GLOSSOPHARYNGEAL NERVE [
item glossopharyngeus (PNA, BNA); the item glossopharyngicus (JNA)] — pair (the IX couple), the nerve mixed cherepnomozgovy. Sensitive fibers Ya. N innervate a mucous membrane of a back third of language, including flavoring zhelobovidny nipples, a mucous membrane of a throat, drum cavity, an Eustachian (acoustical) tube, cells of a mastoid, palatine tonsils and palatal handles, a carotid sine and a carotid glome; motive fibers — a shiloglotochny muscle and through a pharyngeal texture together with a vagus nerve constrictors of a throat and muscle of a soft palate; vegetative parasympathetic secretory fibers — a parotid gland.
The glossopharyngeal nerve has three kernels located in a myelencephalon (see). Sensitive kernel — a kernel of a single way (nucl. tractus solitarii), the general with wandering and front nerves, is located in a medulla. Axons of afferent neurons of a top and bottom nerve of nodes approach cells of this kernel (gangl. superius et inferius); their peripheral shoots have receptors in a mucous membrane of a throat, palatine tonsils, palatal handles, in a mucous membrane of a back third of language, a drum cavity, an Eustachian tube, cells of a mastoid, in carotid (sleepy, T.) sine and carotid (sleepy, T.) glome. Upper node Ya. the N is in area of a jugular foramen (foramen jugulare), the lower node — in a stony dimple (fossula petrosa) on a lower surface of a pyramid of a temporal bone.
A motive kernel — a double kernel (nucl. ambiguus), also general with a vagus nerve, is located in the field of a reticular formation (see) myelencephalon. Neurons of a motive kernel innervate a shiloglotochny muscle (t. stylopharyngeus) and constrictors of a throat.
A vegetative kernel — the lower slyunootdelitelny kernel (nucl. saliva-torius inferior) consists of the cells disseminated in a reticular formation. Its secretory, parasympathetic fibers go to an ear node, and after switching in it — to a parotid gland (see).
Root I. the N forms as a result of merge of all three types of fibers and appears on the basis of a brain in the field of a back lateral furrow of a myelencephalon behind an olive and leaves a head cavity through a jugular foramen together with a vagus nerve (see) and an eleventh cranial nerve
On a neck the nerve goes between an internal jugular vein and an internal carotid artery down, bends around behind a shiloglotochny muscle, turns kpered, forming a flat arch, and approaches a root of language where is divided into trailer lingual branches (rr. linguales), the containing sensitive fibers going to a mucous membrane of a back third of language, including the flavoring, innervating zhelobovidny nipples (fig. 1).
Lateral branches I. N are: a drum nerve (n. tympanicus), in structure to-rogo there pass sensitive and parasympathetic fibers. It originates from cells of the lower node (fig. 2) and gets into a drum cavity through a drum tubule (canaliculus tympanicus), forming on its medial wall together with caroticotympanic nerves (nn. caroticotympanic i) of an internal sleepy texture drum texture (plexus tympanicus). Sensitive branches to mucous
Fig. 1 depart from this texture. Topography of a glossopharyngeal nerve: 1 — lingual branches of a glossopharyngeal
nerve; 2 — a hypoglossal nerve; z — an outside carotid artery; 4 — a carotid sine; 5 — a carotid glome; in — an internal carotid artery; 7 — a vagus nerve; 8 — an upper cervical sympathetic node; 9 — the lower node of a vagus nerve; 10 — a sinus branch of a glossopharyngeal nerve; 11 — a glossopharyngeal nerve; 12 — the internal jugular vein (is dissected away).
GLOSSOPHARYNGEAL NERVE of 495
Fig. 2. Scheme of branching and bonds of a glossopharyngeal nerve: 1 —
a facial nerve; 2 — a drum nerve; 3 — the lower ganglion of a glossopharyngeal nerve;
4 — a glossopharyngeal nerve; 5 — a branch a pricker-glotochnoymyshtsy; 6 — mindalikovy branches;
7 — lingual branches;
8 — pharyngeal branches; 9 — a sinus branch; 10 — connecting branches; 11 — an upper ganglion of a glossopharyngeal nerve; 12 — an ear node; 13 — an ear and temporal nerve; 14 — a pterygopalatine node; 15 — a trigeminal node; 16 — a small stony nerve; 17 — a big stony nerve.
