Accessory &Hypoglossal nerve

Dr. Kavitha ganesh

PNU
 OBJECTIVES
• By the end of the lecture, the student will be
able to:
• Define the deep origin of both Accessory
&Hypoglossal Nerves.
• Describe the course and distribution of each
nerve .
• List the branches of both nerves.
• Describe the effects in case of lesion of XI & XII
Nerves.
 Accessory Nerve
• It is a motor
nerve(SVE)

• 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:

• Cranial part: distributed

through vagus nerve, to
voluntary muscles of
larynx, pharynx, soft
palate & esophagus
• Spinal part:, supplies
sterno-cleidomastoid
muscle muscle and then
crosses the posterior
triangle of the neck and
supplies the trapezius
muscle
 Lesion of Accessory Nerve
• Paralysis of
Sternocleidomastoid
&Trapezius
• Inability to shrug
(raise) the shoulder
• Difficulty in raising the
arm above 90 degrees
• Inability to turn the
head opposite side.
 Injury of the Spinal Root of Accessory
Nerve
• Causes:
• Because of the relatively
superficial position of the
nerve in the posterior
triangle, it may be damaged
by penetrating trauma as
stab wounds.
• It is considered the most
commonly iinjured nerve
during removal of malignant
lymph nodes in the posterior
triangle.
 Hypoglossal Nerve

• Type: Motor (GSE)

• Origin: Hypoglossal nucleus

of the medulla
• The fibers emerge from the
anterior surface of the
medulla oblongata between
the pyramid and the olive.
• It then passes through the
hypoglossal canal .
 Hypoglossal Nerve
• beneath the floor of the
lower part of the fourth
ventricle .
• receives corticonuclear
fibers from both cerebral
hemispheres.
• cells responsible for
supplying the genioglossus
muscle only receive
corticonuclear fibers from
the opposite cerebral
hemisphere
 course
• Courses downward
with cervical
neurovascular
bundle (internal
carotid artery,
internal Jugular
vein, vagus nerve)
• Curves forward
behind mandible to
supply the tongue
 Branches of XII Nerve
• It gives off a small
meningeal branch and
joins with a branch
from
the anterior ramus of
C 1.
• Supplies motor
innervation to all of
the muscles of the
tongue except the
palatoglossus (which is
supplied by the
vagus).
 Muscles of Tongue
• These muscles can be subdivided into two
groups:

• i) Extrinsic muscles

• Genioglossus (makes up the bulk of the

tongue)
• Hyoglossus
• Styloglossus
• Palatoglossus (innervated by vagus
nerve)

• ii) Intrinsic 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