K.D.

MEDICAL COLLEGE
HOSPITAL & RESEARCH CENTER MATHURA

Topics-
-Introduction of 12th Cranial nerve .
-Lesions of hypoglossal nerve
-Supranuclear lesions
Mentor :- Presented by :-
Dr. Abhi Mishra Sir Kritigya Pal
Associate Professor Roll No. -62
Dept. of Anatomy
Introduction
o The Hypoglossal Nerve
is the 12th Cranial
Nerve (Cranial Nerve
XII).
o It is mainly an efferent
nerve for the tongue
musculature.
o The nerve originates
from the medulla and
travels caudally and
dorsally to the tongue.
 Origi
n
◦ Hypoglossal nerve
consists of general
somatic efferent (GSE)
fibers which takes
origin from the
hypoglossal nucleus
and supply the
palatoglossus which
is supplied by the
cranial root of the
accessory via Vagus.
Functional Components
o General somatic efferent column:
The fibres arise from the
hypoglossal nucleus which lies in
the medulla, in the floor of fourth
ventricle deep to the hypoglossal
triangle.
o General somatic afferent column:
The mesencephalic nucleus of (V)
cranial nerve where proprioceptive
fibres from tongue end.
Course of Hypoglossal
nerve
Intracranial
o
course
The fibres pass forward lateral
to the medial longitudinal
bundle, medial lemniscus and
pyramidal tract, and medial to
the reticular formation and
olivary nucleus.
o The nerve is attached to the
anterolateral sulcus of the
medulla, between the pyramid
and the olive, by 10 to15
rootlets.
Extracranial Course
o The nerve first lies deep to the internal jugular vein, but
soon inclines between the internal jugular vein and the
internal carotid artery, crosses the vagus (laterally) and
reaches in front of it .
o It then descends between the internal jugular vein and
the internal carotid artery in front of the vagus , deep to
the parotid gland , the styloid process , the posterior
belly of digastric
o At the lower border of the posterior belly of the
digastric , it curves forward , crosses the internal and
external carotid arteries and the loop of the lingual
artery , and then passes deep to the posterior belly of the
digastric again to enter the submandibular region .
o The nerve then continues forward on the hyoglossus and
genioglossus deep to the submandibular gland and
mylohyoid , enters the substance of the tongue to supply
all its intrinsic and most of its extrinsic musles .
 Branches
o It mainly supplies all the intrinsic
and extrinsic muscles of the tongue
except palatoglossus.
o Meningeal branch-
It enters the skull through
hypoglossal canal and supplies bone
and meninges in anterior part of
posterior cranial fossa.
o Descending branch continues as
upper root of ansa cervicalis.
o Branches are also given to the
thyrohyoid and geniohyoid muscles.
Clinicals
To test the function of hypoglossal nerve , a physician should ask their
patient to protrude their tongue.

◦ Normal –straight ◦ If paralyzed – deviate to paralyzed

forwards side
◦ Lower motor neuron
(nuclear and
infranuclear )Lesions of
Hypoglossal nerve results
in paralysis of the
ipsilateral half of tongue and
on protrusion the tongue
deviates towards the side of
lesion due to unopposed
action of genioglossus of the
healthy side .
◦ Fasciculations.
◦ Upper motor neuron lesions
of hypoglossal nerve.
Since the hypoglossal nucleus
receives corticobulbar fibers only
from the contralateral
hemisphere ,the supranuclear
(UMN)lesions cause weakness of
opposite half of the tongue , and
on protrusion the tongue deviates
to the side opposite to that of
lesion .
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