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Good morning

Good morning. Objectives. Glossopharyngeal and Vagus Origin Course Branches Distribution Applied Anatomy. Glossopharyngeal nerve. GLOSSOPHARYNGEAL NERVE. Ninth cranial nerve. Mixed nerve containing motor , sensory & secretomotor fibers. Nerve of 3 rd branchial arch.

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  1. Good morning

  2. Objectives • Glossopharyngeal and Vagus • Origin • Course • Branches • Distribution • Applied Anatomy

  3. Glossopharyngeal nerve

  4. GLOSSOPHARYNGEAL NERVE • Ninth cranial nerve. • Mixed nerve containing motor, sensory & secretomotor fibers. • Nerve of 3rd branchial arch

  5. Functional components • Branchio-motor to Stylopharyngeusmuscle. • Secreto-motor to parotid gland. • General somatic sensory from posterior one third of the tongue. • General Visceral sensory from mucosa-pharynx,tonsil, soft palate, post 1/3rd of tongue. • Special visceral sensory from the circumvallate papillae of the tongue. • General visceral sensory from the carotid sinus & carotid body.

  6. Course • Arises from upper part of lateral aspect of medulla between olive & inferior cerebellar peduncle • Rootlets unite to form single trunk runs anteriolaterally.

  7. Leaves the cranial cavity – jugular foramen

  8. There is superior & inferior ganglia's on the nerve as it passes through jugular foramen

  9. Course • Base of skull – downwards forwards - IJV & ICA • Finally it reaches the stylopharyngeus & passes along with it . • It provides a branch to the stylopharyngeus • Passes deep to the stylohyoid ligament & posterior edge of the hyoglossus muscle • Here it breaks into terminal branches to supply mucous membrane of posterior 1/3rd of tongue, pharynx and tonsil.

  10. Course

  11. Branches 1.Tympanic branch (Jacobson's nerve) Arises from inferior ganglion - middle ear – tympanic canaliculus forms tympanic plexus – promontory . Branches • Lesser petrosal nerve • Twigs to tympanic cavity, auditory tube, mastoid air cells 2.Carotid branch for carotid body & sinus Baro-receptors, chemo-receptors to regulate BP & heart rate & respiration.

  12. 3.Pharyngeal branches It joins with pharyngeal branches of vagus & cervical sympathetic chain forms pharyngeal plexus on the middle constrictor of the pharynx

  13. 4.Muscular branches it supplies stylopharyngeus 5.Tonsillar branches supplies the mucous membrane of tonsil and palate

  14. 6.Lingual branches • posterior 1/3rd of the tongue & vallate papillae • Conveys taste & general sensations

  15. Clinical anatomy Lesion of glossopharyngeal nerve • Very rare • Usually associated with vagus Results in • Loss of general & taste sensation in posterior 1/3rd of the tongue • Loss of salivation of parotid gland • Unilateral loss of gag reflex Clinical testing of glossopharyngeal nerve • Eliciting gag reflex • Testing taste and general sensation of posterior 1/3rd of the tongue

  16. Applied anatomy • Lesion of glossopharyngeal nerve- • Loss of taste • Difficulty in swallowing • Loss of salivation from parotid gland • Loss of gag reflex • Glossopharyngeal neuralgia

  17. VAGUS NERVE-wandering nerve Tenth cranial nerve. Nuclear origin: • Nucleus Ambiguus • Dorsal nucleus of Vagus • Nucleus of Tractus Solitarius • Nucleus of the spinal tract of Trigeminal nerve.

  18. VAGUS NERVE

  19. Course: • Emerges from the posterolateral sulcus of Medulla. • Many rootlets –single trunk

  20. Leaves the cranial cavity – jugular foramen

  21. There is superior & inferior ganglia's on the nerve as it passes through jugular foramen

  22. Course: • Descends within the carotid sheath vertically between the Internal Carotid Artery & Internal Jugular Vein.

  23. Course: • In the thorax, it passes behind the • lung root & forms pulmonary plexus. • The right Vagus enters the abdomen as the posterior vagal trunk and the left Vagus as the anterior vagal trunk.

  24. Branches in the neck: • Meningeal br. – supplies the meninges of posterior cranial fossa. • Auricular br. (Alderman’s nerve) - to the cr. Surface of the auricle, floor & posterior wall of the external acoustic meatus and the tympanic membrane. • Pharyngeal br. – forms pharyngeal plexus. • Superior Laryngeal nerve – divides into external & internal laryngeal Nerves • To the Carotid body – along with IX nerve supply carotid sinus & body. • Cardiac branches – forms cardiac plexus & supplies heart. • Right recurrent Laryngeal nerve:

  25. Applied anatomy • Stimulation of auricular branch in the external acoustic meatus, increases appetite by enhancing gastric motility.

  26. CLINICALS: • The vagus nerve is tested clinically by comparing the palatal arches on the two sides. • On the paralyzed side there will be no arching and uvula is pulled to normal side.

  27. PARALYSIS OF X NERVE PRODUCES: • Nasal regurgitation of swallowed liquid • 2) Nasal twang in voice • 3) Hoarseness • 4) Flattening of palatal arch • 5) Cadaveric position of vocal cord • 6) Dysphagia

  28. Irritation of the auricular branch of the vagus in the external ear by ear wax, syringing may reflexly cause persistent ear cough vomiting or even sudden death due to sudden cardiac inhibition. • Stimulation of auricular branch may reflexly produce increased appetite. • Irritation of the recurrent laryngeal nerve by enlarged lymph nodes in children may also produce a persistent cough. • A sensory ganglion may have a viral infection called herpes zoster and vesicles appear on the area of skin supplied by the ganglion. • In herpes zoster of the geniculate ganglion vesicles appear on the skin of the auricle.

  29. Thank you

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