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Idiopathic Isolated Unilateral Hypoglossal Nerve Palsy: A Report of 2 Cases and Review of the Literature. J Oral Maxillofac Surg 2018; 76:1454-1459. [DOI: 10.1016/j.joms.2018.01.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Revised: 01/14/2018] [Accepted: 01/14/2018] [Indexed: 11/23/2022]
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Abstract
Ipsilateral headache associated with hypoglossal nerve palsy is uncommon and is usually reported to be secondary to internal carotid artery dissection. Herein, we report three idiopathic cases of berign ipsilateral headache with hypoglossal nerve palsy.
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Bilgin-Freiert A, Fugleholm K, Poulsgaard L. Case Report: Intraneural Intracanalicular Ganglion Cyst of the Hypoglossal Nerve Treated by Extradural Transcondylar Approach. J Neurol Surg Rep 2015; 76:e180-2. [PMID: 26251801 PMCID: PMC4521000 DOI: 10.1055/s-0035-1555016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Accepted: 04/19/2015] [Indexed: 12/04/2022] Open
Abstract
We report a case of an intraneural ganglion cyst of the hypoglossal canal. The patient presented with unilateral hypoglossal nerve palsy, and magnetic resonance imaging showed a small lesion in the hypoglossal canal with no contrast enhancement and high signal on T2-weighted imaging. The lesion was assumed to be a cystic schwannoma of the hypoglossal nerve. Stereotactic irradiation was considered, but in accordance with the patient's wishes, surgical exploration was performed. This revealed that, rather than a schwannoma, the patient had an intraneural ganglion cyst, retrospectively contraindicating irradiation as an option. This case illustrates a very rare location of an intraneural ganglion cyst in the hypoglossal nerve. To our knowledge there are no previous reports of an intraneural ganglion cyst confined to the hypoglossal canal.
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Affiliation(s)
- Arzu Bilgin-Freiert
- Department of Neurosurgery, Copenhagen University Hospital, Copenhagen, Denmark
| | - Kåre Fugleholm
- Department of Neurosurgery, Copenhagen University Hospital, Copenhagen, Denmark
| | - Lars Poulsgaard
- Department of Neurosurgery, Copenhagen University Hospital, Copenhagen, Denmark
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Ali A, Patel A. Oral maxillofacial: dangerous dental abscess. ACTA ACUST UNITED AC 2015; 42:293. [PMID: 26076550 DOI: 10.12968/denu.2015.42.3.293a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Patro SN, Torres C, Riascos R. An unusual case of isolated hypoglossal nerve palsy secondary to osteophytic projection from the atlanto-occipital joint. Neuroradiol J 2014; 27:361-4. [PMID: 24976205 DOI: 10.15274/nrj-2014-10039] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Accepted: 04/05/2014] [Indexed: 11/12/2022] Open
Abstract
We describe an unusual and rare case of isolated left hypoglossal nerve palsy secondary to compression from a prominent degenerative osteophyte from the left atlanto-occipital joint. The hypoglossal nerve is a purely motor cranial nerve innervating the tongue musculature. Palsy of the hypoglossal nerve is frequently associated with other cranial nerve palsies and can be related to vascular, neoplastic, infectious or traumatic conditions. Isolated hypoglossal nerve palsy is quite rare and very few cases have been reported in the literature to date.
