Mixed

nerve, with parasympathetic fibers. Extensive course Major parasympathetic supply to thoracic and abdominal viscera.

 Nerve

of 4th & 6th pharyngeal arches Superior laryngeal branch supplies 4th pharyngeal arch structures Recurrent laryngeal nerve supplies 6th pharyngeal arch derivatives

Main motor: Nucleus ambiguus : long nucleus, lies in medulla, sending motor fibers in 9th, 10th & cranial root of 11th nerves to innervate muscles of pharynx (except stylopharyngeus) & larynx, derived from 3,4& 6 pharyngeal arches. Also supplies skeletal muscles of upper oesophagus & soft palate (except tensor veli palatini)

Dorsal

motor nucleus of vagus : lies in the rostral

Medulla Oblongata, gives preganglionic parasympathetic fibers via vagus nerve to innervate thoracic & abdominal viscera (cardiac muscle & smooth muscle (bronchi & gut)

 Nucleus

located in upper Medulla Oblongata, receives afferents from heart & thoraco abdominal viscera for reflex activities Taste fibers from epiglottis Fibers of general sensation from parts of pharynx & larynx may go to sensory nucleus of trigeminal nerve

solitarius

 Postero-lateral

sulcus (between olive & inferior cerebellar peduncle), between IX and XI, in a series of rootlets

 Jugular

foramen Before and after foramen, there is small superior, and a cylindrical inferior ganglion. Superior (jugular) ganglion has cell bodies of meningeal & auricular branches Inferior (nodose) ganglion lodges cell bodies of all other sensory fibers

Medulla foramen)

post cranial fossa

Exit (jugular

Superior ganglion

Inferior ganglion + cranial root of XI

right
descends

left

 Descends

in the neck in carotid sheath between internal (or common) carotid artery and internal jugular vein

 Enters

thoracic inlet on right side of trachea Travels downward posterior to right brachiocephalic vein and superior vena cava Forms posterior esophageal plexus Forms posterior vagal trunk at esophageal hiatus where it leaves thorax and passes into abdominal cavity, then divides into posterior gastric and celiac branches

 Enters

thoracic inlet between left common carotid & left subclavian arteries

Crosses

aortic arch where left recurrent laryngeal nerve branches off anterior esophageal plexus anterior vagal trunk at esophageal hiatus where it leaves thorax and passes into abdominal cavity , then divides into anterior gastric and hepatic branches

Forms

Forms

 In

the neck:

a. meningeal b. auricular c. pharyngeal d. branches to carotid body e. superior laryngeal f. recurrent laryngeal (right) g. cardiac
a. recurrent laryngeal (left) b. pulmonary c. oesophageal a. gastric b. coeliac c. hepatic d. renal

In

the thorax:

In the abdomen:

 Meningeal:

arises from superior vagal ganglion, passes through jugular foramen- infra-tentorial dura in posterior cranial fossa Auricular: arises from SVG & runs b/w tympanic & mastoid parts of Temporal bone- PI quadrant of Tympanic membrane, external auditory meatus & corresponding skin behind auricle

 Pharyngeal

branch: arises from inferior vagal ganglion, contains fibers from XI nerve pharyngeal plexus, supplies all the muscles of pharynx (except, stylopharyngeus) & soft palate (except, tensor veli palitini)
body branches

Carotid

 Superior

laryngeal nerve: passes down side of pharynx and given rise to Internal branch (sensory) pierces thyrohyoid membrane to innervate mucous membrane of larynx upto vocal cords External branch (motor) innervates cricothyroid muscle

 Cervical

cardiac branches : terminate in cardiac plexus

 Recurrent

laryngeal

nerves Right one hooks around right subclavian artery, left one hooks around Ligamentum arteriosum/ aortic arch Both ascend in tracheoesophageal groove to reach the larynx

 Nerves

enter larynx, divide into 2 or more branches, anterior branch motor, called inferior laryngeal nerve Innervations: laryngeal mucosa below vocal cords , all laryngeal muscles except cricothyroid

 Bronchial

and esophageal branches: terminate in pulmonary & oesophageal plexus

 Anterior

and posterior gastric branches Run close to lesser curvature and innervate anterior and posterior surfaces of stomach, as far as pyloric antrum

 Hepatic

branches: join hepatic plexus and then supply liver and gallbladder branches: send branches to celiac plexus, distributed with sympathetic fibers to liver, pancreas, spleen, kidneys, intestine as far as left colic flexure

Celiac

 Unilateral

lesion of vagus is followed by ipsilateral paralysis of the soft palate, pharynx and larynx, leading to hoarseness of voice, dyspnoea and dysphagia. During phonation, soft palate is raised on the normal side & uvula is deviated to normal side. Loss of gag reflex, cough reflex, carotid sinus reflex on the effected side. Bilateral lesions are fatal