Clinical Records

Aberrant anatomy of the hypoglossal nerve

S Islam^a1 c1, G M Walton^a1a2 and D Howe^a1a2

^a1 Department of Head and Neck Surgery, University Hospitals of Coventry and Warwickshire, Coventry, UK

^a2 Department of Head and Neck Surgery, Heart of England Foundation Trust, Birmingham Heartlands Hospital, Birmingham, UK

Abstract

Objective: Variant anatomy of the hypoglossal nerve is very rare. We report an unusual intra-operative finding of an aberrant branch of the hypoglossal nerve, encountered during a facial reanimation procedure.

Case report: A 50-year-old man was referred to the head and neck surgery department by the neurosurgeons for hypoglossal-facial nerve anastomosis to treat his facial paralysis, which had occurred following the removal of an intracranial neoplasm. During surgery, we identified an aberrant branch of the hypoglossal nerve, which took a more ventral and superior course in the carotid triangle, prior to entering the base of the tongue. Following further dissection, we found the main trunk of the ‘true’ hypoglossal nerve. Several interconnecting strands were seen in the proximal aspect of both the aberrant branch and the main trunk of the hypoglossal nerve. These interconnecting fibres appeared to have tethered the main trunk into an abnormal anatomical position.

Conclusion: As far as we can ascertain, this is the first report of an aberrant branch of the hypoglossal nerve. Although this variant would appear to be extremely rare, surgeons must consider all variations of this nerve during head and neck procedures, in order to minimise iatrogenic complications.

(Accepted July 26 2011)

(Online publication January 10 2012)

Key words

• Hypoglossal Nerve;
• Anatomy;
• Abnormalities

Correspondence:

^c1 Address for correspondence: Mr S Islam, Department of Otolaryngology, The Royal Wolverhampton Hospital, New Cross, Wolverhampton WV10 0PQ, UK Fax: + 44 (0)2476 844105 E-mail: drshafiqislam@hotmail.co.uk

Footnotes

Mr S Islam takes responsibility for the integrity of the content of the paper

Competing interests: None declared