hypoglossal nerve palsy

1. HYPOGLOSSAL NERVE PALSY

2. Hypoglossal nerve The  hypoglossal nerve  is the twelfth  cranial nerve  (XII), leading to the tongue. The nerve arises from the  hypoglossal nucleus  and emerges from the  medulla oblongata  in the preolivary  sulcus  separating the  olive  and the  pyramid . It then passes through the  hypoglossal canal .

3. It supplies motor fibres to all of the muscles of the  tongue , except the  palatoglossus muscle , which is innervated by the vagus nerve  (cranial nerve X) or, according to some classifications, by fibers from the  glossopharyngeal nerve  (cranial nerve IX) that "hitchhike" within the vagus. The hypoglossal nerve is derived from the  basal plate  of the  embryonic   medulla oblongata .

4. Testing the hypoglossal nerve To test the function of the nerve, a person is asked to poke out his/her  tongue . If there is a loss of function on one side ( unilateral paralysis ), the tongue will point toward the affected side. The strength of the tongue can be tested by getting the person to poke the inside of his/her cheek, and feeling how strongly he/she can push a finger pushed against the cheek - a more elegant way of testing than directly touching the tongue.

5. The tongue can also be looked at for signs of  lower motor neuron  disease, such as  fasciculation  and  atrophy . Paralysis/paresis of one side of the tongue results in ipsilateral curvature of the tongue (apex toward the impaired side of the mouth); i.e., the tongue will move toward the affected side. Cranial Nerve XII is innervated by the contralateral cortex, so a purely upper motor neuron lesion will cause the tongue to deviate away from the cortical lesion.

6. CAUSES The causes may be central or peripheral and include cerebrovascular accidents, brain stem tumours, multiple sclerosis, syringomyelia, and infectious poly neutritis. Injury to this nerve causes dysarthria and dysphagia.

7. CHARACTERISTICS In peripheral lesion there is deviation of the tongue towards the affected side, during protrusion. When in tongue rest on the floor of the mouth, a mild deviation towards the unaffected side may be observed. In central lesion, involvement is often bilateral. The patient cannot protrude the tongue, and attempt movement of tongue posteriorly is defective and un co-ordination. The tongue is also small and firm.

8. These individuals will also have problem in swallowing. There is no control over tongue that results in swallowing problems

9. SPEECH CHARACTERISTICS The abnormality of tongue will lead to misarticulation . The individuals will have problem in producing /t/, /d/,/t∫/,/l/,/n/,/ i /,/j/,/k/ and /g/. Due to dysarthria these individuals may have distorted vowel and word flow without pauses Severity ranges from occasional articulation difficulties to verbal speech that is completely unintelligible.

10. MANAGMENT Speech therapy should be given Exercise for the treatment of dysarthria may help to improve tongue co-ordination and strength. Treatment of hypoglossal nerve injuries due to penetrating wounds is surgical and the nerve tend to recover quite well