Locating The Inclusionary Hypoglossal Nerve Branches Flashcards
Instructor: Now that you’ve exposed the genioglossus, what is the next step?
Trainee: The next step is to identify and expose the hypoglossal nerve branches, which are located along the lateral borders of the genioglossus muscle.
Instructor: How will you approach the dissection to locate the hypoglossal nerve branches?
Trainee: I will perform blunt dissection along the lateral edges of the genioglossus muscle.
Instructor: What anatomical structure can serve as a reliable reference point for identifying the hypoglossal nerve (HGN)?
Trainee: “The ranine vein generally runs directly on top of the hypoglossal nerve, making it an excellent anatomical landmark for precise identification during the procedure.
→ Instructor: How do you identify inclusionary hypoglossal nerve fibers during the dissection?
Trainee: I will identify inclusionary HGN fibers by their location lateral to the genioglossus muscle. Using the nerve integrity monitoring (NIM) system.
Instructor: How do you use anatomy, NIM signals, and muscle contraction together during the procedure?
Trainee: Anatomy helps me see and locate the muscles visually, IONM signals confirm nerve activity, and muscle contraction shows the function of the fibers in real time. By looking at all three, I can precisely target the inclusionary nerve branches and effectively distinguish the exclusionary branches.
Instructor: What is the goal when identifying and targeting specific nerve fibers during the procedure?
Trainee: The goal is to protrude and stiffen the tongue. This involves excluding the primary retractors, which are the hyoglossus (HG) and styloglossus (SG), while including the main stiffeners and protrusors such as the genioglossus horizontal (GGh), genioglossus oblique (GGo), and transversus/verticalis (T/V) fibers.
Instructor: What is the next step after defining the inclusionary branches?
→ Trainee: The next step is to create the paddle area by preparing the muscle surface for implant placement. This involves ensuring a smooth, well-exposed area over the inclusionary branches while avoiding interference from the exclusionary branches.
Instructor: What do you do after defining the paddle area on one side?
Trainee: After defining the paddle area on one side, I will leave a neurosurgical pattie in the paddle area. Then, I will proceed to the other side to repeat the process. Afterwards we are ready to place the implant.