to a cover of a drum cavity, an Eustachian tube and cells of a mastoid, and preganglionic parasympathetic fibers form a small stony nerve (n. petrosus minor), to-ry leaves a drum cavity through a crevice of the channel of this nerve and through a stony and scaly crack (fissura petro-squamosa) reaches an ear node (gangl. oticum). After switching in a node parasympathetic postganglionic fibers approach a parotid gland as a part of an ear and temporal nerve (n. auriculotem-poralis) which is a branch of a mandibular nerve (n. mandibular is, the third branch of a trifacial). In addition to a drum nerve lateral branches I. N are a branch of a shiloglotochny muscle (ramus m. stylopharyngei) innervating the muscle of the same name; mindalikovy branches (rr. tonsillares), going to a mucous membrane of palatine tonsils and palatal handles; pharyngeal branches (rr. pharyngei), going to a pharyngeal texture; a sinus branch (of sinus carotici) — a sensory nerve of a sinocarotid reflexogenic zone; connecting branches (rr. communicantes) with ear and meningeal branches of a vagus nerve and with a drum string of the intermediate nerve which is a part of a facial nerve (see).
Pathology includes sensitive, vegetative and motive disturbances. At neuritis (neuropathy) I. N develop symptoms of loss: anesthesia of a mucous membrane of an upper half of a throat, unilateral disorder of taste (ageusia) on a back third of language (see Taste), decrease or the termination of salivation by a parotid gland; on the party of defeat difficulty of swallowing is possible (see the Dysphagy). The reflex from a mucous membrane of a throat on the party of defeat dies away. Dryness of a mouth usually happens insignificant owing to compensatory activity of other sialadens, paresis of muscles of a throat can be absent since them
generally vagus nerve innervates. At bilateral defeat I. N motive frustration can be one of displays of bulbar paralysis (see), to-ry arises at the combined defeat of kernels, roots or trunks of the glossopalatine, wandering and hypoglossal cranial nerves (IX, X, XII couples). At bilateral defeat of cortical kernels - nykh the ways going from a cerebral cortex to kernels of these nerves there are displays of psevdobul-bar paralysis (see). The isolated defeats of kernels I. N, as a rule, do not meet. Usually they arise together with defeat of other kernels of a myelencephalon and its conduction paths and enter a clinical picture of alternating syndromes (see).
At irritation I. the N develops a spasm of pharyngeal muscles — a pharyngospasm. It can arise at inflammatory or tumoral diseases of a throat, gullet, at hysteria, a neurasthenia, etc.
To symptoms of irritation I. the N belongs neuralgia of a glossopharyngeal nerve (see Sikar a syndrome). Distinguish two forms of neuralgia I. N: neuralgia preferential central (idiopathic) and preferential peripheral genesis. In development of neuralgia I. N of preferential central genesis matter disbolism, atherosclerotic changes of vessels of a brain, and also an adenoid disease, quinsy, flu, an allergy, intoxications (e.g., poisoning with tetraethyllead), etc. Neuralgia I. the N of preferential peripheral genesis arises at irritation I. N at the level of his first neuron, napr, owing to traumatizing a bed of a palatine tonsil the extended awl-shaped shoot, ossification of a shi-lopodjyazychny sheaf, and also at tumors in the field of a mostomozzhechkovy corner (see), aneurism of a carotid artery, throat cancer.
Neuralgia I. the N is shown by the attacks of unilateral pains arising during the swallowing (especially excessively hot or cold food), fluent speech, intensive chewing or a zevaniye. Pains are localized in the field of a root of language or a palatine tonsil, extend to a palatine velum, a pharynx, an ear, sometimes irradiate in a corner of a mandible, an eye, a neck. The attack can last 1 — 3 min. Patients have a fear of repetition of attacks at meal, speech disturbances (it is not articulated - naya)))) as manifestation «shchazhe-niya» develop. Sometimes there is dry pristupoobrazny cough. Before an attack of pain often appears to Osh
shcheny numbness of the sky and the short-term strengthened hypersalivation, sometimes burdensome feeling of deafness. Attacks of pains can be followed by syncopal states with a sconce dikar a diya, falling of the system ABP. Development of these states is connected with the fact that I. the N innervates a carotid sine and a carotid glome.
Special form of neuralgia I. the N is the neuralgia of a drum nerve (a syndrome of a drum texture, a painful tic drum, or a yakobsonova, a nerve, Rae-herta syndrome) for the first time described by F. L. Reichert in 1933. This form of neuralgia I. the N is shown by the attacks of the shooting pains in the field of outside acoustical pass which sometimes are followed by unilateral face pains and kzad from an ear. The unpleasant feelings in the field of outside acoustical pass arising generally at phone conversation (a phenomenon of «receiver») can be signal symptoms. Morbidity at a palpation of outside acoustical pass is noted.
