hypoglossal nerve stimulator implantation

how to pick up "mixed

activation" and improve
surgical outcomes for
patients with
obstructive sleep
the plan
1. Map the hypoglossal nerve
2. Recording from 2 muscles
a. the genioglossus
(activates during
medial branch
stimulation)
b. the hyoglossuss
(activates during
lateral branch
stimulation).
the supplies
1. Two paired electrodes for EMG
2. Two paired electrodes for
stimulation and recording of a
TOF.
3. One single electrode for a
ground
4. One monopolar or bipolar probe
5. One single electrode for a
reference (for the monopolar
probe).
the program

(just use your thyroid program)

 the setup

Green = Go. Genioglossus mm.

Red= Stop. Hypoglossal mm.
the goal
A good response on the
genioglossus muscle and no
response on hypoglossal muscle.
 the reason
If the hypoglossus muscle
contracts during our mapping, it
will do so every time the
implanted stimulator turns on.
This retracts the tongue causing a
smaller respiratory airway.
We can help verify the
genioglossus muscle is isolated to
push the tongue forward, opening
the airway.
if you find this helpful, please
let me know in the comments
It helps others see it

Joe Hartman
IntraoperativeNeuromonitoring.com