192 Cranial Nerves

Connections via the reticulobulbar pathway (between the reticular formation

and cranial nerve nuclei in the brain stem) to the dorsal vagal motor nucleus enable
the parasympathetic fibers of the vagus nerve to control these reflex responses (see
Figure X-7, inset).

BRANCHIAL MOTOR (EFFERENT) COMPONENT

Bilateral corticobulbar fibers (fibers connecting the cortex with cranial nerve
nuclei in the brain stem) are composed of axons from the premotor, motor, and other
cortical areas. They descend through the internal capsule to synapse on motor
neurons in the nucleus ambiguus, a column of cells just dorsal to the inferior olivary
nucleus in the medulla. The nucleus ambiguus also receives sensory signals from
other brain stem nuclei, mainly the spinal trigeminal and solitary nuclei, initiating
reflex responses (eg, coughing and vomiting). Lower motor neuron axons leave
the nucleus ambiguus and travel laterally to leave the medulla as eight to ten
rootlets. The caudal rootlets travel briefly with cranial nerve XI, rejoining with the
rostral rootlets of cranial nerve X just below the inferior vagal ganglion (see Figure
X-2). The nerve leaves the skull through the jugular foramen to reach the constrictor
muscles of the pharynx and the intrinsic muscles of the larynx (see Figures X—4 and
X-8).
The branchial motor fibers leave the vagus nerve as three major branches: pha-
ryngeal, superior laryngeal, and recurrent laryngeal. The pharyngeal branch, the
principal motor nerve of the pharynx, traverses the inferior ganglion and passes
inferomedially between the internal and external carotid arteries. It enters the phar -
ynx at the upper border of the middle constrictor and breaks up into the pharyn geal
plexus to supply all the muscles of the pharynx and soft palate except the
stylopharyngeus (cranial nerve IX) and tensor (veli) palati (branchial motor com -
ponent of V3). Therefore, it supplies the superior, middle, and inferior constrictors,
levator palati, salpingopharyngeus, palatopharyngeus, and one muscle of the
tongue, the palatoglossus (many are illustrated in Figure X-8).
The superior laryngeal nerve branches from the main trunk of the vagus
nerve at the inferior vagal ganglion distal to the pharyngeal branch. It descends
adjacent 'to the pharynx, dividing into internal (mainly sensory) and external
(motor) laryngeal nerves. Branchial motor axons in the external laryngeal branch
supply the inferior constrictor and the cricothyroid muscles. It also sends branches
to the pharyngeal plexus. The pharyngeal plexus, supplying the palate and pharynx,
is formed by branches from the external laryngeal and pharyngeal nerves, as well as
branches from cranial nerve IX and the sympathetic trunk
The recurrent laryngeal nerve, the third major branch, takes a different path
on the right and left sides of the body (see Figure X-3). The right recurrent
laryngeal nerve arises from the vagus nerve anterior to the subclavian artery, then
hooks back under the artery and ascends posterior to it in the groove between the
trachea and the esophagus. The left recurrent laryngeal nerve arises from the left
vagus on the aortic arch. It hooks back posteriorly under the arch and ascends
through the