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Affiliation(s)
- Satya Narayana Patro
- Department of Radiology, University of Ottawa, The Ottawa Hospital; Ottawa, ON, Canada -
| | - Carlos Torres
- Department of Radiology, University of Ottawa, The Ottawa Hospital; Ottawa, ON, Canada
| | - Roy Riascos
- Department of Radiology, The University of Texas Medical Branch; Galveston, TX, USA
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Ilardi A, Moglia C, Cammarosano S, Canosa A, Bertuzzo D, Manera U, Fuda G, Chiò A, Calvo A. Persistent idiopathic hypoglossal nerve palsy: A motor neuron disease-mimic syndrome? Amyotroph Lateral Scler Frontotemporal Degener 2014; 16:274-6. [PMID: 24920472 DOI: 10.3109/21678421.2014.924144] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Antonio Ilardi
- ALS Centre, 'Rita Levi Montalcini' Department of Neuroscience, University of Torino , Torino , Italy
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Nonaka Y, Grossi PM, Bulsara KR, Taniguchi RM, Friedman AH, Fukushima T. Microsurgical management of hypoglossal schwannomas over 3 decades: a modified grading scale to guide surgical approach. Neurosurgery 2012; 69:ons121-40; discussion ons140. [PMID: 21709593 DOI: 10.1227/neu.0b013e31822a547b] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Schwannomas originating from the hypoglossal nerve are extremely rare. Microsurgical resection with the goal for cure has traditionally been associated with a high risk of postoperative deficits. OBJECTIVE To summarize our clinical experience using tailored cranial base approaches for these formidable lesions. METHODS The clinical records of 13 patients were retrospectively reviewed. In addition, all reported patients in the literature were reviewed. The extreme lateral infrajugular transcondylar-transtubercular exposure approach was used in all of our patients. Based on our experience and literature analysis, we propose the following modified grading scale to facilitate surgical planning: type A, intradural tumors; type B, dumbbell-shaped tumors; type C, extracranial tumors; and type D, peripheral tumors. RESULTS All 13 patients underwent total, near-total, or subtotal tumor resection. Eight patients were men, 5 were women (mean age, 41.7 years). Sural nerve graft reconstruction for the hypoglossal nerve was performed in 4 patients. Three of the 4 patients in whom nerve reconstruction was performed regained satisfactory movement of their tongue. In the review of the literature, the mean patient age was 45.8 years. Patients presented with tongue atrophy (91.6%), headache (60.9%), and dysphagia (31.8%). The tumors were categorized as type A in 31.7% of these patients, type B in 38.6%, type C in 6.2%, and type D in 23.4%. CONCLUSION The extreme lateral infrajugular transcondylar-transtubercular exposure approach, which is a modification of the extreme lateral suboccipital approach, provides sufficient exposure for most intracranial dumbbell-shaped hypoglossal schwannomas. Hypoglossal nerve reconstruction using a sural nerve graft improves tongue atrophy and movement for patients with resected nerves.
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Affiliation(s)
- Yoichi Nonaka
- Division of Neurosurgery, Duke University Medical Center, Durham, North Carolina 27710, USA.
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Enseñat J, Alobid I, de Notaris M, Sanchez M, Valero R, Prats-Galino A, Ferrer E. Endoscopic endonasal clipping of a ruptured vertebral-posterior inferior cerebellar artery aneurysm: technical case report. Neurosurgery 2011; 69:onsE121-7; discussion onsE127-8. [PMID: 21572362 DOI: 10.1227/neu.0b013e318223b637] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND IMPORTANCE Aneurysms arising from the vertebral and posterior inferior cerebellar artery complex account for only 0.5 to 3% of all aneurysms. Surgery for these aneurysms is technically challenging because of the deep location and intimate relation with the medulla and lower cranial nerves. The authors report the case of a patient with a right vertebral-posterior inferior cerebellar artery complex (VA-PICA) aneurysm that was successfully clipped via an extended endoscopic endonasal transclival approach. CLINICAL PRESENTATION A 74-year-old woman with the sudden onset of severe headache, nausea, and vomiting was admitted to our hospital. A computed tomography (CT) of the brain revealed diffuse subarachnoid hemorrhage associated with intraventricular hemorrhage and incipient hydrocephalus. Cerebral angiography revealed a 1.2-mm aneurysm arising at the origin of the right PICA. The aneurysm was considered unsuitable for selective coil embolization, so neck clipping was performed. With the use of an extended endoscopic endonasal transclival approach, the aneurysm was accurately reached endoscopically and successfully clipped from the parent artery. The patient was discharged neurologically intact. CONCLUSION To the best of the authors' knowledge, this is the first report of a successfully treated VA-PICA ruptured aneurysm using a pure endoscopic endonasal transclival approach. Endoscopic surgery may be added to the armamentarium of procedures for the treatment of posterior circulation aneurysms.
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Affiliation(s)
- Joaquim Enseñat
- Departments of Neurosurgery, Rhinology Unit, Hospital Clinic de Barcelona, Faculty of Medicine, Universitat de Barcelona, Barcelona, Spain
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Khan M, Ohri N. Unilateral hypoglossal nerve palsy due to infected molar: a rare entity. ACTA ACUST UNITED AC 2011; 2:293-5. [PMID: 25426902 DOI: 10.1111/j.2041-1626.2011.00073.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Isolated hypoglossal nerve palsy is a rare condition. There are several causes that can be attributed to it. We present a case where a patient presented herself with pain in the left back tooth region, with unilateral left hypoglossal nerve palsy. All investigations were negative. The infected tooth was removed, and the patient had speech therapy and was actively rehabilitated. The isolated hypoglossal nerve palsy could have been due to the infected impacted tooth. Therefore, dentists presented with a case of isolated hypoglossal nerve palsy should consider the infected impacted tooth as the differential diagnosis.
