The lips are often weak and unable to exhale

Introduction Examination of the sublingual nerve injury: firstly, unilateral or bilateral dyskinesia is found, followed by lingual muscle atrophy and fasciculation; the lips are often weak and unable to suffocate, that is, the use of fingers to close the nostrils often cannot be drumsticked, only Can be drumsticked when the lips are pressed. It can be seen that the sacral palsy and the sucking reflex disappear. Tongue muscle atrophy with or without lingual muscle fibrillation, abnormal brain stem reflex. Sublingual nerve injury is usually divided into two types, namely central hypoglossal nerve injury and peripheral hypoglossal nerve injury.

Cause

Sublingual nerve injury is usually divided into two types, namely central hypoglossal nerve injury and peripheral hypoglossal nerve injury. The causes of the two types of damage are different.

Central sublingual nerve injury

(1) bilateral supraoptic supracondylar and one-sided suprarenal lingual tendon: can be caused by various causes, but most commonly in the sequela of factor or number of strokes, amyotrophic lateral sclerosis, diffuse brain Arteriosclerosis, multiple sclerosis, multiple cerebral infarction, syphilitic cerebral arteritis, medullary cavity, poliomyelitis, cerebrovascular disease, cerebral hemorrhage, cerebral embolism, intracranial tumor and craniocerebral injury.

(2) sublingual nuclear lesions: medullary vascular lesions, medullary cavity, progressive bulbar palsy; craniocerebral malformations such as skull base depression, congenital cerebellar tonsillar mandibular deformity; metastatic carcinoma infiltration at the base of the skull (such as nasopharyngeal carcinoma); lesions near the foramen magnum, such as tumors, fractures, meningitis, neck tumors.

2. Peripheral hypoglossal nerve injury

Mainly caused by sublingual nerve peripheral lesions, the most common causes are skull base fractures, aneurysms, tumors, submandibular injuries (gunshot wounds), cervical dislocation, occipital condyle fractures, anterior occipital perforostitis, and skull base or Unintentional or intentional (such as sublingual nerve and facial nerve anastomosis) injury during neck surgery, as well as primary sublingual tumor. The signs of peripheral hypoglossal nerve lesions were unilateral except for the lingual tendon, and the rest were similar to the damage of the hypoglossal nucleus.

an examination

Related inspection

Blood routine serum complement C4

1, simple peripheral hypogland nerve injury: unilateral hypoglossal nerve paralysis when the disease side of the tendon tendon, when the tongue is extended, the tip of the tongue is biased to the affected side, the diseased side of the tongue muscle atrophy; both sides of the sublingual nerve paralysis, the tongue muscle is completely paralyzed, The tongue can not be stretched out at the bottom of the mouth, and it has difficulty in speaking and swallowing.

2. Sublingual nerve injury (bulbar palsy) with posterior group of cranial nerve injury: The posterior group of cranial nerves (lingual pharyngeal nerve, vagus nerve, accessory nerve, sublingual nerve) originate from the medulla oblongata, and the relationship is very close. Medullary nerve. When the central sublingual nerve injury (nuclear and supra-nuclear) and the peripheral sublingual nerve of the skull base are combined with the cerebral nerve injury, it is often combined with the clinical manifestations of the medullary-related lesions, and the medullary paralysis The form appears to be one of the most common and dominant types of hypoglossal nerve injury.

Differential diagnosis

1. Correctly distinguish between bulbar palsy and simple peripheral hypoglossal nerve injury, and determine the location and type of hypoglossal nerve injury.

(1) Medullary paralysis: the main difference between true bulbar palsy and pseudobulbar paralysis:

1 No muscle atrophy, fasciculation and electrical displacement reaction, especially with or without atrophy of the tongue muscle, have important clinical significance for differential diagnosis.

2 The voluntary movement of the affected muscles is paralyzed, while the reflex movement dominated by the medulla oblongs. In particular, the facial muscles that are used for grinning and tooth movements are paralyzed, but there are still strong crying and strong laughing movements, and they can still swallow and still have nausea symptoms. Its main performance is dysphonia, and it is more obvious than dysphagia. Generally, it is not easy to swallow. If there is difficulty in swallowing, it is mainly because the food cannot be moved to the back of the mouth.

3 brain stem hyperthyroidism: Because pseudobulbar paralysis is an upper motor neuron paralysis, there can be a variety of brainstem reflexes (reflection center located in the brain stem) hyperthyroidism; brain stem reflex in the true medullary paralysis decreased or disappeared. Brain stem reflexes include:

(2) simple peripheral hypoglossal nerve injury: one side of the hypoglossal nerve paralysis, the tongue is biased to the disease side, the affected side of the tongue muscle atrophy, and often accompanied by muscle fiber fibrillation; swallowing and pronunciation generally no difficulty. When the bilateral sublingual nerves are paralyzed, complete tongue numbness occurs, and the tongue cannot move at the bottom of the mouth, resulting in difficulty in eating and swallowing, dysphonia, especially when the tongue is sounded.

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