Ultrasound of the Hypoglossal Nerve in the Neck: Visualization and Initial Clinical Experience with Patients

Meng, Stefan; Reissig, Lukas F.; Tzou, Chieh‐Han John; Meng, Kun; Grisold, Wolfgang; Weninger, Wolfgang J.

doi:10.3174/ajnr.a4494

Cited by 14 publications

(20 citation statements)

References 26 publications

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“…Jean suggested that the main motor nuclei involved in swallowing motor activity are the hypoglossal nucleus, and the nucleus ambiguus, hypoglossal, glossopharyngeal, and trigeminal nerves are the main motor nerves [ 48 ]. A lesion of the hypoglossal nerve can cause dysarthria, dysphagia, and tongue paralysis [ 49 ]. Sundman et al suggested that the three mechanisms underlying dysphagia were delayed initiation of the swallowing reflex, impaired pharyngeal muscle function, and impaired coordination [ 50 ]; these symptoms of dysphagia are attributed to the damage of several central nuclei associated with swallowing [ 51 , 52 ].…”

Section: Discussionmentioning

confidence: 99%

Electroacupuncture Involved in Motor Cortex and Hypoglossal Neural Control to Improve Voluntary Swallowing of Poststroke Dysphagia Mice

Cui

Yao

et al. 2020

Neural Plasticity

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The descending motor nerve conduction of voluntary swallowing is mainly launched by primary motor cortex (M1). M1 can activate and regulate peripheral nerves (hypoglossal) to control the swallowing. Acupuncture at “Lianquan” acupoint (CV23) has a positive effect against poststroke dysphagia (PSD). In previous work, we have demonstrated that electroacupuncture (EA) could regulate swallowing-related motor neurons and promote swallowing activity in the essential part of central pattern generator (CPG), containing nucleus ambiguus (NA), nucleus of the solitary tract (NTS), and ventrolateral medulla (VLM) under the physiological condition. In the present work, we have investigated the effects of EA on the PSD mice in vivo and sought evidence for PSD improvement by electrophysiology recording and laser speckle contrast imaging (LSCI). Four main conclusions can be drawn from our study: (i) EA may enhance the local field potential in noninfarction area of M1, activate the swallowing-related neurons (pyramidal cells), and increase the motor conduction of noninfarction area in voluntary swallowing; (ii) EA may improve the blood flow in both M1 on the healthy side and deglutition muscles and relieve PSD symptoms; (iii) EA could increase the motor conduction velocity (MCV) in hypoglossal nerve, enhance the EMG of mylohyoid muscle, alleviate the paralysis of swallowing muscles, release the substance P, and restore the ability to drink water; and (iv) EA can boost the functional compensation of M1 in the noninfarction side, strengthen the excitatory of hypoglossal nerve, and be involved in the voluntary swallowing neural control to improve PSD. This research provides a timely and necessary experimental evidence of the motor neural regulation in dysphagia after stroke by acupuncture in clinic.

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Section: Discussionmentioning

confidence: 99%

Electroacupuncture Involved in Motor Cortex and Hypoglossal Neural Control to Improve Voluntary Swallowing of Poststroke Dysphagia Mice

Cui

Yao

et al. 2020

Neural Plasticity

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“…Magnetic resonance is described as being the best imaging method for assessing the extracranial segment of the hypoglossal nerve, but it is limited by small nerve sizes [25]. Nevertheless, one study proposed an imaging protocol for the nerve visualization using ultrasound applied on healthy volunteers and patients [14]. The correct identification of the nerve was also confirmed, in the same study, by ultrasound guided ink injections and dissection of cadaveric specimens.…”

Section: The Hypoglossal Nervementioning

confidence: 95%

“…Moreover, cranial nerves received less attention compared to peripheral nerves [9]. Currently, reference values for cranial nerves in healthy volunteers were reported only by a few articles [10][11][12][13][14].…”

Section: Background and Aimsmentioning

confidence: 99%

“…Next, the probe was moved cranially, to the submandibular region where the hypoglossal nerve was identified adjacent to the intermediate tendon of the digastric muscle, beneath the surface of the mylohyoid muscle and next to the lingual nerve ( Figure 3). This is a modification of the technique described by Meng et al [14] in which the posterolateral border of the mylohyoid muscle was used as a reference. The greater auricular nerve was identified on the external surface of the sternocleidomastoid (SCM) muscle, as it runs around its posterior border and then following a cranial course towards the ear.…”

Section: High-resolution Ultrasound Examination Of the Nervesmentioning

confidence: 99%

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Ultrasound appearance of peripheral nerves in the neck: vagus, hypoglossal and greater auricular

