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Microsurgical Anatomy of the Terminal Hypoglossal Nerve Relevant for Neurostimulation in Obstructive Sleep Apnea
Bahar Bassiri Gharb, MD PhD, Kashyap Komarraju Tadisina, BS, Antonio Rampazzo, MD PhD, Ahmed Hashem, MD, Huseyin Elbey, MD, Grzegorz J. Kwiecien, MD, Gaby Doumit, MD MSc, Richard Drake, PhD, Francis P
Cleveland Clinic
2015-03-13
Presenter: Kashyap Tadisina
Affidavit:
This abstract has not been published in any scientific journal or previously presented at a major meeting. All work on this project represents the original work of the authors.
Director Name: Steven Bernard
Author Category: Medical Student
Presentation Category: Basic Science Research
Abstract Category: Craniomaxillofacial
Background:
Neurostimulation of the hypoglossal nerve has shown promising results in treating obstructive sleep apnea. This anatomic study describes the topography of the hypoglossal nerve's motor points as a premise for super-selective neurostimulation in order to avoid complications related to whole nerve stimulation.
Methods:
Thirty cadaveric hypoglossal nerves were dissected and characterized by number of branches, arborization pattern, and terminal branch motor point location. Per motor point, distance to cervical midline (x axis), distance to posterior mandibular symphysis (y axis), and depth from the plane formed by the inferior symphysis and anterior hyoid (z axis) were registered.
Results:
The average number of distal branches for each hypoglossal nerve was found to be 9.95 2.28. The average number of branches per muscle was found to be 3.3 1.5 for the hyoglossus muscle, 1.8 0.9 for the geniohyoid muscle, and 5.0 1.6 for the genioglossus muscle.
It was found that branches to the genioglossus and geniohyoid muscles were located closer to midline (normalized lengths of 0.19 and 0.19 respectively) while hyoglossus branches were located more laterally (0.38). Branches to the genioglossus were the most anterior/ closest to the posterior mandibular symphysis (0.48), followed by the geniohyoid (0.66), and hyoglossus (0.76). Branches to the geniohyoid were the most superficial (0.26), followed by the genioglossus (0.36), and hyoglossus branches (0.47), which were located deeply.
Conclusion:
A 3-dimensional topographical map of the hypoglossal nerve terminal motor points was successfully created and could provide a framework for the optimization of neurostimulation techniques.
