GLOSSOPHARYNGEAL NERVE

(C N IX)

Wg Cdr Abhishek Banerjee

Asst. Prof (Anatomy)
 Clinical Scenario
A 27-year-old male. Complain – Pain right side
face, ear and neck - one year. The pain- pricking
type radiating to Rt. side deep in throat and
mouth. It was intermittent. Pain aggravated
opening the mouth or moving head side to
side. Pain also during swallowing- foreign body
sensation in the throat. Pt. underwent surgical
removal of impacted tooth (Rt 3rdmolar) one yr.
before for the same complaint- no relief . On
examination, extreme tenderness on palpating
the right tonsillar fossa. A bony mass was
palpable in the tonsillar bed .
Imaging- C T – 3 D Reconstruction
Base of brain & CN-IX
 GLOSSOPHARYNGEAL NERVE
• Introduction
• Nerve components
• Nuclei
• Intraneural course
• Intracranial course
• Extracranial course
• Branches & Distribution
• Applied Anatomy
 IX CN: INTRODUCTION
• Mixed nerve
• Nerve of 3rd branchial arch
• Innervation
1. Motor to Stylopharyngeus
2. Secretomotor to Parotid gland
3. Sensory to Soft palate, Pharynx, Carotid body &
Sinus, Tonsil, Post 1/3 Tongue
4. Gustatory to Post 1/3 Tongue
5. Sensory to TM & Tympanic cavity
CN: COMPONENTS (Basic)
CN IX COMPONENTS
• BE/SVE (III Arch)
– Stylopharyngeus
• GVE
– Through Otic Ganglion
• GVA
– Gen sensations: Palate,
Tongue, Tonsil, Oropharynx,
Carotid sinus
• SVA
– Taste post 1/3 tongue, Palate
• SA/GSA
– Tympanic membrane
 INTRANEURAL COURSE IX-CN

IX CN
Sup Ganglia

Olive
& Carotid sinus

•Fibres from various nuclei run laterally

•IX CN Emerges at posterior lateral sulcus between Olive & ICP
INTRACRANIAL COURSE

• 3-4 rootlets join to form trunk under floculus of Cerebellum

• Rests on jugular tubercle
• Bends sharply
• Enters central part of jugular foramen; making a notch in Inf part
of petrous temporal
• Comes out with separate sheath.(Common sheath for CN X & XI)
 EXTRACRANIAL COURSE
• Comes out under
Styloid apparatus
• Passes forwards
between IJV & ICA
• Descends in front of ICA
• Upto lower border of
Stylopharyngeus
• Curves forwards over
Stylopharyngeus
• Runs deep to ECA &
Stylohyoid ligament
• Ascends under
Hyoglossus; enters
tongue
 BRANCHES & DISTRIBUTION
• Tympanic nerve: Forms tympanic plexus: gives brs to
Tympanic membrane, Auditory tube, Mastoid air cells, br to
Lesser petrosal nerve
• Carotid br: carry afferent fibres from chemoreceptors in
carotid body & baroreceptors in carotid sinus
• Lesser petrosal nerve: Otic ganglion- Parotid
• Pharyngeal brs: Pharyngeal mucosa
• Muscular br: Stylopharyngeus
• Tonsillar brs: Tonsil & Soft palate
• Lingual brs: Posterior 1/3 Tongue; Sensory & Gustatory
 IX CN: SUMMARY
• Motor (BE/SVE-Nucleus Ambiguus-Medulla)
– Stylopharyngeus
• Secretomotor (GVE-Inf. Salivatory Nuc.-LowerPons)
– Through OTIC Ganglion: Parotid gland
• General sensations (GVA-Dorsal Nuc. Vagus-Medulla)
– Palate, Tongue, Tonsil, Oropharynx, Carotid sinus
• Taste (SVA-Nuc. Tractus Solitarius-Medulla)
– Post 1/3 Tongue, CV papillae, Soft Palate
• Somatic Afferent (SA/GSA-Spinal Nuc. CN-V–Pons/
Medulla)
– Tympanic membrane
 APPLIED ANATOMY-IX CN LESIONS
• Damage to IX CN rarely seen without involvement of other lower CNs
• Transient or sustained HT after section of IX CN- involvement of
carotid branch

• Isolated lesions of IX CN leads to

• Loss of sensations of ipsilateral Soft palate, Pharynx, Tonsil, posterior
1/3 Tongue
• Loss of taste from post 1/3 Tongue
• Gag reflex reduced
• Absent salivary secretion from Parotid gland
 TESTING OF IX CN: GAG REFLEX
• Gag Reflex
– Elevation of soft palate
– Contraction of pharyngeal
muscles
When palate, tonsil, post tongue
or posterior pharyngeal wall
touched with unfamiliar objects
• Afferent: IX CN to
Nucleus of Tractus
Solitarius
• Efferent: X CN
 APPLIED ANATOMY
• Testing of IX CN
– Gag reflex
– Taste sensations from post 1/3 of tongue
• L C N (IX, X, XI & XII) Lesions more common
than in isolation
• Glossopharyngeal Neuralgia
– Eagles syndrome
– Jugular Foramen Synd.
• Vascular occlusion(PICA)
• Tumour (Post.cranial fossa – Cerebello Pontine Angle)
 EAGLES SYNDROME
• Burning sensation in
Tonsil, Pharynx
(Glossopharyngeal
Neuralgia)
• Styloid process
significantly long
• Compresses IX CN;
affects fibres carrying
sensations from
oropharynx
 GLOSSOPHARYNGEAL NEURALGIA
Pain in the back of throat (Swallowing) & inside
the ear. Forign body sensation in throat.
 Clinical Scenario- IX CN Neuralgia
A 27-year-old male. Complain – Pain right side
face, ear and neck - one year. The pain- pricking
type radiating to Rt. side deep in throat and
mouth. It was intermittent. Pain aggravated
opening the mouth or moving head side to
side. Pain also during swallowing- foreign body
sensation in the throat. Pt. underwent surgical
removal of impacted tooth (Rt 3rdmolar) one yr.
before for the same complaint- no relief . On
examination, extreme tenderness on palpating
the right tonsillar fossa. A bony mass was
palpable in the tonsillar bed .
 Imaging- C T – 3 D Reconstruction

Image revealing the length of the styloid process as 35.8 mm (yellow arrow) on
the right and 26 mm (red arrow) on the left.(Styloid more than 3cm is elongated)
QUESTIONS