Curcean¹,

Rusu²,

Dudea³

2019

Medicine and Pharmacy Reports

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Background and aim. Information in ultrasonography about reference values of nerves, particularly of those located in the neck is limited. The aim of the study is to demonstrate the feasibility of direct visualization of the vagus, hypoglossal and greater auricular nerves, testing the method on healthy volunteers and estimate the reference values for two perpendicular diameters and cross-sectional area (CSA). Methods. A prospective study was carried out on 21 healthy volunteers (12 women and 9 men), recording their demographic characteristics. A 13 MHz transducer was used on a Hitachi EUB-8500 machine. The vagus nerve was measured at the bifurcation of common carotid artery (CCA) and at the intersection of the internal jugular vein with omohyoid muscle. The hypoglossal nerve was identified as it crosses the posterolateral border of the mylohyoid muscle in the submandibular space. The auricular nerve was identified on the superficial surface of the sternocleidomastoid muscle at 1 cm from its posterior margin. The mean CSA on axial scans, nerve width and thickness were determined. The side-to-side and gender differences of the estimated reference values and their correlations with the weight, height, and body mass index (BMI) were evaluated. Results. The mean ultrasound-estimated CSA was measured for the vagus nerve at CCA bifurcation (2.14 ± 0.79 on the left 2.86 ± 1.27 on the right), vagus nerve at the level of omohyoid muscle (2.10 ± 0.06 on the left and 2.43 ± 0.08 on the right), hypoglossal nerve (1.71 ± 0.08 on the left, 1.24 ± 0.06 on the right) and greater auricular nerve (0.90 ± 0.53 on the left and 0.79 ± 0.71 on the right). The vagus nerve was significantly larger on the right side compared to the left side. Larger hypoglossal nerve was observed in men compared to women. Significant correlations were observed between weight and CSA of the greater auricular nerve. Conclusion. Direct visualization of the vagus, greater auricular nerve and hypoglossal nerves is feasible. Reference values for the size of the studied nerves at specific anatomic landmarks were established. Side, gender and body weight differences of the nerves CSA were noted.

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“…18,19 Nevertheless, both nerves can be localized with standard diagnostic ultrasound (US) equipment. 20,21 We hypothesized that both could also be stimulated percutaneously under US guidance, and we recently published results of an acute neurostimulation experiment in patients with OSA. 10 Here we describe in detail procedural techniques and equipment for successful nerve localization and stimulation.…”

mentioning

confidence: 99%

Ultrasound Localization and Percutaneous Electrical Stimulation of the Hypoglossal Nerve and Ansa Cervicalis

Kent

Schwartz

Zealear

2020

Otolaryngol.--head neck surg.

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Objective Hypoglossal nerve stimulation for obstructive sleep apnea (OSA) can be effective for appropriately selected patients, but current patient selection criteria are complex and still result in a proportion of nonresponders. Ansa cervicalis stimulation of the infrahyoid cervical strap muscles has recently been proposed as a new form of respiratory neurostimulation (RNS) therapy for OSA treatment. We hypothesized that percutaneous stimulation of both nerves in humans with temporary electrodes would make testing of the physiologic response to different RNS strategies possible. Study Design Nonrandomized acute physiology study. Setting Tertiary care hospital. Methods Fifteen participants with OSA underwent ultrasonography and placement of percutaneous electrodes proximal to the medial division of the hypoglossal nerve and the branch of the ansa cervicalis innervating the sternothyroid muscle (ACST). Procedural success was documented in each participant, as were any failures or procedural complication. Results The hypoglossal nerve was successfully localized in 15 of 15 (100%) participants and successfully stimulated in 13 of 15 (86.7%). The ACST was successfully localized in 15 of 15 (100%) participants and successfully stimulated in 14 of 15 (93.3%). Stimulation failure of the hypoglossal nerve was due to suboptimal electrode placement in 1 participant and electrode displacement in the other 2 cases. No complications occurred. Conclusions The hypoglossal nerve and ACST can be safely stimulated via percutaneous electrode placement. Larger trials of percutaneous stimulation may help to identify responders to different RNS therapies for OSA with temporary or permanent percutaneous electrodes. Techniques for electrode design, nerve localization, and electrode placement are described.

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Ultrasound of the Hypoglossal Nerve in the Neck: Visualization and Initial Clinical Experience with Patients

Cited by 14 publications

References 26 publications

Electroacupuncture Involved in Motor Cortex and Hypoglossal Neural Control to Improve Voluntary Swallowing of Poststroke Dysphagia Mice

Electroacupuncture Involved in Motor Cortex and Hypoglossal Neural Control to Improve Voluntary Swallowing of Poststroke Dysphagia Mice

Ultrasound appearance of peripheral nerves in the neck: vagus, hypoglossal and greater auricular

Ultrasound Localization and Percutaneous Electrical Stimulation of the Hypoglossal Nerve and Ansa Cervicalis

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