Infratemporal fossa approach to the hypoglossal canal: practical landmarks for elusive anatomy.
OBJECTIVE
At the conclusion of the article the readers should be able to safely and reliably find the hypoglossal canal using the infratemporal fossa approach.


OBJECTIVE
Very little has been written on the regional anatomy of the hypoglossal canal as seen through a transtemporal approach. This project attempts to further define the anatomy of the hypoglossal canal and provide the surgeon with guidelines for reaching it. Our hypothesis is that the hypoglossal canal can be safely and consistently reached by way of the temporal bone with preservation of hearing and cranial nerves (CN) IX to XI.


METHODS
Prospective anatomic study.


METHODS
The study was performed using cadaver temporal bones. Infratemporal fossa Fisch type-A dissections were performed. The hypoglossal canal was then completely exposed. The distance from the canal to the jugular bulb, carotid artery, round window, lateral canal, and roots of CN IX to XI were recorded.


RESULTS
Fifteen temporal bones were dissected and measured. The position of the hypoglossal canal is consistently located anterior, inferior, and medial to the jugular bulb. The distance from midcanal to the jugular bulb and the roots of CN IX to XI at the posterior fossa dura was 5.3 mm +/- 0.82 and 7.1 mm +/- 2.49, respectively. The distance from the carotid artery where it meets the jugular vein to the midcanal was 15.3 mm +/- 2.09. The distance from the round window to the canal was 21.7 mm +/- 3.17.


CONCLUSIONS
The hypoglossal canal can be consistently reached using the infratemporal fossa approach. Hearing and CN IX to XI can be preserved. The distance from the jugular bulb and roots of CN IX to XI can be used as guideposts. If a tumor is involving the bulb, then the carotid artery and the round window are the next most reliable indicators of position.
Hadley
Kevin S
KS
Division of Otolaryngology, University of Utah, Salt Lake City, UT, USA.
Shelton
Clough
C
D000055:Accessory Nerve / Q000033:anatomy & histology / Q000601:surgery; D002339:Carotid Arteries / Q000033:anatomy & histology / Q000601:surgery; D005930:Glossopharyngeal Nerve / Q000033:anatomy & histology; D006801:Humans; D007002:Hypoglossal Nerve / Q000033:anatomy & histology* / Q000601:surgery; D007601:Jugular Veins / Q000033:anatomy & histology / Q000601:surgery; D008866:Microsurgery; D010579:Petrous Bone / Q000033:anatomy & histology / Q000601:surgery; D011446:Prospective Studies; D012016:Reference Values; D012405:Round Window, Ear / Q000033:anatomy & histology / Q000601:surgery; D019291:Skull Base / Q000033:anatomy & histology / Q000601:surgery; D013126:Spinal Nerve Roots / Q000033:anatomy & histology / Q000601:surgery; D013701:Temporal Bone / Q000033:anatomy & histology* / Q000601:surgery