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Affiliation(s)
- Mubeen Khan
- Department of Oral Medicine and Radiology, Government Dental College and Research Institute, Bangalore, Karnataka, India
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Isolated Hypoglossal Nerve Palsy due to Infected Impacted Tooth. Case Rep Med 2009; 2009:231947. [PMID: 19756258 PMCID: PMC2743198 DOI: 10.1155/2009/231947] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2009] [Accepted: 08/03/2009] [Indexed: 11/22/2022] Open
Abstract
Case of isolated hypoglossal nerve palsy is an extremely rare condition. There are several causes that can be attributed to it. We present a case where a patient presented herself with swelling on the right side of her cheek extending to the floor of the mouth, with unilateral right hypoglossal nerve palsy. Removal of the impacted tooth resulted in the improvement of function of the hypoglossal nerve. The transient isolated hypoglossal nerve palsy could have been due to the infected impacted tooth. Therefore, the dentist or doctors coming across with isolated hypoglossal nerve palsy should consider the infected impacted tooth as the differential diagnosis.
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Mathiesen T, Svensson M, Lundgren J, Kihlström L, Parisotto R, Bagger-Sjöbäck D. Hypoglossal schwannoma-successful reinnervation and functional recovery of the tongue following tumour removal and nerve grafting. Acta Neurochir (Wien) 2009; 151:837-41; discussion 841. [PMID: 19290472 DOI: 10.1007/s00701-009-0226-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2008] [Accepted: 10/13/2008] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Hypoglossal nerve schwannomas are rare tumours that usually cause ipsilateral hypoglossal palsy. This report describes such lesions in two patients and suggests nerve grafting as part of the treatment regimen. METHOD Two patients with intra- and extra-dural hypoglossal schwannomas respectively were treated by direct surgery via a postero-lateral approach to the posterior fossa, hypoglossal canal and carotid sheath. Following tumour removal, sural nerve grafting was used to reconstruct the nerves. Unexpectedly, muscle bulk and motor function returned within 6 months in both patients. CONCLUSION Nerve grafting was highly successful in achieving functional recovery following surgery for hypoglossal nerve schwannomas.
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Affiliation(s)
- Tiit Mathiesen
- Department of Neurosurgery, Skull Base Center, Karolinska Hospital, Stockholm, Sweden
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Elhammady MS, Farhat H, Aziz-Sultan MA, Morcos JJ. Isolated unilateral hypoglossal nerve palsy secondary to an atlantooccipital joint juxtafacet synovial cyst. J Neurosurg Spine 2009; 10:234-9. [DOI: 10.3171/2008.12.spine08158] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Juxtafacet cysts of the atlantooccipital joint that present with isolated hypoglossal nerve palsy are rare and may mimic more common pathological entities. The authors report on the third such case in the literature and discuss the differential diagnosis, imaging hallmarks, preoperative recognition, and surgical management of this lesion, and provide a review of the literature.
The authors discuss their experience with the treatment of a 67-year-old woman who presented with an isolated hypoglossal nerve palsy caused by a nonenhancing cystic septated lesion abutting the lateral medulla just medial to the left hypoglossal canal. The lesion was presumed to be a necrotic hypoglossal schwannoma or epidermoid tumor. Intradural surgical exploration failed to demonstrate an intradural lesion, but confirmed the presence of an extradural mass caudal to the hypoglossal nerve. Extradural exploration revealed a synovial cyst of the atlantooccipital joint, which was then resected. Postoperatively, the patient developed worsening dysphagia and hoarseness. Failure to recognize this rare entity preoperatively resulted in unnecessary intradural exploration and cranial nerve morbidity. In retrospect, the preoperative diagnosis of this lesion was suggested by lack of central enhancement, absence of dumbbell formation and the presence of erosive synovial changes. Regardless, the extreme rarity of this lesion at this location will always make its recognition challenging.
