FACIAL REANIMATION BY MEANS OF THE HYPOGLOSSAL NERVE
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Abstract:
OBJECTIVE The goal of this study was to determine the various anatomical and surgical relationships between the facial and hypoglossal nerves to define the required length of each for a nerve transfer, either by means of a classical hypoglossal-facial nerve anastomosis or combined with any of its variants developed to reduce tongue morbidities. METHODS Five adult cadaver heads were bilaterally dissected in the parotid and submaxillary regions. Two clinical cases are described for illustration. RESULTS The prebifurcation extracranial facial nerve is found 4.82 ± 0.88 mm from the external auditory meatus, 5.31 ± 1.50 mm from the mastoid tip, 15.65 ± 0.85 mm from the lateral end of C1, 17.19 ± 1.64 mm from the border of the mandible condyle, and 4.86 ± 1.29 mm from the digastric muscle. The average lengths of the mastoid segment of the facial nerve and the prebifurcation extracranial facial nerve are 16.35 ± 1.21 mm and 18.93 ± 1.41 mm, respectively. The average distance from the bifurcation of the facial nerve to the hypoglossal nerve turn is 31.56 ± 2.53 mm. For a direct hypoglossal-facial nerve anastomosis, a length of approximately 19 mm of the hypoglossal nerve is required. For the interposition nerve graft technique, a 35 mm-long graft is required. For the technique using a longitudinally dissected hypoglossal nerve, an average length of 31.56 mm is required. Exposure of the facial nerve within the mastoid process drilling technique requires 16.35 mm of drilling. CONCLUSION This study attempts to establish the exact graft, dissection within the hypoglossal nerve, and mastoid drilling requirements for hypoglossal to facial nerve transfer.Keywords:
Hypoglossal nerve
Mastoid process
Digastric muscle
Meatus
Facial paralysis
Objective: Mastoid process is the downward projection from the mastoid part of the temporal bone located posteroinferior to external auditory meatus. Mastoid process is a palpable bony structure which enables to determine the location of asterion. The aim of this study is to define details of mastoid process anatomy to enlighten surgeons, anatomists, anthropologists and forensic experts.Material and Methods: Present study was conducted on 20 skulls (20 left + 20 right=40) and 18 hemi skulls of unknown sex. All measurements were taken by two observers simultaneously by using digital caliper. Of the 58 mastoid processes 30 were right sided and 28 were left sided.Results: Mean and standard deviation of all measurements were reported on each mastoid process. The difference between right A line (distance between right asterion and right apex of mastoid process) and left A line was statistically significant (p=0.022). The difference between right D line (Vertical distance between imaginary plane from the superior border of right external auditory meatus to right apex of mastoid process) and left D line was statistically significant (p<0.001).Conclusion: Mastoid process morphology and its anatomical relations are important for anatomists, neurosurgeons, anthropologists and forensic experts. As it is common centre of interest for multidisciplines, morphometry of this feature should be well defined.
Mastoid process
Meatus
Calipers
Apex (geometry)
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Cranial nerve injury is one of the neurologic complications following carotid endarterectomy. The hypoglossal nerve is one of the most frequently injured nerves during carotid endarterectomy. Guidelines suggest that proper anatomic knowledge is crucial to avoid cranial nerve injury. The aim of the present study is to provide landmarks for the localization of the hypoglossal nerve during carotid endarterectomy. 33 anterior cervical triangles of formalin-fixed adult cadavers were dissected. The âcarotid axisâ was defined and measured, the level of the carotid bifurcation within the carotid axis was registered. âHigh carotid bifurcationâ was considered for those carotid bifurcation found in the upper 25 mm of the carotid axis. The distance between the hypoglossal nerve and the carotid bifurcation was measured (length 1). The relationship between the hypoglossal nerve and the posterior belly of the digastric muscle was registered. For caudal positions, the distance between hypoglossal nerve and posterior belly of the digastric muscle was determined (length 2). Carotid axis range 88.3 mm-155.4 mm, average 125.8 mm. Level of the carotid bifurcation within the carotid axis range 75.3 mm-126.5 mm, mean 102.5 mm. High carotid bifurcation was found in 19 cases (57 %). Length 1 ranged from 1.6 mm to 38.1, mean 17.5. Finally, in 29 specimens (87.8 %) the hypoglossal nerve was caudal to posterior belly of the digastric muscle, whereas in 4 cases (12.2 %) it was posterior. Length 2 ranged from 1 mm to 17.0 mm, mean 6.9 mm. Distances between the hypoglossal nerve and nearby structures were determined. These findings may aid the surgeon in identifying the hypoglossal nerve during carotid endarterectomy and thus prevent its injury.