Diagnosis of neuralgia I. N establish a wedge, inspections on the basis of characteristic complaints and data. At a palpation morbidity of a corner of a mandible and certain sites of outside acoustical pass, decrease in a gag reflex, easing of mobility of a soft palate, a hypergeusia (strengthening of flavoring feelings) to bitter on a back third of language comes to light. At the long course of neuralgia there can be symptoms of loss characteristic of neuritis I. N. In this case pains become constants (especially in a root of language, a pharynx, an upper part of a throat and in an ear), periodically amplify. At inspection the hypesthesia and disturbance of taste on a back third of language, a hypesthesia in the field of a palatine tonsil, a palatine velum and an upper part of a throat, decrease in salivation on the party of defeat of a glossopharyngeal nerve is noted.
Neuralgia I. the N should be differentiated with an epileptiform neuralgia (see), however the last has rather accurate a wedge, a picture.
Treatment is usually conservative, however in some cases resort to an operative measure (see below). For stopping of a painful attack the root of language and a pharynx grease 5% with solution of cocaine; appoint injections of 1 — 2% of solution of novocaine in a root of language, non-narcotic analgesics, synthetic derivatives salicylic to - you, pyrazyl ketone, etc. For treatment of a basic disease use anti-inflammatory drugs, neuro
leptik, fortifying means. The diadynamic or harmonic modulated currents on parotid and chewing area, almonds, a throat are effective. In the absence of effect of conservative treatment and in case of increase in an awl-shaped shoot resort to an operative measure.
Operational treatment is carried out generally at neuralgia I. N of preferential central genesis or in cases of involvement in process of a trunk of a nerve at nonresectable tumors of a throat, almonds, tumors of a base of skull. Carry out three types of operations: ekstrakranial-ny crossing I. N, intracranial section of branches I. N and a bulbar tractotomy (see). Section I. N on a neck make seldom in connection with danger of damage of adjacent cranial nerves and vessels and impossibility of access to a nerve at locally-spread tumors of a nasopharynx, tumors of a base of skull. Intracranial section of branches I. N carry out at the place of an exit them from a myelencephalon or in the field of an internal jugular foramen. The tractotomy is carried out at the level of a myelencephalon, in the place of passing of a spinal way of a trifacial (see), to-rogo fibers and I are a part. N. Unlike a tractotomy at an epileptiform neuralgia the place of a section of the descending path is medialny projections of a root of a trifacial and lateralny Burdakh's bunch. Localization of an estimated section of conductors is specified on reaction of the patient to mechanical irritation of the sensitive conductor. After extra-cranial or intracranial crossing I. N arise disturbances of sensitivity in a zone of its innervation. After a tractotomy at patients with advanced tumors and in cases of neuralgia I. N of preferential central genesis of pain usually pass. At the same time tachycardia disappears, the area of disturbances of sensitivity outside a zone of an innervation I is reduced. N. Complications at operative measures are noted seldom, paralysis of a soft palate, muscles of a throat is possible. According to nek-ry researchers, the tractotomy is more physiologic method of treatment, than crossing of fibers of a glossopharyngeal nerve.
The forecast at neuralgia I. the N is generally favorable. However as at neuralgia, and especially at neuritis prolonged persistent adequate treatment is required. Bibliography: Gabibov G. A. and L and at - t and V. V. K N to a question of surgical treatment of neuralgia of a glossopharyngeal nerve, Vopr * neyrokhir., century 3, page 15, 1971;
G. P Lip. Reference book on a neurologic semiology, page 36, 287, Kiev, 1983; To r about-lm. To a B. ifedorovaa. And. Main neuropathological syndromes, page 135, M., 1966; Kuntz 3. Treatment of essential neuralgia of a glossopharyngeal nerve bulbospinalny tractotomy, Vopr. neyrokhir., century 6, page 7, 1959; The Pool that in
A. M and N and to and f about r about in A. S. Reference book on semiotics of nervous diseases, Tashkent, 1983; Sinelnikov R. D. Atlas of anthropotomy, t. 3, page 154, M», 1981; A. V Triumphs. Topical diagnosis of diseases of a nervous system, L., 1974; Clara M. Das Nervensys-tem des Menschen, Lpz., 1959; The cranial nerves, ed. by M. Samii a. P. J. Jannetta,
B. — N. Y., 1981; Handbook of clinical neurology, ed. by P.< J. Vinken a. G. W Bruyn, v. 2, Amsterdam — N. Y., 1975;
White I. C. a. S w e e t W. H. Pain. Its mechanisms and neurosurgical control, Springfield, 1955.
V. B. Grechko; V. S. Mikhaylovsky (hir.), F. V. Sudzilovsky (An.).