RIVERS STATE UNIVERSITY

NKPOLU-OROWORUKWO PORT HARCOURT, RIVERS STATE

COLLEGE OF MEDICAL SCIENCES
FACULTY OF BASIC MEDICAL SCIENCES
DEPARTMENT OF MEDICINE AND SURGERY

PRESENTATION ON
 VAGUS NERVE
Presented by
Njoku Temple Chikaire : De.2017/5473
Osamudiamen Wilson : De.2021/TR/0013
Sido Efeoghene : De.2021/TR/0017
Prince .C. Princess: DE.2019/5465
Nwachukwu Ebubechukwu Faith DE.2020/5249
Kwani wokoma prince De.2020 /5359
Charles Obisike:2017/4776
Atuzie Chimbuoso Divine DE.2020/5268
Mike-minichim Ogburia DE.2020/5291
 Functional components & nuclei
• Special visceral efferent fibres: supply the muscles of palate, pharynx, and larynx. They arise from
nucleus ambiguus.

• General visceral efferent fibres: arise from the dorsal nucleus of vagus, and provide
parasympathetic innervation to heart, bronchial tree, and most of the GIT.
•
• Special visceral afferent fibres: carry taste sensations from the posteriormost part of the tongue
and epiglottis and terminate in the nucleus tractus solitarius.

• General visceral afferent fibres: carry general sensations from the mucous membrane of pharynx,
larynx, trachea, esophagus, and thoracic and abdominal viscera and terminate in the nucleus
tractus solitarius and some in the dorsal nucleus of the vagus.

• General somatic afferent fibres: carry general sensations from skin of the auricle and terminate in
the nucleus of the spinal tract of the trigeminal nerve.
 VAGAL NUCLEI
• The vagal nucleus consists of four nuclei located in the medulla oblongata.
• The three main nuclei are the dorsal motor nucleus of the vagus nerve (cranial
nerve [CN] X), nucleus ambiguus, and the solitary nucleus.

• The fourth nucleus has a minor input from the vagus nerve, the spinal trigeminal
nucleus, which receives the main input from the trigeminal nerve
• .
• These nuclei all contribute to the various functions of CN X as well as the function of
several other cranial nerves.

• The functions of CN X include motor, sensory, taste, and chemoreception involving

numerous organ systems of the body, such as the heart, pharynx, tongue, and
gastrointestinal system.
 ORIGIN AND INTRACRANIAL COURSE
• It rises from the lateral aspect of the medulla between the olive and
inferior cerebellar peduncle by about 10 rootlets below and in line of
the rootlets of the glossopharyngeal nerve.

• The rootlets unites to form the nerve trunk which runs laterally,
crosses the jugular tubercle, and leaves the cranial cavity by passing
through the middle part of the jugular foramen enclosed in the
common dural sheath with the 11th nerve. Within the cranium, the
auricular branch arises.

• This supplies sensation to the posterior part of the external auditory

canal and external ear.
BRANCHES AND DISTRIBUTION
According to the nuclei:
1. Sensory/Special sensory
2. Motor supply
3. Parasympathetic
Sensory supply
• Internal laryngeal branch to Laryngopharynx and
upper part of Larynx

• Cardiac Branch to the heart

• Terminal abdominal branches to the GIT

• SPECIAL SENSORY to the valleculae

Motor Supply
• Pharyngeal branches to the pharyngeal contractors, palatophayngeus
and salpingopharyngeus.

• Recurrent Laryngeal branch to the Thyro-arytenoid, posterior, lateral,

transverse and oblique crico-arytenoid muscles; and vocalist.

• External laryngeal to cricothyroid muscle

• Pharyngeal plexus to palatine muscle except TVP

Parasympathetic supply
• Cardiac plexus to the S.A and A.V nodes of the
heart
• Terminal abdominal branches to GIT (up to splenic
flexure).
 Branches & ganglia of Vagus nerve.

 In the jugular fossa

meningeal, & auricular branches
 In the neck:
pharyngeal, superior laryngeal, recurrent laryngeal
nerves; superior cardiac branches
 In the thorax:
inferior cardiac nerve, anterior & posterior bronchial
branches, oesophageal branches
 In the abdomen:
gastric, celiac and hepatic branches.

Ganglia
 Superior
 Inferior
Branches & ganglia of vagus
Branches in
Head and neck
• In jugular fossa :-

1. Meningeal branch (GSA) to

dura of posterior cranial cavity
2. Auricular branch (GSA)
Branches in the
Head & Neck
In the Neck :-
1. Pharyngeal branch (SVE ) :-
supply all muscles of pharynx and
soft palate except for
stylopharyngus (IX) and tensor
veli palatine (V) { form pharyngeal
plexus with CN IX and external
laryngeal nerve }
2. Superior laryngeal nerve ( SVE )
(GSA) divides into external
laryngeal n. ( SVE ) and internal
laryngeal n. (GSA)
3. Recurrent laryngeal nerve (SVE)
and (GSA)
4. Cardiac branch .
 Course in the neck.
• In the neck, the vagus nerve passes into the
carotid sheath, travelling inferiorly with the
internal jugular vein and common carotid
artery.

