CRANIAL

NERVE XII
HYPOGLOSSAL
NUCLEUS
Lower motoneuron bodies in the
hypoglossal nucleus.
Consist of a column of cells that
extends nearly the entire length
of the medulla in a position just
under the fourth ventricle close
to the midline
 COURSE
Hypoglossal Nerve fibers emerge on the anterior
surface of the medulla oblongata.
It crosses the posterior cranial fossa and leaves
the skull through hypoglossal canal.
It descends in the neck between the internal
carotid artery and internal jugular vein until it
reaches the posterior belly of digastric.
It turns forward and crosses the internal and
external carotid arteries and loop of lingual
artery.
It passes deep to posterior margin of mylohyoid
muscle and then sends branches to the muscles
of tongue
 MUSCLE
INNERVATION AND
FUNCTION
Innervate the intrinsic muscle
musculature of tongue as well as
muscles at its base.
Genioglossi
- draw the root of the tongue forward
and cause the tip to protrude and
deviates it in the opposite side
 DYSFUNCTION
Lower motoneuron lesion,
with paralysis and atrophy of
the muscles on the same
side of lesion.
On voluntary protrusion, the
tongue deviates to the
paralyzed side.
 TESTING CN XII
To test the function of the nerve, a person is
asked to poke out his/hertongue. 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.
The tongue can also be looked at for signs
oflower motor neurondisease, such
asfasciculationandatrophy.
 CLINICAL
CORRELATE
Lesions of the hypoglossal nerve
may occur anywhere along its
course and may result from tumor,
demyelinating diseases,
syringomyelia, and vascular
accidents. Injury of the nerve in the
neck may also follow stab and
gunshot wounds.
 LOWER MOTOR
NEURON LESION

The tongue will be observed to

deviate toward the paralyzed side
The tongue will be smaller on
the side of the lesion, owing to
muscle atrophy
fasciculation may accompany or
precede the atrophy
 LESION OF THE
CORTICONUCLEAR FIBERS

Lesion of the corticonuclear

fibers
no atrophy or fibrillation of the
tongue, and on protrusion
the tongue will deviate to the
side opposite the lesion. (Note
that the genioglossus is the
muscle that pulls the tongue
 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
 MANAGEMENT
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.