Digastric muscle
Hypoglossal nerve
Carotid bifurcation
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Hypoglossal nerve
Digastric muscle
Hyoid bone
Jugular foramen
Mastoid process
Occipital artery
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Digastric muscle
Hypoglossal nerve
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OBJECTIVE The goal of this study was to determine the various anatomical and surgical relationships between the facial and hypoglossal nerves to define the required length of each for a nerve transfer, either by means of a classical hypoglossal-facial nerve anastomosis or combined with any of its variants developed to reduce tongue morbidities. METHODS Five adult cadaver heads were bilaterally dissected in the parotid and submaxillary regions. Two clinical cases are described for illustration. RESULTS The prebifurcation extracranial facial nerve is found 4.82 ± 0.88 mm from the external auditory meatus, 5.31 ± 1.50 mm from the mastoid tip, 15.65 ± 0.85 mm from the lateral end of C1, 17.19 ± 1.64 mm from the border of the mandible condyle, and 4.86 ± 1.29 mm from the digastric muscle. The average lengths of the mastoid segment of the facial nerve and the prebifurcation extracranial facial nerve are 16.35 ± 1.21 mm and 18.93 ± 1.41 mm, respectively. The average distance from the bifurcation of the facial nerve to the hypoglossal nerve turn is 31.56 ± 2.53 mm. For a direct hypoglossal-facial nerve anastomosis, a length of approximately 19 mm of the hypoglossal nerve is required. For the interposition nerve graft technique, a 35 mm-long graft is required. For the technique using a longitudinally dissected hypoglossal nerve, an average length of 31.56 mm is required. Exposure of the facial nerve within the mastoid process drilling technique requires 16.35 mm of drilling. CONCLUSION This study attempts to establish the exact graft, dissection within the hypoglossal nerve, and mastoid drilling requirements for hypoglossal to facial nerve transfer.
Hypoglossal nerve
Mastoid process
Digastric muscle
Meatus
Facial paralysis
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Hypoglossal nerve
Digastric muscle
Internal jugular vein
Mastoid process
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Iatrogenic injuries to cranial nerves, half of which affect the hypoglossal nerve, occur in up to 20% of surgical procedures involving the neck. The risk of injury could be minimized by in-depth knowledge of its positional and relational anatomy. Forty-one hypoglossal nerves were dissected from cadaveric specimens and positions described in relation to the internal carotid artery (ICA), external carotid artery (ECA), carotid bifurcation, mandible, hyoid bone, mastoid process, and the digastric tendon. The distance of the nerve from where it crossed the ICA and ECA to the carotid bifurcation was 29.93 (±5.99) mm and 15.19 (±6.68) mm, respectively. The point where it crossed the ICA was 12.24 (±3.71) mm superior to the greater horn of hyoid, 17.16 (±4.40) mm inferior to the angle of the mandible, and 39.08 (±5.69) mm from tip of the mastoid. The hypoglossal nerve loop was inferior to the digastric tendon in 73% of the cases. The hypoglossal nerves formed high loops in this study population. Caution should be exercised during surgical procedures in the neck. The study also revealed that the mastoid process is a reliable fixed landmark to locate the hypoglossal nerve.
Hypoglossal nerve
Mastoid process
Hyoid bone
Digastric muscle
Cadaveric spasm
Cervical Nerve
External carotid artery
Mandibular nerve
Jugular foramen
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In this investigation we dissected 3 cadavers with the lateral cervical approach to assess the usefulness of the transverse process of the atlas (TPA) as a reference guide in the upper lateral neck. Our results indicate that all the important structures in this space can be identified systematically. Lateral to the TPA sits the posterior belly of the digastric muscle, the stylohyoid muscle, and the occipital artery. Anterior to the TPA, the styloid process can be exposed. The internal jugular vein and cranial nerves X, XI, and XII sit between the styloid process and the TPA. Superior to the TPA, tracing the carotid sheath upward, the carotid canal and jugular foramen can be reached. Anteroinferior to the jugular foramen, the hypoglossal nerve emerges from the cranial cavity through the hypoglossal canal. Posterior to the TPA, the suboccipital triangle can be recognized. Within the triangle, the vertebral artery and its accompanying venous complex can be identified.
Jugular foramen
Hypoglossal nerve
Occipital condyle
Digastric muscle
Internal jugular vein
Cranial cavity
Foramen
Mastoid process
Occipital artery
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Objective This study was performed to determine the anatomical landmarks and optimal dissection points of the facial nerve (FN) and the hypoglossal nerve (HGN) in the submandibular region to provide guidance for hypoglossal-facial nerve anastomosis (HFNA). Methods Twenty-nine specimens were obtained from 15 formalin-fixed adult cadavers. Distances were measured based on the mastoid process tip (MPT), common carotid artery bifurcation (CCAB), and the digastric muscle posterior belly (DMPB). Results The shortest distance from the MPT to the stylomastoid foramen was 14.1±2.9 mm. The distance from the MPT to the FN origin was 8.6±2.8 mm anteriorly and 5.9±2.8 mm superiorly. The distance from the CCAB to the crossing point of the HGN and the internal carotid artery was 18.5±6.7 mm, and that to the crossing point of the HGN and the external carotid artery was 15.1±5.7 mm. The distance from the CCAB to the HGN bifurcation was 26.6±7.5 mm. The distance from the digastric groove to the HGN, which was found under the DMPB, was about 35.8±5.7 mm. The distance from the digastric groove to the HGN, which was found under the DMPB, corresponded to about 65.5% of the whole length of the DMPB. Conclusion This study provides useful information regarding the morphometric anatomy of the submandibular region, and the presented morphological data on the nerves and surrounding structures will aid in understanding the anatomical structures more accurately to prevent complications of HFNA. Key Words: Facial nerve · Hypoglossal nerve · Morphometric anatomy.
Hypoglossal nerve
Digastric muscle
Mastoid process
Jugular foramen
Facial artery
Foramen
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