The physical examination of sublingual nerve injury first reveals unilateral or bilateral tongue movement disorder, followed by tongue muscle atrophy and muscle bundle tremor; the mouth and lips are often weak and unable to puff, even when using fingers to press the nostrils closed often still can not puff the cheeks, only when pressing the lips to close the mouth puff. The palatal arch is paralyzed and the sucking reflex is absent. Tongue muscle atrophy with or without tongue muscle tremor and abnormal brainstem reflexes. What are the examination methods of sublingual nerve injury? 1.X-ray film and tomography film include X-ray film of the skull, head and neck, cervical spine and tomographic X-ray film of the jugular foramen area. (1) The jugular foramen area is divided into two parts: the medial part of the nerve and the lateral part of the vein. The nerve sheath tumor in the jugular foramen area enlarges the medial part of the nerve, while the jugular venous bulb tumor enlarges the lateral part of the vein. In jugular venous bullae, abnormal enlargement and erosion of the jugular foramen and middle ear cavity at the base of the skull are seen on cranial radiographs. An enlarged jugular foramen may be seen on cranial radiographs. Comparing both sides of jugular foramen, enlargement of jugular foramen (normal bilateral difference can be 1-18mm, 95% difference is below 12mm) difference of more than 20mm on both sides indicates diagnostic significance and tumor in jugular foramen area can be considered. In order to fully reveal the size of jugular foramen, special position photography is needed, such as taking skull base position (chin top position) or performing tomography. Large tumors developing toward the pontocerebellar horn are often clinically difficult to distinguish from auditory neuroma, but can be distinguished if the jugular foramen is enlarged and the internal auditory canal is normal in the X-ray. (2) Bone destruction in the jugular foramen area of subungual neuroma can invade the mastoid and inner ear canal along the rock bone. (3) Craniocervical junction tumor can be seen on cranial X-ray as bone enlargement or destruction at the edge of the foramen magnum, bone resorption and widening of the cervical 1 and 2 vertebral plates or pedicles, and enlargement of the intervertebral foramen. (4) Congenital atlanto-occipital deformity: subungual herniation of the cerebellar tonsils, flattened skull base in congenital deformity, atlanto-occipital fusion, incomplete cervical segmentation and atlanto-axial dislocation can be diagnosed on the basis of plain X-rays. Skull base depressions can also be partially diagnosed on radiographs. The head and neck X-ray shows the inversion of the edge of the foramen magnum and the upward shift of the dentate process of the cardinal vertebrae, and the measurement methods and values are as follows: ① hard palate occipital foramen line (Chamberlain line): on the lateral skull film, the line from the posterior edge of the hard palate to the posterior edge of the foramen magnum, if the dentate process is more than 3mm above this line, it is a skull base depression, if it is only 3mm above, it is suspicious. ② hard palate – occipital line: on the lateral skull film, the line from the posterior edge of the hard palate to the lowest point of the occipital scales, if the dentate is higher than this line by more than 9mm, that is, the skull base depression, such as higher than this line by 7-9mm is suspicious. ③Hard palate-circumferential angle (Bull angle): the angle formed by the plane of the hard palate and the plane of the circumferential vertebrae, if it is above 13?is the skull base depression. The distance from the tip of the dentate process to this line is normally 10mm, if it is less than this value, it is skull base depression. If the distance from the tip of the dentate process to this line is normally 10mm, if it is less than this value, the skull base is depressed. ⑤ Occipital foramen-slope angle: the angle formed between the line of the anterior and posterior edges of the occipital foramen and the slope of the occipital bone, normal is 120?~136?and this angle increases when the skull base is depressed. Atlanto-occipital fusion is also known as circumferential occipitalization. The fusion of the atlanto-occipital spine with the occipital bone can be total or limited to partial fusion of the anterior vertebral arch, posterior vertebral arch or lateral blocks, and can be accompanied by partial vertebral defects, and the atlanto-occipital spine can be rotated or tilted to one side. Flat skull base refers to an abnormally large skull base angle formed by the long axis of the pterygoid body and the slope of the occipital bone. The cranial base angle is measured by the angle between the center point of the pterygoid saddle (saddle node or posterior bed process) and the line connecting the nasal root and the anterior border of the foramen magnum. The normal angle is 110?~145? and the average is about 130? The cranial base angle is measured by measuring the angle between the saddle node and the line connecting the nasal root and the anterior border of the foramen magnum on a lateral cranial x-ray. The normal value is 110?~145? Small skull base angle is not clinically significant, and skull base angle over 145?is flat skull base. (5) Cervical spine X-ray: including frontal, lateral, open mouth, hyperextension and hyperflexion. ①It can show cervical subsegmentation incompleteness (cervical fusion): the lack of cervical vertebrae number and different degrees of cervical fusion often occur in combination with cranial base depression, cervical rib, spina bifida, scoliosis, congenital pterygoid scapula and other deformities. ②Atlantoaxial subluxation: On X-ray lateral films (especially tomographic films), the normal distance between the anterior atlantoaxial arch and the front of the dentate process of the cardinal vertebrae is <2.5 mm, or <4.5 mm in children, exceeding this range is anterior atlantoaxial subluxation. The distance between the dentate process and the blocks on both sides of the atlantoaxial vertebrae should be equal and symmetrical in the open-mouth orthostatic radiograph, if the blocks on both sides are asymmetrical with the pivot body joints, or if the joint gap disappears on one side, it is dislocation. 2.X-ray imaging (1)Spinal iodine oil imaging When craniocervical junction tumor is suspected, spinal iodine oil imaging can be performed through lumbar puncture with iodophenyl ester, which is very helpful for diagnosis and can show the filling defect area with clear boundary in occipital foramen. (2) Angiography of subungual neuroma shows masses at the pontocerebellar angle and jugular foramen, and the transverse and ethmoid sinuses are compressed. (3) Carotid artery and/or vertebral artery angiography Jugular venous bullae tumor in early arterial images, abnormal tumor staining and blood supplying arteries are seen, and the obstruction and compression of the affected jugular vein can be understood in larger fashion. The vertebral arteriogram of jugular venous foramen area tumor mostly shows the elevation of anterior inferior cerebellar artery and posterior inferior cerebellar artery, and light tumor staining can be seen at the tumor site, which can be distinguished from some epithelioid tumors or arachnoid cysts that lack vascular shadow, and also from meningioma and jugular venous bulb tumor that have darker tumor staining. (4) Pneumoencephalography and spinal iodine water (oil) imaging of subungual herniation malformation of the cerebellum Because of their limitations and certain risks, they are less used clinically. 3.CT and MRI CT scan and especially MRI examination of tumor in craniocervical junction area can confirm the diagnosis of tumor in occipital foramen and upper cervical spinal cord, and can clearly show the adjacent relationship between tumor and medulla oblongata, cervical medulla and vertebral artery and posterior inferior cerebellar artery. CT scan of subungual neuroma shows occupancy of the pontocerebellar horn with image enhancement.