Hypoglossal-the hypoglossal nerve crosses the carotid artery before diving into the floor of the mouth, so it might get injured during this procedure. this nerve innervates the muscles of the tongue. when the hypoglossal nerve is injured and a patient sticks out the tongue, the tongue points to the side with the injured nerve. so, this patient, who had the right side endarctectomy, has an injury to the right hypoglossal nerve. the symptoms that you see in this case should point you toward suspecting damage to the hypoglossal nerve.the glossopharyngeal nerve crosses around the internal carotid artery and the stylopharyngeus muscle-it could theoretically be injured in this procedure, but the symptoms are not consistent with an injury to this structure. the inferior alveolar nerve and lingual nerves are branches of the mandibular division of the trigeminal nerve. they are not associated with the carotid vessels. the vagus nerve is found in the carotid sheath. this nerve can be easily injured by an endarterectomy, although damage to the vagus would cause problems with swallowing, not with tongue movements.
