Hypoglossal Research Articles

Electromyography findings in radiation-induced unilateral tongue immobility.

We used electromyography to characterize hypoglossal nerve function among radiation-treated head and neck cancer survivors with later onset unilateral tongue immobility. Patients with unilateral tongue immobility without evidence of recurrent cancer were seen at a tertiary academic institution between February and September 2021. All patients were at least 2 years post-treatment with radiation therapy for head and neck squamous cell carcinoma. Participants were under annual surveillance and displayed no evidence of operative injury to the hypoglossal nerve. The median symptom-free interval for the 10 patients included in this study was 13.2 years (range 2-25 years). Myokymia alone was present in 3 of 10 patients, fibrillation potentials alone were present in 3 of 10 patients, and 1 subject displayed both fibrillation and myokymia. Three out of 10 patients had normal hypoglossal nerve function. These findings highlight how disparate mechanisms may underlie similar clinical presentations of radiation-induced neuromuscular dysfunction.

Electromyographic findings directing the diagnosis of an upper motor neuron lesion of the hypoglossal nerve

A 45-year-old woman presented with a subacute, intermittent deviation of the tongue to the right side, and dysarthria. Symptoms worsen and become more evident when the patient attempts to speak for a prolonged period of time. Neurological examination

Right Versus Left Cuff Position for Upper Airway Stimulation.

Upper airway stimulation (UAS) is a treatment option for obstructive sleep apneain which electrical stimulation is applied to the hypoglossal nerve. Nerve branches that control tongue protrusion are located inferiorly. Due to positioning, left-sided implants are typically placed with an inferiorly oriented electrode cuff (L-down) as opposed to superiorly on the right (R-up). In this study, we assess the impact of left- versus right-sided UAS on patient outcomes. Retrospective cohort study. Tertiary Academic Medical Center. Patients who underwent UAS implantation between 2016 and 2021 with an L-down or R-up oriented cuff as confirmed by X-ray were included. Data were collected retrospectively. Most recent sleep study variables were used for analysis. A total of 190 patients met the inclusion criteria. The average age was 61.0 ± 11.0 years, with 55 (28.9%) females. L-down orientation was present in 21 (11.1%) patients vs 169 (88.9%) R-up. Indications for L-down included hunting/shooting (n = 15), prior radiation/surgery (n = 4), central port (n = 1), and brachial plexus injury (n = 1). Adherence was higher among L-down patients (47.1 vs41.0 hours use/week, P = .037) in univariate analysis, with a similar time to adherence data collection (4.4 vs4.2 months, P = .612), though this finding was not maintained in the multivariate regression analysis. Decrease in apnea-hypopnea index (21.3 vs22.8, P = .734), treatment success (76.5% vs84.0%, P = .665), functional threshold (1.5 vs1.6, P = .550), therapeutic amplitude (2.3 vs2.4, P = .882), and decrease in Epworth Sleepiness Scale (4.9 vs2.6, P = .060)were not significantly different between cohorts. This study is the first to examine the orientation of the UAS electrode cuff concerning the electrodes' natural position and the potential effect on postoperative outcomes. Our study found no significantly different treatment outcomes between the L-down versus R-up cohort, with the exception of device adherence, which was significantly higher in the L-down group on univariate analysis though not on multivariate analysis. Future studies with larger patient cohorts are needed to further investigate this potential relationship between treatment outcomes and electrode cuff orientation.

Hypoglossal Nerve Stimulation: Experience at the VA Ann Arbor

Hypoglossal Nerve Stimulation: Experience at the VA Ann Arbor

The value of excessive daytime sleepiness in predicting outcome after hypoglossal nerve stimulation in obstructive sleep apnea

The value of excessive daytime sleepiness in predicting outcome after hypoglossal nerve stimulation in obstructive sleep apnea

Effectiveness of Hypoglossal Nerve Stimulation changes with body mass index and supine sleep

Effectiveness of Hypoglossal Nerve Stimulation changes with body mass index and supine sleep

Three-year outcomes of Targeted Hypoglossal Nerve Stimulation randomized controlled trial (THN3) for Obstructive Sleep Apnea

Three-year outcomes of Targeted Hypoglossal Nerve Stimulation randomized controlled trial (THN3) for Obstructive Sleep Apnea

The effect of combined hypoglossal nerve stimulation with palatine tonsillectomy on treatment response in obstructive sleep apnea patients with oropharyngeal lateral wall collapse

The effect of combined hypoglossal nerve stimulation with palatine tonsillectomy on treatment response in obstructive sleep apnea patients with oropharyngeal lateral wall collapse

Clinical and physiological predictors of response to hypoglossal nerve stimulation for sleep apnea

