonly affect them.
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Dokdok M, Göçmen S, Kahraman S, Kütükçü Y. Isolated Unilateral Hypoglossal Nerve Palsy Caused by Internal Carotid Artery Loop. Cureus 2021; 13:e14819. [PMID: 34094773 PMCID: PMC8171351 DOI: 10.7759/cureus.14819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Isolated unilateral hypoglossal nerve (HN) palsy caused by vascular compression is a rare condition. We report a case of a 42-year-old male, presenting with tongue paresis and unilateral atrophy of the tongue due to an internal carotid artery (ICA) loop. The compression of HN by ICA loop and concomitant wall irregularities of the loop segment were observed in magnetic resonance imaging and digital subtraction angiography (DSA). The patient was managed with antithrombotic without the need of any further intervention. To our best knowledge, this is the first reported case of isolated compressive neuropathy of the HN caused by loop of the ICA. Here, the clinical presentation, etiology, and management of isolated HN palsy caused by vascular lesions are discussed along with the relevant literature.
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Affiliation(s)
- Murat Dokdok
- Radiology Department, Anadolu Medical Center, Kocaeli, TUR
| | - Selçuk Göçmen
- Neurosurgery Department, Anadolu Medical Center, Kocaeli, TUR
| | - Serdar Kahraman
- Neurosurgery Department, Anadolu Medical Center, Kocaeli, TUR
| | - Yaşar Kütükçü
- Neurology Department, Anadolu Medical Center, Kocaeli, TUR
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Hypoglossal Canal Cyst Causing Unilateral XII Nerve Palsy. Can J Neurol Sci 2020; 48:560-561. [PMID: 33077010 DOI: 10.1017/cjn.2020.235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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