Lingual Hypoglossal Reflex: An Unusual Reflex of Head and Neck.

INTRODUCTION: Oral-pharyngeal reflexes demonstrate a wide range of complexities due to their intricate synaptic pattern. Most of the reflexes are protective in nature such as preventing aspiration. These reflexes in oral cavity affect the muscles and can be evoked either in isolation or in combination in order to achieve a specific response. Certain sensory inputs induce an entire motor behavior pattern as seen in lingual hypoglossal reflex. MATERIALS AND METHODS: A case report depicting this reflex have been presented. To our knowledge, this is the first case documented in a living human. Along with this, cadaveric studies have been also done in fifteen specimens. RESULTS: Extralingual anastomosis between lingual nerve and hypoglossal nerve were found in six specimens. CONCLUSION: Hereby, we present a clinical paper of this unusual phenomenon which has not been documented in the literature.

Fractures of the Stylomandibular Complex: A Prospective Study Proposing a Classification and Clinical Protocol.

PURPOSE: Mandibular trauma can result in stylomandibular complex (SMC) fractures with clinical symptoms including glossopharyngeal neuralgia, globus pharyngeus, otalgia, and dysphonia. Fracture of the styloid process is noteworthy because of its proximity to numerous vital structures. The study objectives were 1) to determine the incidence of SMC fractures and develop a clinical grading system and 2) to institute and assess a treatment protocol. MATERIALS AND METHODS: This prospective clinical trial involved 206 patients with mandibular trauma based on a set of inclusion and exclusion criteria. On the basis of the clinical presentation of symptoms, patients were categorized as mild, moderate, or severe, and the radiographic features were characterized as type 1, 2, or 3. Patients were treated by an institutional protocol, and outcome was evaluated. A grading system was developed by correlating clinical features with imaging. Data were analyzed using SPSS software (version 22; IBM, Armonk, NY). Descriptive and analytic statistics were computed. RESULTS: The incidence of styloid fracture was 11.17%. The most common concomitant mandibular fractures were condyle (13 patients) and angle (7 patients) fractures. Dysphagia and restricted mouth opening were the most common symptoms. The distribution of radiographic types 1, 2, and 3 was 26.1%, 69.6%, and 4.3%, respectively. A significant correlation (P < .001) was found between clinical symptoms and radiographic types using the Fisher exact test. CONCLUSIONS: This study proposes a clinical grading system for SMC fractures and a symptom-based management algorithm.