Clinical and physiological predictors of response to hypoglossal nerve stimulation for sleep apnea

Long-term morbidity and prevalence of revision surgery after implantation of a breathing synchronized hypoglossal nerve stimulator

Long-term morbidity and prevalence of revision surgery after implantation of a breathing synchronized hypoglossal nerve stimulator

Adverse event reports for continuous positive airway pressure, hypoglossal nerve stimulation and oral appliance therapy devices: an fda maude database analysis

Adverse event reports for continuous positive airway pressure, hypoglossal nerve stimulation and oral appliance therapy devices: an fda maude database analysis

Hypoglossal Nerve Stimulation for Obstructive Sleep Apnea: a multi-institutional study demographic observations

Hypoglossal Nerve Stimulation for Obstructive Sleep Apnea: a multi-institutional study demographic observations

Effectiveness of hypoglossal nerve stimulation to treat obstructive sleep apnea: systemic review and meta-analysis

Effectiveness of hypoglossal nerve stimulation to treat obstructive sleep apnea: systemic review and meta-analysis

Immediate effects of simple palatal augmentation prosthesis in maximum tongue pressure and swallowing functions for acute stroke patients: An observational study.

Acute stroke often leads to dysphagia. In the oral stage of dysphagia, there is a potential for immediate benefit from using a palatal augmentation prosthesis (PAP). We investigated whether our quickly fabricated, simple, and expedited version of PAP would result in an immediate improvement in swallowing function after an acute stroke. We analyzed the records of stroke patients that were hospitalized between October 2019 and March 2022 and met the following criteria: they had a rehabilitation prescription and had paralysis of facial or hypoglossal nerves and either repeated salivary swallowing test ≤2 times or modified water swallow test ≤3, they were fasting, were within 3 weeks of onset, and had a simple PAP made for them. Outcomes included with/without PAP, maximum tongue pressure, repeated salivary swallowing test, and modified water swallow test on the day after starting to wear PAP was started. In addition, within one week, a videofluoroscopic examination was performed to measure the oral transit time, pharyngeal transit time, and penetration aspiration scale. Statistical analyses were performed using Wilcoxon signed-rank tests. Statistical significance was set at P < 0.05. Fifteen patients met the inclusion criteria and were included in this study. The mean age of the subjects was 76.9 ± 9.0 years. The use of PAP significantly increased maximum tongue pressure (P < 0.0001*) and shortened oral transit time (P < 0.0091*). There were no significant differences among the other items. Simple PAP immediately increased the maximum tongue pressure and improved swallowing function during the oral stage.

Giant cervical lipoma adjacent to carotid artery: a case report and literature review

Cervical lipomas accompanied by neurovascular compression are extremely rare and require surgical treatment in case of appropriate symptoms. The preferable method is gross total resection, as otherwise they tend to recur. Invasive growth is not typical for lipomas. However, large tumors can involve adjacent nerves and vessels and significantly complicate resection. We present a 57-year-old patient who underwent resection of giant soft tissue cervical lipoma invading neurovascular bundle and compressing the oropharynx and esophagus with dysphagia and positional asphyxia. The patient was followed-up for previous 5 years. Resection was necessary due to tumor enlargement with appropriate symptoms. Searching for literature data was performed in the Pubmed, Medline, EMBASE, Cochrane Library and eLibrary databases. Gross total resection of 7-cm tumor was accompanied by mobilization of hypoglossal and vagus nerves, common, external and internal carotid arteries and jugular vein with repositioning of the oropharynx and esophagus. There was mild Horner's syndrome in early postoperative period. The patient was discharged in 4 days after surgery with regression of complaints. We found only 5 reports describing giant cervical lipomas invading neurovascular bundle. Giant cervical lipomas are extremely rare, and total resection with preservation of critical structures is possible in a specialized hospital.

A Comprehensive Review on Hypoglossal Nerve Palsy Presenting with Cervical Pain

Hypoglossal nerve palsy HNP is an uncommon neurological condition that can manifest with symptoms such as tongue deviation swallowing difficulties and speech impairments. While the classic presentation of HNP involves deficits in tongue movement and function it is essential to recognize that cervical pain can also be an associated symptom. This manuscript comprehensively reviews the literature examining the relationship between HNP and cervical pain. A thorough search of Pubmed and Google Scholar was conducted to identify relevant articles published between 2012 and 2023. Four case studies were selected for analysis illustrating various etiologies of HNP in the context of cervical pain. These cases underscore the importance of a thorough neurological assessment in patients presenting with neck pain as it may lead to the timely diagnosis and management of HNP. Clinicians should maintain a high index of suspicion for HNP in individuals complaining of cervical pain especially when accompanied by other neurological symptoms. Further research is warranted to elucidate the underlying mechanisms and optimal treatment strategies for HNP presenting with cervical pain.

