THE VAGUS NERVES

Right

 Enters the thorax posterior-lateral to the brachiocephalic artery

 Descends lateral to the trachea and medial to the terminal part of the azygos vein
 Passes posterior to the root of the right lung
 Descends onto the posterior surface of the oesophagus to enter the abdomen and posterior surface of the
stomach

Left

 Enters the thorax between the left common carotid and left subclavian arteries
 Crosses the left side of the aortic arch
 Is crossed by the left phrenic nerve
 Descends posterior to the root of the left lung
 Then passes onto the anterior surface of the oesophagus to enter the abdomen

Branches

 Both nerves contribute to their respective pulmonary and oesophageal plexuses

 The right vagus gives off a cardiac branch
 The left vagus gives off the left recurrent laryngeal nerve at the level of the ligamentum arteriosum. The
nerve hooks around the ligament to ascend between the trachea and the oesophagus on the left side and
supplies all the muscles of the left vocal cord except the cricothyroid muscle (external laryngeal branch of
the vagus)

THE PHRENIC NERVES

Right

 Arises in the neck from the anterior rami of C3,4,5

 Enters the thorax on the right side of the right brachiocephalic vein and inferior vena cava
 Descends anterior to the root of the right lung
 Is separated by the pericardium from the right atrium
 Leaves the thorax through the caval opening of the diaphragm on the right side of the inferior vena cava

Left

 Enters the thorax on the left side of the left subclavian artery
 Crosses the left side of the aortic arch and the left vagus nerve
 Descends anterior to the root of the left lung
 Is separated from the left ventricle by the pericardium
 Terminal branches pierce the muscle of the diaphragm and supply the central part of the peritoneum on its
under surface
 Provide motor supply to the diaphragm and sensory supply to the pericardium, mediastinal pleura, the
central part of the diaphragmatic pleura and peritoneum.

THORACIC SYMPATHETIC TRUNK

 Continuation of the cervical sympathetic trunk, descends on the head of the ribs
 Arranged in 11 to 12 segmental ganglia
 Enters the abdomen on the side of the body of T12 by passing behind the medial arcuate ligament
 First ganglion often fused with the inferior cervical ganglion to form the stellate ganglion
 Gives grey rami communicantes to the thoracic spinal nerves
 Receives white rami communicantes from the thoracic spinal nerves
 Upper five ganglia give POST-ganglionic fibres to the heart, lungs, oesophagus and aorta
 Lower eight ganglia give PRE-ganglionic fibres which form the greater (5th-9th), lesser (10th & 11th) and
lowest (12th) splanchnic nerves