• Joe Iwanaga, Christian Fisahn, Fernando Alonso, Daniel DiLorenzo, Peter Grunert, Matthew T Kline, Koichi Watanabe, Rod J Oskouian, Robert J Spinner, and R Shane Tubbs.
• Seattle Science Foundation, Seattle, Washington, USA; Department of Anatomy, Kurume University School of Medicine, Kurume, Fukuoka, Japan; Dental and Oral Medical Center, Kurume University School of Medicine, Kurume, Fukuoka, Japan. Electronic address: joei@seattlesciencefoundation.org.
• World Neurosurg. 2017 Apr 1; 100: 590-593.

ObjectiveDistal branches of the C1 nerve that travel with the hypoglossal nerve have been well investigated but relationships of C1 and the hypoglossal nerve near the skull base have not been described in detail. Therefore, the aim of this study was to investigate these small branches of the hypoglossal and first cervical nerves by anatomic dissection.MethodsTwelve sides from 6 cadaveric specimens were used in this study. To elucidate the relationship among the hypoglossal, vagus, and first and cervical nerve, the mandible was removed and these nerves were dissected under the surgical microscope.ResultsA small branch was found to always arise from the dorsal aspect of the hypoglossal nerve at the level of the transverse process of the atlas and joined small branches from the first and second cervical nerves. The hypoglossal and C1 nerves formed a nerve plexus, which gave rise to branches to the rectus capitis anterior and rectus capitis lateralis muscles and the atlanto-occipital joint.ConclusionsImproved knowledge of such articular branches might aid in the diagnosis and treatment of patients with pain derived from the atlanto-occipital joint. We believe this to be the first description of a branch of the hypoglossal nerve being involved in the innervation of this joint.Copyright © 2017 Elsevier Inc. All rights reserved.

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