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Goel M, Agnihotri A. Idiopathic Unilateral Isolated Hypoglossal Nerve Palsy : A Case Report. ACTA ACUST UNITED AC 2008. [DOI: 10.5005/johcd-2-3-62] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
ABSTRACT
A Idiopathic isolated hypoglossal nerve palsy is an extremely rare condition. Presented here is a case report of self limiting IHNP on the basis of clinical finding and criteria of exclusion as all the investigations including ultrasound were negative. The patient is on speech therapy and is being actively rehabilitated.
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Maffei C, Gonçalves MIR, de Mello MM, Kluppel JH, Camargo PAM. Pharyngeal cervical neurinoma: dysphonia and dysphagia. Braz J Otorhinolaryngol 2007; 73:718. [PMID: 18094817 PMCID: PMC9445957 DOI: 10.1016/s1808-8694(15)30136-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2006] [Accepted: 08/03/2006] [Indexed: 11/19/2022] Open
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Manfredi M, Merigo E, Pavesi G, Macaluso GM, Vescovi P. Tongue lesions and isolated hypoglossal nerve palsy: a case report. ACTA ACUST UNITED AC 2007; 104:e18-20. [PMID: 17560142 DOI: 10.1016/j.tripleo.2007.01.039] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2006] [Revised: 01/12/2007] [Accepted: 01/30/2007] [Indexed: 11/21/2022]
Abstract
We report the case of a patient with oral lesions on the upper surface of his tongue. Intraoral examination revealed marked right-sided hemiatrophy of the tongue with fasciculation, partial deviation of the tongue on the right side, and inability of the patient to completely deviate the tongue toward the left side of his mouth on protrusion. A magnetic resonance image showed presence of a tumor lesion characterized by irregular margins localized in the intradural space, with a lateral extension along the omolateral hypoglossal canal. This was consistent with the diagnosis of a hypoglossal neurinoma, later confirmed by the histopathologic examination.
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Affiliation(s)
- M Manfredi
- Division of Odontostomatology, Department of Dental Ophthalmogolic and Cervicofacial Sciences, University of Parma, Parma, Italy.
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Khoo SG, Ullah I, Wallis F, Fenton JE. Isolated hypoglossal nerve palsy: a harbinger of malignancy. The Journal of Laryngology & Otology 2007; 121:803-5. [PMID: 17295942 DOI: 10.1017/s0022215107006275] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/15/2006] [Indexed: 11/06/2022]
Abstract
AbstractThe hypoglossal nerve is an underrated nerve usually consigned to a few words in anatomical text books, under the last four cranial nerves. However, paralysis of this nerve may be the first indication of a serious underlying disorder. Excluding previous surgery, radiotherapy and trauma, 50 per cent of cases of isolated hypoglossal nerve palsy are idiopathic. A further 20 per cent are malignant, 20 per cent are vascular and 10 per cent are due to miscellaneous causes. Presentation of an isolated hypoglossal nerve palsy is therefore an ominous sign. There is confusion over both cause and investigation, and management protocols for isolated hypoglossal nerve palsy are ill-defined. We present a case of isolated hypoglossal palsy which was due to a metastatic skull base deposit. This case illustrates the fact that magnetic resonance imaging is the investigation of choice in assessing the entire course of the hypoglossal nerve.
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Affiliation(s)
- S G Khoo
- Department of Otolaryngology/Head and Neck Surgery, Mid-Western Regional Hospital, Limerick, Ireland.
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Ho MWS, Fardy MJ, Crean SJV. Persistent idiopathic unilateral isolated hypoglossal nerve palsy: a case report. Br Dent J 2004; 196:205-7. [PMID: 15039724 DOI: 10.1038/sj.bdj.4810980] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Isolated hypoglossal nerve palsy (IHNP) although a rare condition, has been previously reported. A literature review revealed that in most cases, IHNP indicates the presence of an intracranial or extracranial space occupying lesion, head and neck injury, vascular abnormality, infection, autoimmune disease or neuropathy. Reports of idiopathic cases are rare and the vast majority of IHNP are reversible. We report a case of persistent idiopathic unilateral hypoglossal nerve palsy, with an emphasis on the investigations necessary to be undertaken on presentation of such a lesion.
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Affiliation(s)
- M W S Ho
- Oral and Maxillofacial Surgery, Department of Oral Surgery, Oral Medicine and Oral Pathology, University of Wales College of Medicine, Cardiff, Wales, UK.
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