Its fibers arise from the cells of the hypoglossal nucleus, which is an upward prolongation of the base of the anterior column of gray substance of the medulla spinalis. This nucleus is about 2 cm. in length, and its upper part corresponds with the trigonum hypoglossi, or lower portion of the medial eminence of the rhomboid fossa (page 779). The lower part of the nucleus extends downward into the closed part of the medulla oblongata, and there lies in relation to the ventro-lateral aspect of the central canal. The fibers run forward through the medulla oblongata, and emerge in the antero-lateral sulcus between the pyramid and the olive.
The rootlets of this nerve are collected into two bundles, which perforate the dura mater separately, opposite the hypoglossal canal in the occipital bone, and unite together after their passage through it; in some cases the canal is divided into two by a small bony spicule. The nerve descends almost vertically to a point corresponding with the angle of the mandible. It is at first deeply seated beneath the internal carotid artery and internal jugular vein, and intimately connected with the vagus nerve; it then passes forward between the vein and artery, and lower down in the neck becomes superficial below the Digastricus. The nerve then loops around the occipital artery, and crosses the external carotid and lingual arteries below the tendon of the Digastricus. It passes beneath the tendon of the Digastricus, the Stylohyoideus, and the Mylohyoideus, lying between the last-named muscle and the Hyoglossus, and communicates at the anterior border of the Hyoglossus with the lingual nerve; it is then continued forward in the fibers of the Genioglossus as far as the tip of the tongue, distributing branches to its muscular substance.
The communications with the vagus take place close to the skull, numerous filaments passing between the hypoglossal and the ganglion nodosum of the vagus through the mass of connective tissue which unites the two nerves. As the nerve winds around the occipital artery it gives off a filament to the pharyngeal plexus.
The communication with the sympathetic takes place opposite the atlas by branches derived from the superior cervical ganglion, and in the same situation the nerve is joined by a filament derived from the loop connecting the first and second cervical nerves.
Of these branches, the meningeal, descending, thyrohyoid, and the muscular twig to the Geniohyoideus, are probably derived mainly from the branch which passes from the loop between the first and second cervical to join the hypoglossal (Fig. 795).
Meningeal Branches (dural branches).—As the hypoglossal nerve passes through the hypoglossal canal it gives off, according to Luschka, several filaments to the dura mater in the posterior fossa of the skull.
The Descending Ramus (ramus descendens; descendens hypoglossi), long and slender, quits the hypoglossal where it turns around the occipital artery and descends in front of or in the sheath of the carotid vessels; it gives a branch to the superior belly of the Omohyoideus, and then joins the communicantes cervicales from the second and third cervical nerves; just below the middle of the neck, to form a loop, the ansa hypoglossi. From the convexity of this loop branches pass to supply the Sternohyoideus, the Sternothyreoideus, and the inferior belly of the Omohyoideus. According to Arnold, another filament descends in front of the vessels into the thorax, and joins the cardiac and phrenic nerves.
The Thyrohyoid Branch (ramus thyreohyoideus) arises from the hypoglossal near the posterior border of the hyoglossus; it runs obliquely across the greater cornu of the hyoid bone, and supplies the Thyreohyoideus muscle.
The Muscular Branches are distributed to the Styloglossus, Hyoglossus, Geniohyoideus, and Genioglossus. At the under surface of the tongue numerous slender branches pass upward into the substance of the organ to supply its intrinsic muscles.
The United States Medical Licensing Examination (USMLE) is a three-step examination for medical licensure in the United States. The Federation of State Medical Boards (FSMB) and the National Board of Medical Examiners (NBME) sponsors USMLE.
The Three Steps of the USMLE
Step 1 tests the important concepts of basic sciences basic to the practice of medicine. It also places special emphasis on principles and mechanisms underlying health, disease, and modes of therapy. Step 1 ensures mastery of the sciences that provide a foundation for the safe and competent practice of medicine. It also tests the scientific principles required for maintenance of competence through lifelong learning.
Step 2 CK tests the medical knowledge, skills, and understanding of clinical science essential for the provision of patient care under supervision. It also includes emphasis on health promotion and disease prevention. Step 2 CK ensures that due attention is devoted to principles of clinical sciences and basic patient-centered skills.
Step 2 CS tests your capacity to practice and provide good medical service in real-life situations. It also tests your communication skills.
Step 3 tests your medical knowledge and understanding of biomedical and clinical science essential for the unsupervised practice of medicine. Step 3 provides a final assessment of physicians assuming independent responsibility for delivering general medical care.
