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Glossopharyngeal (CN IX) and Hypoglossal (CN XII) Nerve Stimulation and Monitoring

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Intraoperative Cranial Nerve Monitoring in Otolaryngology-Head and Neck Surgery

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Abstract

The glossopharyngeal nerve (CN IX) has primarily sensory function but does innervate the stylopharyngeus muscle which is involved with elevating the larynx and dilating the pharynx during swallowing. Of the lower cranial nerves with motor function, the glossopharyngeal is less commonly identified during head and neck surgery but may be selectively stimulated and monitored during skull base and/or neurosurgery. The nerve can be monitored intraorally with electrodes in or along the soft palate or posterior pharyngeal wall and requires co-monitoring of the vagus (CN X) to identify selective glossopharyngeal stimulation. Reduction in the ratio of glossopharyngeal to vagal amplitude is associated with soft palate dysfunction, dysphagia, and loss of gag reflex.

The hypoglossal nerve (CN XII) provides primary motor innervation to the tongue, and its function is critical for speaking, swallowing, and maintenance of the oropharyngeal airway. The hypoglossal nerve has traditionally been vulnerable to injury during surgery of the tongue and upper neck including head and neck cancers, hypoglossal to facial nerve anastomosis, tumors of the jugular foramen, and carotid endarterectomy. Hypoglossal nerve stimulation and monitoring have successfully been used selectively for nerve identification and preservation in some of these cases. More recently, hypoglossal nerve stimulation and monitoring have become critical for distal nerve branch identification to facilitate accurate cuff electrode placement for hypoglossal nerve stimulator implantation to treat obstructive sleep apnea, involving both children and adults. Perhaps in no other surgery involving the lower cranial motor nerves are direct surgeon stimulation and EMG monitoring of the various branches of the nerve more critical to the successful outcome of surgery. The microsurgical dissection requires a bipolar nerve stimulator due to the precision necessary for this procedure. Failure to include the branches to the genioglossus muscle (which protrudes the tongue) and/or failure to exclude the branches to the styloglossus and hyoglossus muscles (which retract the tongue) within the cuff electrode will result in failure to improve obstructive sleep apnea.

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Authors and Affiliations

  1. Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medicine, New York, NY, USA

    Maria V. Suurna

  2. Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati, College of Medicine, Cincinnati, OH, USA

    David L. Steward

Authors
  1. Maria V. Suurna
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  2. David L. Steward
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Correspondence to Maria V. Suurna .

Editor information

Editors and Affiliations

  1. Head and Neck Institute, Cleveland Clinic, Cleveland, OH, USA

    Joseph Scharpf

  2. Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, MA, USA

    Gregory W. Randolph

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Suurna, M.V., Steward, D.L. (2022). Glossopharyngeal (CN IX) and Hypoglossal (CN XII) Nerve Stimulation and Monitoring. In: Scharpf, J., Randolph, G.W. (eds) Intraoperative Cranial Nerve Monitoring in Otolaryngology-Head and Neck Surgery. Springer, Cham. https://doi.org/10.1007/978-3-030-84916-0_18

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  • DOI: https://doi.org/10.1007/978-3-030-84916-0_18

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-84915-3

  • Online ISBN: 978-3-030-84916-0

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