Case

A 20-year-old patient is admitted to the hospital after thrown from their horse during a gallop along a pathway. The patient struck their head and did not lose consciousness. The patient exhibits difficulty with control of their tongue, but exhibits normal sensation and expressions from the face and scalp, a normal gag reflexes, and is able to swallow. They are are also able to hear instructions and turn their head left and right. You suspect a base of skull fracture and cranial nerve damage.

Question 3/4 - What tongue control problem do you expect?

Click on your selected option(s) below  (correct = 1, over-thinking = 2+)

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Correct! Tongue protrusion works by being pulled forwards against the inside of the mandible. As a consequence when the intact side pulls forwards the injured side does not and the tongue protrudes to the weak (injured) side.

Incorrect. Tongue protrusion works by being pulled forwards against the inside of the mandible. As a consequence when the intact side pulls forwards the injured side does not and the tongue protrudes to the weak (injured) side. 

Possible, but less likely. There is a left and right side to the tongue, controlled by the left and right hypoglossal nerves. To have total tongue paralysis there would need to be symmetrical injury to both hypoglossal nerves. Possible, but less likely with an injury.

Incorrect. The hypoglossal nerve carries only motor fibers to the tongue. Taste to the anterior 2/3rd of the tongue is carried by Facial (VI) via the chorda tympani nerve and the posterior 1/3rd by the glossopharyngeal nerve.

Incorrect. General sensation to the anterior 2/3rd of the tongue is from the trigeminal nerve (V3 mandibular division) and to the posterior 1/3rd of the tongue is from the glossopharyngeal nerve.