Kariuki Brian Ngure, Butt Fawzia, Mandela Pamela, Odula Paul
Department of Human Anatomy, University of Nairobi, Nairobi, Kenya.
Craniomaxillofac Trauma Reconstr. 2018 Mar;11(1):21-27. doi: 10.1055/s-0037-1601863. Epub 2017 May 2.
Iatrogenic injuries to cranial nerves, half of which affect the hypoglossal nerve, occur in up to 20% of surgical procedures involving the neck. The risk of injury could be minimized by in-depth knowledge of its positional and relational anatomy. Forty-one hypoglossal nerves were dissected from cadaveric specimens and positions described in relation to the internal carotid artery (ICA), external carotid artery (ECA), carotid bifurcation, mandible, hyoid bone, mastoid process, and the digastric tendon. The distance of the nerve from where it crossed the ICA and ECA to the carotid bifurcation was 29.93 (±5.99) mm and 15.19 (±6.68) mm, respectively. The point where it crossed the ICA was 12.24 (±3.71) mm superior to the greater horn of hyoid, 17.16 (±4.40) mm inferior to the angle of the mandible, and 39.08 (±5.69) mm from tip of the mastoid. The hypoglossal nerve loop was inferior to the digastric tendon in 73% of the cases. The hypoglossal nerves formed high loops in this study population. Caution should be exercised during surgical procedures in the neck. The study also revealed that the mastoid process is a reliable fixed landmark to locate the hypoglossal nerve.
医源性颅神经损伤在涉及颈部的外科手术中发生率高达20%，其中一半会影响舌下神经。通过深入了解其位置和关系解剖结构，可将损伤风险降至最低。从尸体标本中解剖出41条舌下神经，并描述了其相对于颈内动脉（ICA）、颈外动脉（ECA）、颈动脉分叉、下颌骨、舌骨、乳突和二腹肌肌腱的位置。神经从穿过ICA和ECA到颈动脉分叉处的距离分别为29.93（±5.99）mm和15.19（±6.68）mm。其穿过ICA的点位于舌骨大角上方12.24（±3.71）mm、下颌角下方17.16（±4.40）mm以及距乳突尖端39.08（±5.69）mm处。在73%的病例中，舌下神经袢位于二腹肌肌腱下方。在本研究人群中，舌下神经形成高位袢。颈部手术过程中应谨慎操作。该研究还表明，乳突是定位舌下神经的可靠固定标志。
