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Accessory &hypoglossal Nerve 2023
Accessory &hypoglossal Nerve 2023
• Formed by the
union of cranial
&spinal root.
CRANIAL ROOT;
• Origin: Nucleus
ambiguus (NA) in the
medulla oblongata
• The fibers emerge from
the anterior surface of
the medulla oblongata
between the olive and
the inferior cerebellar
peduncle
SPINAL ROOT
• ORIGIN;
• Formed by the
axons of the nerve
cells in the spinal
nucleus which is
located in the
ventral grey horn
in the upper 5
cervical segments
COURSE
• Spinal part:
• Fibers emerge from the spinal
cord, form a nerve trunk that
ascends into the cranial cavity
through the foramen
magnum, pass laterally and
join the cranial root.
• Cranial root;
• It joins the spinal root &leaves
through the jugular foramen.
Course
• Then the cranial
part separates
from the spinal
part and joins the
vagus nerve.
• The spinal part
runs downwards
to supply muscles
of neck
(sternocleidomast
oid & trapezius)
Distribution:
• i) Extrinsic muscles
• Superior longitudinal
• Inferior longitudinal
• Transverse
• Vertical
• Together, these muscles are responsible for
all movements of the tongue.
– Function:
– 1. Supplies motor innervation to all of the muscles of
the tongue Except the palatoglossus (which is
supplied by the vagus nerve).
– So, it Controls the movements and shape of the
tongue during speech and swallowing
– 2. Carries proprioceptive afferents from the tongue
muscles.
Nerve supply of tongue
Cranial nerve examination
• Hypoglossal nerve is examined by asking
the patient to protrude their tongue.
• Other movements such as asking the patient
to push their tongue against their cheek and
feeling for the pressure on the opposite side
of the cheek may also be used if damage is
suspected.
• Manifestations of Lesion of the
nerve (LMN) :
– Loss of tongue movements
– Difficulty in chewing and
speech Normal
– The tongue paralyses,
atrophies, becomes shrunken
and furrowed on the
affected side (LMN paralysis)
– On protrusion, tongue
deviates to the affected side
• If both nerves are damaged,
person can’t protrude tongue
Lesion left CN 12