Key Points of Surgery and Current Status in Japan on Hypoglossal Nerve Electrical Stimulation

Key Points of Surgery and Current Status in Japan on Hypoglossal Nerve Electrical Stimulation

Oral appliance therapy and hypoglossal nerve stimulation as non-positive airway pressure treatment alternatives for obstructive sleep apnea: a narrative expert review.

This perspective on alternatives to positive airway pressure (PAP) therapy for the treatment of obstructive sleep apnea (OSA) summarizes the proceedings of a focus group that was conducted by the Sleep Research Society Foundation. This perspective is from a multidisciplinary panel of experts from sleep medicine, dental sleep medicine, and otolaryngology that aims to identify the current role of oral appliance therapy and hypoglossal nerve stimulation for the treatment of OSA with emphasis on the US practice arena. A secondary aim is to identify-from an implementation science standpoint-the various barriers and facilitators for adoption of non-PAP treatment that includes access to care, multidisciplinary expertise, reimbursement, regulatory aspects, current treatment guidelines, health policies, and other factors related to the delivery of care. The panel has contextualized the review with recent events-such as a large-scale PAP device recall compounded by supply chain woes of the pandemic-and emerging science in the field of OSA and offers solutions for multidisciplinary approaches while identifying knowledge gaps and future research opportunities.

Morphological analysis of the hypoglossal canal and its relationship with surrounding anatomical structures

Aim: The aim of this study was to investigate the hypoglossal canal morphologically and to emphasize the importance of its relation to the adjacent anatomical structures, which may affect some surgical procedures, such as the transcondylar surgical approach. Methods: In the study, 25 adult human skulls belonging to Bursa Uludağ University Anatomy Laboratories were evaluated. The 22 parameters were measured on the skulls. Results: The distance between the hypoglossal canal and the anterior border of the occipital condyle was found to be 15.8±2.8 mm on the left side and 15.8±3.1 mm on the right side. The external distance between the hypoglossal canal and the anterior border of the occipital condyle was found to be 11.5±2 mm on the left and 11.6±2 mm on the right. The distance between the hypoglossal canal and the posterior margin of the occipital condyle was 11.7±1.8 mm on the left side and 12.2±2.1 mm on the right side. Furthermore, the distance measured externally between the same anatomical structures was found to be 14.04±1.89 mm and 14.4±1.6 mm on the left and right, respectively. We also found a positive correlation between the length of the foramen magnum and the occipital condyle. In addition, the diameter of the foramen magnum and the distance between the hypoglossal canal and the anterior margin of the occipital condyle were positively correlated. Conclusion: In the transcondylar approach, the locations of important anatomical structures must be well known to perform a safe occipital condyle resection without harming the neural tissue. Especially surgeons should pay attention to the distances between the hypoglossal canal and the anterior and posterior margins of the occipital condyle in order to prevent hypoglossal nerve injury. The operational success of a condylectomy may be affected by the length of the hypoglossal canal. A detailed anatomical assessment is needed before similar procedures to avoid surgical injuries. How to cite this article: Yıldız Yılmaz M, Babacan S, Kafa İM, Coşkun İ. Morphological analysis of the hypoglossal canal and its relationship with surrounding anatomical structures. J Med Dent Invest 2023; 4: e230343. https://doi.org/10.5577/jomdi.e230343

On the Cranial Nerves.

The twelve cranial nerves play a crucial role in the nervous system, orchestrating a myriad of functions vital for our everyday life. These nerves are each specialized for particular tasks. Cranial nerve I, known as the olfactory nerve, is responsible for our sense of smell, allowing us to perceive and distinguish various scents. Cranial nerve II, or the optic nerve, is dedicated to vision, transmitting visual information from the eyes to the brain. Eye movements are governed by cranial nerves III, IV, and VI, ensuring our ability to track objects and focus. Cranial nerve V controls facial sensations and jaw movements, while cranial nerve VII, the facial nerve, facilitates facial expressions and taste perception. Cranial nerve VIII, or the vestibulocochlear nerve, plays a critical role in hearing and balance. Cranial nerve IX, the glossopharyngeal nerve, affects throat sensations and taste perception. Cranial nerve X, the vagus nerve, is a far-reaching nerve, influencing numerous internal organs, such as the heart, lungs, and digestive system. Cranial nerve XI, the accessory nerve, is responsible for neck muscle control, contributing to head movements. Finally, cranial nerve XII, the hypoglossal nerve, manages tongue movements, essential for speaking, swallowing, and breathing. Understanding these cranial nerves is fundamental in comprehending the intricate workings of our nervous system and the functions that sustain our daily lives.