Semiotics defeat of the path of the glossopharyngeal nerve. Nervus vagus
Complaints of the patient for choking when taking solid food are associated with paralysis (paresis) of the glossopharyngeal muscle, which begins to advance the food lump. Some patients complain of pain.
Neuralgia of the glossopharyngeal nerve characterized by a twitching pain in the side sectionspharynx and tonsil. Pain is provoked by eating, especially bitter, talking, swallowing. Sometimes it arises at the slightest movement of the pharynx or even the tongue. The pain in some patients is paroxysmal, in others - permanent. M.B. Krol, E.A. Fedorova, 1966, indicate that sometimes pain, starting in the tonsils, irradiates into the ear, is accompanied by an increase in taste sensitivity, especially to bitter, hypersalivation or, conversely, hypo-salivation. There may be a spread of pain to the zones of innervation of the trigeminal, cervical and vagus nerves. It is the latter that binds the bradycardia, even cardiac arrest, seizures during pain paroxysm. Patients with neuralgia of the IX couple avoid eating, talking. At an objective inspection at them it is possible to reveal morbidity at a palpation in the field of a corner of a mandible and separate sites of an external acoustical passage. Particularly distinct, these symptoms become during an attack of pain.
Usually, neuralgia of the glossopharyngeal nerve is symptomatic. Its causes may be thrombosis of the jugular vein (the glossopharyngeal nerve from the cranial cavity emerges from the jugular aperture along with the wandering and additional nerves), tumors of the lateral sections of the pharynx and tongue, tonsils, aneurysms of the general and internal carotid arteries.
Diagnostic differences in neuralgia of the glossopharyngeal nerve with pain in the language lead IP. Antonov, Ya.A. Lupianov, 1986.
Neuralgia of the drum nerve (Reichert's syndrome, Jacobson's nerve syndrome). In this case, the patient is concerned about sharp, shooting pains in the external auditory canal. They appear paroxysmally, for no apparent reason and gradually subside. The frequency of seizures at the onset of the disease is no more than 5-6 per day. Sometimes neuralgia of the tympanic nerve is accompanied by hyperemia and swelling of the tissues of the external auditory canal.
Lesion of the glossopharyngeal nerve. Characterized by difficulty in swallowingsolid food. With a bilateral paralysis of the IX pair, ingestion of solid food becomes impossible. The posterior wall of the pharynx on the side of the lesion of the IX pair becomes flabby, with phonation dragged to the healthy side. With bilateral paralysis, it is immovable. When swallowing liquid food flows down, hard - is delayed. The pharyngeal reflex on the side of the focus falls out or decreases.
When the process is localized in the trunk and involvement in the process IX couples CHN there are alternating syndromes (Avellis, Wallenberg-Zakharchenko, Schmidt).
X pair - nervus vagus - mixed. It consists of fibers of general sensitivity, vegetative motor fibers to the smooth muscles of the vessels, secretory glands, somatic motor - to the striated muscle.
Nervus vagus leaves the cavity of the skull through the jugular openingalong with the glossopharyngeal and accessory nerves, is located on the neck in the neurovascular bundle, where it adjoins the internal jugular vein, the common and internal carotid arteries, the nerves of the caudal group. Penetrates into the thoracic cavity through the upper orifice of the thorax, where the right vagus nerve lies in front of the subclavian artery, and the left one is located on the anterior surface of the aortic arch. Passing through the posterior mediastinum, the left and right vagus nerves form the esophagus plexus, from which the anterior and posterior trunks of the vagus nerve are formed, which through the esophageal opening of the diaphragm descend into the abdominal cavity, forming here a series of plexuses.
Sensitive cells of the vagus nerve are laid in the upper (ganglion superius) and lower(ganglion inferius) nodes. The upper node is located in the jugular opening, the lower one - after exiting it. Dendrites of cells of the upper node form a meningeal branch returning to the cranial cavity through the jugular opening and innervating the dura mater of the posterior cranial fossa, and the auricularis (ramus auricularis). After departing from the vagus nerve, the auricle branches back, crosses the bulb of the jugular vein, and through the mastoid canaliculus (canaliculus mastoideus) penetrates the pyramid of the temporal bone, where it anastomoses with the facial nerve, then leaves the pyramid through the tympanum (fissura tympanomastoidea). It innervates the skin of the posterior wall of the external auditory canal, anastomoses with the posterior ear (nerve branch of the facial nerve).
Dendrites cells of the lower node together with branchesthe glossopharyngeal nerve is formed by the pharyngeal plexus (pl. pharyngeus), which provides innervation of the pharyngeal mucosa. The upper laryngeus superior (n. Laryngeus superior), passing behind the internal carotid artery, approaches the laryngeal mucosa above the vocal cords, to the epiglottis mucosa, partly to the root of the tongue.
Mucous membrane of the larynx below the vocal cords is innervated by a recurrentnerve (n. laryngeus reccurens). The right recurrent nerve departs from the vagus nerve at the level of the subclavian artery, the left - at the level of the aortic arch. Having rounded the vessels, the recurrent nerves rise upward in the furrow between the trachea and the esophagus, giving in their path fibers to the heart and trachea.
From the lower sensory node of the vagus nerve the innervation of the bronchi, the pericardial sac is also performed. In the vagus nerve pass sensitive fibers for the esophagus, gastrointestinal tract, liver, kidneys.
Axons of cells of the upper and lower nodes are sent to the cranial cavity through the jugularhole, enter the substance of the brain with several roots in the region of the posterolateral sulcus of the medulla oblongata, and terminate at the nucleus of somatic sensitiveness, in general with the sensitive nucleus of the IX pair. The axons of the second neurons from this nucleus are directed to the thalamus and hence to the sensitive cortex.
Central motor vagus nerve analyzer for striated muscle is located in the lowersections of the anterior central gyrus. Hence the fibers go in the pyramid path and terminate in the double core of the vagus nerve (n. Ambiquus) of its and the opposite side. The axons of this nucleus, together with the pharyngeal branches and the superior laryngeal nerve, reach the pharyngeal muscles, the muscles lifting the soft palate, the muscles of the tongue and the larynx. Through the lower laryngeal nerve (the terminal branch of the recurrent nerve), the vagus nerve carries the innervation of the vocal cords, pharynx, and heart. The wandering nerve has a parasympathetic motor nucleus (nucl. Dorsalis n. Vagi). The central path of this nucleus is not traced. Peripheral fibers of the vegetative nucleus of the vagus nerve innervate the vessels, glands of the esophagus, gastrointestinal tract, respiratory tract. Its function is to extend the vessels of the heart, slow down heart contractions, narrow the bronchi, strengthen intestinal motility, activate the glands of the gastrointestinal tract.