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Ceneral anatomy
Hypoglossal nerve

name‫بيداء عدي عبدالرزاق‬

2nd stage .department of dentistry
For : dr.akram kareem
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Definition :
This nerve controls all tongue movements. Nuclear or
infranuclear lesions produce paralysis, atrophy, and
fasciculations
of the tongue on the involved side. Supranuclear lesions
produce mild to moderate contralateral weakness that may
be transient. Bilateral supranuclear lesions, seen in
pseudobulbar palsy, produce moderate to severe inability
of the tongue to function.

Introduction :
The Hypoglossal Nerve is the 12th Cranial Nerve (Cranial
Nerve XII). It is mainly an efferent nerve for the tongue
musculature. The nerve originates from the medulla and
travels caudally and dorsally to the tongue.

Branches :
The hypoglossal nerve (CN XII) has two lateral, and
terminal lingual branches. The two lateral branches are
the meningeal branch and the superior root of the ansa
cervicalis, whereas the terminal branches are the terminal
lingual nerves.
Key facts about the branches of the hypoglossal nerve
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Meningeal branch
Dura mater on the floor of the posterior cranial fossa
Posterior wall of the posterior cranial fossa
Superior root of the ansa cervicalis
Sternohyoid muscle
Sternothyroid muscle
Omohyoid muscle
Terminal lingual branches
The intrinsic muscles of the tongue
Three extrinsic muscles of the tongue (genioglossus,
hyoglossus, and styloglossus), and the
Geniohyoid muscle
The meningeal branch carries fibers from the sensory
spinal ganglion of the spinal nerve C2. This branch
returns to the skull
(https://www.kenhub.com/en/library/anatomy/the-skull)
through the hypoglossal canal and innervates the dura
mater on the floor of the posterior cranial fossa, and the
posterior wall of the posterior cranial fossa. Want to recall
the dura mater and cranial anatomy? We got you covered
with great video tutorials.
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The superior root of the ansa cervicalis actually carries

the fibers from the cervical plexus that joined the nerve
outside the cranium. It supplies three of the infrahyoid
muscles: the sternohyoid
(https://www.kenhub.com/en/library/anatomy/sternohyoid
-muscle), sternothyroid
(https://www.kenhub.com/en/library/anatomy/sternothyro
id-muscle) and the omohyoid muscles
(https://www.kenhub.com/en/library/anatomy/omohyoid-
muscle). Learn more about the infrahyoid muscles in a
more fun and engaging way with our article and video
tutorial.When it comes to the terminal lingual branches,
the nerve literally diverges into these branches after it
passes through the aforementioned intermuscular crack
between the hyoglossus muscle and the mylohyoid
muscle. These terminal lingual branches of the
hypoglossal nerve are exclusively motor and innervate all
of the intrinsic muscles of the tongue, three extrinsic
muscles of the tongue (genioglossus, hyoglossus, and
styloglossus), and the geniohyoid muscle additionally.

Clinical Significance :
Supranuclear lesions usually produce a transient mild
weakness of the contralateral side of the tongue. There is
considerable individual variation, however, and on
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occasion a supranuclear lesion can produce what appears

to be a nuclear lesion, due to the degree of the weakness.
The transient nature is usually the clue.
Nuclear lesions produce atrophy, weakness, or paralysis
and fasciculations. Amyotrophic lateral sclerosis and
polio are two causes. Syringobulbia, infarction, and
intraspinal tumors are other etiologies. Nuclear lesions are
often bilateral because of the closeness of the two nuclei
in the medulla.
Hypoglossal nerve involvement after the individual fibers
exit from the medulla is seen with many of the lesions
that affect the spinal accessory nerve (see Chapter 64
(https://www.ncbi.nlm.nih.gov/books/n/cm/A1966/?
report=reader)). Tumors can compress the nerve in the
hypoglossal canal and in the jugular foramen. Basilar
meningitis, due to granulomatous infection or carcinoma,
can produce hypoglossal lesions. Unilateral twelfth nerve
palsy has been reported as one of the more common
cranial mononeuropathies due to metastases.

Function :
Provides motor innervation to the muscles of the tongue
(except for the palatoglossus, which is innervated by the
vagus nerve) and other glossal muscles. Important for
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swallowing (bolus formation) and speech articulation.

Located in the hypoglossal canal
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Resources :
 https://www.imaios.com/en/e-Anatomy/Anatomical-
Parts/Hypoglossal-nerve-XII
 https://www.kenhub.com/en/library/anatomy/the-
hypoglossal-nerve
 https://www.ncbi.nlm.nih.gov/books/NBK532869/#a
rticle-23265.r1
 https://www.ncbi.nlm.nih.gov/books/NBK388/