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Der terminale N. hypoglossus und seine anatomische Vielfalt

The terminal hypoglossal nerve and its anatomical variability

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Zusammenfassung

Die obere Atemwegstimulation spielt in der Therapie der obstruktiven Schlafapnoe (OSA) eine immer wichtigere Bedeutung. Ziel der Stimulation ist der N. hypoglossus (N. XII), der als rein motorischer Nerv die Zungenmuskulatur innerviert. Durch die selektive Stimulation einzelner Nervenfasern kann der obere Atemweg mithilfe einer Protrusion der Zunge geöffnet werden. Der N. XII weist eine Vielzahl von anatomischen Varianten auf, die v. a. bei der chirurgischen Implantation dieser Schrittmachersysteme entscheidend sind. Das intraoperative Neuromonitoring ist hier sehr hilfreich. Für die genaue Platzierung der Stimulationselektrode bei der selektiven oberen Atemwegstimulation sind nun die Kenntnisse der Anatomie des N. XII, das intraoperative Neuromonitoring und die genaue Beurteilung von Muskelkontraktionen und Zungenbewegungen von entscheidender Bedeutung.

Abstract

Upper airway stimulation plays an increasingly important role in the treatment of obstructive sleep apnea (OSA). The target of stimulation is the hypoglossal nerve (N. XII), which—as a pure motor nerve—innervates the intrinsic and extrinsic tongue muscles. By selectively stimulating individual nerve fibers, the upper airway can be opened by protruding the tongue. The N. XII has a number of anatomical variants, which are decisive during surgical implantation of these pacemaker systems. Intraoperative neuromonitoring is very helpful in this regard. Accurate placement of the stimulation electrode for selective upper airway stimulation requires knowledge of N. XII anatomy, intraoperative neuromonitoring, and accurate assessment of muscle contractions and tongue movements.

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Authors and Affiliations

  1. Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Klinikum rechts der Isar, der Technischen Universität München, Ismaninger Str. 22, 81675, München, Deutschland

    C. Heiser, A. Knopf & B. Hofauer

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  1. C. Heiser
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  2. A. Knopf
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  3. B. Hofauer
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Correspondence to C. Heiser.

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Interessenkonflikt

C. Heiser ist als Berater für die Fa. Inspire Medical Systems (Maple Grove, USA) tätig. B. Hofauer hat Reisekostenzuschüsse und Vortragsentgelte von der Fa. Inspire Medical Systems (Maple Grove, USA) erhalten. A. Knopf gibt an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

Additional information

Anton-von-Tröltsch-Preis 2018

PD. Dr. med. Clemens Heiser, München, hat für seine Publikation „Surgical anatomy of the hypoglossal nerve: A new classification system for selective upper airway stimulation“ auf der 89. Jahresversammlung der Deutschen Gesellschaft für Hals-Nasen-Ohren-Heilkunde, Kopf- und Halschirurgie e. V. (DGHNO KHC) in Lübeck den Anton-von-Tröltsch-Preis 2018 erhalten.

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Heiser, C., Knopf, A. & Hofauer, B. Der terminale N. hypoglossus und seine anatomische Vielfalt. HNO 67, 242–250 (2019). https://doi.org/10.1007/s00106-019-0632-8

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  • DOI: https://doi.org/10.1007/s00106-019-0632-8

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