• At the base of the neck, the right and left

vagus nerves have differing pathways.
The right vagus nerve: passes anterior to the subclavian artery and
posterior to the sternoclavicular joint entering the thorax

The left vagus nerve: passes inferiorly between the left common
carotid and left subclavian artery, posterior to the sternoclavicular
joint entering the thorax
 Several branches arise in the neck
1. Pharyngeal branches: provides motor innervation to majority of the muscles of the
pharynx and soft palate

2. Superior laryngeal nerve: splits into internal and external branches. The external
laryngeal nerve innervates the cricothyroid muscle of the larynx. The internal laryngeal
provides sensory innervation to the laryngopharynx and superior part of the pharynx

Recurrent Laryngeal nerve: ( Right side only)

Hooks underneath the right subclavian artery, then descends towards the larynx. It
innervates the majority of the intrinsic muscles of the larynx
 Intrathoracic course
• The right and left vagus nerve enter into the thorax following
different course.
• Right Vagus Nerve : Passes anterior to the 1st part of the
subclavian artery and posterior to the brachiocephalic vein. It
thens run posterior to the sternoclavicular joint to enter the
thorax.
• Left Vagus Nerve :
• Runs between the common carotid artery and the left
subclavian artery and enters the thorax passing posterior to
the sternoclavicular joint.
Left recurrent laryngeal nerve.
 On entering the thorax, the left vagus nerve gives rise to the
recurrent laryngeal nerve at the level of T4-T5 vertebrae.
Inferior cardiac nerve
 The recurrent laryngeal nerve gives rise to the Inferior cardiac
nerve. It terminates in the cardiac plexus.
Anterior and Posterior bronchial branches
 On the anterior and posterior surface of the root of the lung,
they form the anterior and posterior pulmonary plexus. The
posterior plexus is larger than the it's anterior counterpart.
Esophageal branches
 The Esophageal plexus extend from above and below the
bronchial plexus. It's is worthy to note that the Esophageal
plexus is both motor and sensory to the esophagus.
 Abdominal Branches
 On entering the abdomen, the left vagus turns anteriorly and the
right vagus nerve turns posteriorly.
Gastric plexus
 The posterior and anterior vagal branches forms the posterior
and anterior gastric plexus

Celiac branches
 Celiac branches of the vagus nerve are primarily derived from the
right vagus nerve. These branches join the celiac plexus, which
innervates the pancreas, kidneys, spleen, suprarenal bodies and
intestine.

Hepatic branches
Hepatic branches of the vagus nerve are primarily derived from the left
vagus nerve. These branches join the hepatic plexus which innervates
the liver.
 Abdominal course of Vagus nerve
• The vagus nerve is the longest and most widely distributed
cranial nerve.
• It is the only nerve with thoracic and abdominal distribution.
• Vagus nerve enters the abdominal cavity through the
oesophageal hiatus.
During the development of the foregut, the stomach rotates
90 degrees in the clockwise direction, shifting the left vagus
nerve to the anterior and the right vagus nerve to the
posterior.
 Anterior Vagal Trunk (Left vagus nerve) gives rise to:
 1. Hepatic branches
 2. Gastric branches.
 The hepatic branches supply
 a. Liver.
 b. Gall bladder.
 c. Extra biliary system.
 Gastric branch supplies the anterior and superior surfaces of the stomach.
 Posterior Vagal Trunk: It gives off
 1. Gastric branch; which runs in the lesser omentum and supplies the posterior
and inferior parts of the stomach.
 2. Celiac branch: It passes around the left gastric artery and joins with the celiac
plexus and superior mesenteric plexus to supply the abdominal organs.
CLINICAL
CORRELATION
OF THE VAGUS
NERVE
 VASOVAGAL SYNCOPE
 When someone faints from heat exposure, standing for a long time or from
something surprising such as the sight of blood, the vagus nerve is partly to
blame. Vasovagal syncope does not require treatment unless the person faints
frequently.

 LESIONS OF THE VAGUS NERVE

 Lesion of the pharyngeal branches can lead to dysphagia (difficulty swallowing)
due to involvement with the muscles of the pharynx.
 Lesion of one of the recurrent laryngeal nerves will cause dysphonia.
 A lesion of both recurrent laryngeal nerves will cause aphonia (i.e, loss of urine)
and a stridor ( inspiratory wheeze).
 PARALYSIS OF THE RECURRENT LARYNGEAL NERVE
 This occurs due to cancer of the larynx or thyroid gland or due to surgical
complications.

 ALDERMAN,S PHENOMENON
 The tickling of the cutaneous distribution of the vagus nerve stimulates jaded
appetite.
 LESIONS OF VAGUS NERVE
 The bilateral lesions of vagus nerve cause:
 a. Nasal regurgitation of the swallowed liquids.
 b. Nasal twang of voice.
 c. Hoarseness of voice.
 d. Flattening of palatal arches.
 e. Cadaveric position of vocal cords.
 f. Loss of cough reflex.

 CLINICAL TESTING OF THE VAGUS NERVE

 The vagus nerve can be tested clinically by asking the patient to open his mouth
and say “ah”, and then comparing the palate arches of the two sides.
 Conclusion
The VAGUS NERVE is the longest cranial nerve. It contains motor and
sensory fibers and, because it passes through the neck and thorax to
the abdomen, has the widest distribution in the body. It contains
somatic and visceral afferent fibers, as well as general and special
visceral efferent fiber.
Also it’s Importance in the parasynthetic nervous system can not be
overemphasize as it makes up about 75% of the parasympathetic
innervation to visera and all other structures it innervates.hence it’s one
important nerve that if truncated will affect a lot of structures within
the neck,thorax,abdomen and The entire homeostasis Of the body