Glossofaringeus IX

Origin, course and branches (Fig. 14.1)

• From medulla by a vertical series of rootlets lateral to olive, above
and in series with those of X and XI.
• Passes through jugular foramen (middle portion). Two sensory
ganglia: superior and petrosal (inferior).
• Parasympathetic axons from inferior salivatory nucleus to otic
ganglion (for parotid gland) enter tympanic branch (see Chapter
17).May also convey sensory fibres from ear.
• Nerve descends in neck, supplying stylopharyngeus and carotid
body.
• Passes between internal and external carotid arteries to enter
pharynx. Sensory fibres to pharyngeal plexus supplying mucosa
of pharynx and posterior tongue.

The third branchial arch

The glossopharyngeal nerve is the nerve of the third
branchial arch which gives rise to the lower part of the hyoid bone
and the stylopharyngeus muscle. Arterial components of the third
arch form part of the common and internal carotid arteries thus
explaining the carotid sinus innervation.

Nerve fibres and nuclei

Visceral sensory fibres: to nucleus of the solitary tract.
Sensory fibres, including taste, from oropharynx, posterior tongue
and carotid body chemoreceptors. Cell bodies in petrosal ganglion.
Central processes pass to nucleus of the solitary tract.
Branchiomotor fibres: from nucleus ambiguus to stylopharyngeus.
Parasympathetic fibres: from inferior salivatory nucleus.
Preganglionic axons from inferior salivatory nucleus to auriculotemporal
nerve and otic ganglion. Postganglionic fibres enter
parotid gland. See Chapter 17.
Somatic sensory fibres: to nuclei of the trigeminal nerve.
From variable portion of skin in external ear, axons pass in tympanic
branch to main trunk of IX. Cell bodies in superior ganglion of IX.
Central processes pass to the sensory trigeminal nuclei.

Vagus X

Origin, course and branches (Fig. 15.1)

The vagus is the most extensively distributed of all cranial
nerves. Its name reflects both its wide distribution and the type of
sensation it conveys (Latin: vagus – vague, indefinite, wandering).
• Arises from medulla by rootlets lateral to olive.
• Leaves posterior cranial fossa through jugular foramen (middle
portion). In and below foramen are two sensory ganglia: jugular
and nodose, containing cell bodies of sensory fibres. Auricular
branch passes through canal in temporal bone and conveys sensory
fibres from external acoustic meatus and tympanic membrane

Descends in carotid sheath posteriorly behind internal jugular

vein and internal/common carotid arteries. Gives pharyngeal
branches, and superior laryngeal nerve which has internal (sensory
above vocal cords) and external (cricothyroid) branches.
• Cardiac (slowing heart rate) and tracheal (sensory) branches
arise in the root of neck and upper thorax.
• Recurrent laryngeal nerves arise in superior mediastinum: left
related to ligamentum arteriosum, right to subclavian artery. Both
ascend between trachea and oesophagus to laryngeal muscles (not
cricothyroid) and sensation of larynx below vocal cords, trachea,
oesophagus.
• Forms oesophageal plexus. Enters abdomen through oesophageal
hiatus in diaphragm as anterior and posterior trunks and contributes fibres to abdominal
viscera and to coeliac, superior
mesenteric and myenteric plexuses. Branches pass in lesser omentum
alongside lesser curvature of stomach to innervate pyloric
antrum (nerves of Latarjet), and to give hepatic branches.

The fourth and sixth branchial arches: embryological

considerations
The vagus is the nerve of the fourth and sixth branchial
arches. Structures derived from these include the pharyngeal and
laryngeal cartilages and muscles. The sixth arch artery on the left
gives rise to the ductus arteriosus (ligamentum after birth) around
which the left sixth arch nerve, the recurrent laryngeal, is caught
when the artery descends. The sixth arch artery on the right degenerates,
so the right recurrent laryngeal nerve is related to the most
caudal persisting branchial arch artery, the fourth, which becomes
the right subclavian. The motor function of the vagus in the neck
is branchiomotor (special visceral motor): motor function in the
thorax and abdomen is parasympathetic (general visceral motor).

Nerve fibres and central connections

Branchiomotor fibres: from nucleus ambiguus
Nucleus ambiguus in medulla: branchiomotor nucleus of the third,
fourth and sixth branchial arches.Axons pass to muscles of pharynx
and larynx.
Parasympathetic fibres: from dorsal motor nucleus of vagus.
Dorsal motor nucleus of vagus (DMNX) in medulla gives preganglionic
axons to innervate heart and thoracoabdominal viscera
(foregut and midgut). Cell bodies of postganglionic neurons are
generally in wall of destination organ, for example cardiac, myenteric
plexuses.
Somatic sensory fibres: to sensory nuclei of the trigeminal nerve
From posterior wall of external auditory meatus and posterior portion
of external surface of tympanic membrane, fibres pass in
auricular branch of X to main trunk in jugular foramen. Cell bodies
in jugular (superior) ganglion. Central axonal processes pass to
trigeminal sensory nuclei.
Visceral sensory fibres: to nucleus of the solitary tract.
Taste fibres from epiglottic area, visceral sensory fibres from
hypopharynx, larynx, oesophagus, trachea, thoracoabdominal viscera
and aortic baro- and chemo-receptors. Cell bodies in nodose
(inferior) ganglion. Central axonal processes pass to nucleus of
solitary tract.