Nervus vagus (X)
Vagus nerve, n. vagus , is a mixed nerves. Its sensory fibers end in the nucleus of the solitary tract, motor fibers begin from the double nucleus (both nuclei are common with the glossopharyngeal nerve), and autonomic fibers begin from the posterior nucleus vagus nerve. The vagus nerve innervates a wide area. The fibers emerging from the vegetative nucleus constitute most the vagus nerve and provide parasympathetic innervation to the organs of the neck, chest and abdominal cavities. The fibers of the vagus nerve carry impulses that slow down the heart rate, dilate blood vessels (reflexively regulate blood pressure in the vessels), narrow the bronchi, increase peristalsis and relax the intestinal sphincters, causing increased secretion of the glands of the gastrointestinal tract.
The vagus nerve leaves the medulla oblongata in the posterior lateral sulcus with several roots, which, when connected, form a single trunk heading to the jugular foramen. In the foramen itself and at the exit from it, the nerve has two thickenings: the upper and lower nodes, ganglion supe- rius et ganglion inferius. These nodes are formed by the bodies of sensory neurons. The peripheral processes of the neurons of these nodes go to the internal organs, the dura mater of the brain, and the skin of the external auditory canal. In the jugular foramen, the internal branch of the accessory nerve approaches and connects with the trunk of the vagus nerve.
After emerging from the jugular foramen, the nerve travels downward, located on the prevertebral plate of the cervical fascia behind and between the internal jugular vein and the internal carotid artery. IN chest cavity the vagus nerve passes through the superior aperture chest. The right nerve is located between the subclavian artery posteriorly and the subclavian vein anteriorly. The left nerve runs between the common carotid and subclavian arteries, continuing to the anterior surface of the aortic arch (Fig. 178). Further, the right and left nerves are located behind the roots of the lungs. Then the right vagus nerve passes to the posterior, and the left - to the anterior surface of the esophagus, dividing into several branches that connect with each other. This is how the esophageal plexus is formed, from which the anterior and posterior vagal trunks are formed. The latter, together with the esophagus, pass into the abdominal cavity and give off their final branches there.
Topographically, the vagus nerve can be divided into 4 sections: head, cervical, thoracic and abdominal.
Head office The vagus nerve is located between the beginning of the nerve and the superior ganglion. The following branches depart from this department:
1Meningeal branch, G.meningeus, departs from the superior node and goes to the dura mater of the brain in the region of the posterior cranial fossa, including the walls of the transverse and occipital sinuses.
2Auricular branch, G.auricularis, starts from the lower part of the superior node, penetrates the jugular fossa, where it enters the mastoid canaliculus temporal bone. Coming from the latter through the tympanomastoid fissure, the auricular branch innervates the skin of the posterior wall of the external auditory canal and the skin of the outer surface of the auricle.
TO cervical spine The vagus nerve refers to that part of it that is located between the lower node and the origin of the recurrent laryngeal nerve. Branches cervical region vagus nerve:
1pharyngeal branches, rr. pharyngei [ pharingedlis], go to the wall of the pharynx, where, connecting with the branches of the glossopharyngeal nerve and sympathetic trunk, they form pharyngeal plexus,ple xus pharyngeus [ pharyngedlis]. The pharyngeal branches innervate the mucous membrane of the pharynx, constrictor muscles, and muscles of the soft palate, with the exception of the muscle that strains the velum palatine.
2Superior cervical cardiac branches, rr. cardiaci cervicles superiores, 1-3 in number depart from the vagus nerve, descending along the common carotid artery, and, together with the branches of the sympathetic trunk, enter the cardiac plexuses.
3Superior laryngeal nerve, P.laryngeus [ laryngea- lis] superior, originates from the inferior ganglion of the vagus nerve, runs forward along the lateral surface of the pharynx and, at the level of the hyoid bone, divides into external and internal branches. Outer branch, cityexternus, innervates the cricothyroid muscle of the larynx. Internal branch, cityinternus, accompanies the superior laryngeal artery and, together with the latter, pierces the thyrohyoid membrane. Its terminal branches innervate the mucous membrane of the larynx above the glottis and part of the mucous membrane of the root of the tongue.
4Recurrent laryngeal nerve, P.laryngeus [ la- rhyngealis] recurrences, has a different origin on the right and left. The left recurrent laryngeal nerve begins at the level of the aortic arch and, going around it from below in the anteroposterior direction, rises vertically upward in the groove between the esophagus and trachea. The right recurrent laryngeal nerve departs from the vagus nerve at the level of the right subclavian artery, bends around it from below and also in the posterior direction and rises up the lateral surface of the trachea. Terminal branch of the recurrent laryngeal nerve - inferior laryngeal nerve, n.laryngealis info rior, innervates the mucous membrane of the larynx below the glottis and all muscles of the larynx, except the cricothyroid. The portal laryngeal nerve also gives rise to tracheal branches,rr. trachedles, esophageal branches,rr. esophagei [ oesophagealis] And loweruieuHbieheart branches,rr. cardiaci cervicles info- riores, which go to the cardiac plexuses. It also departs from the inferior laryngeal nerve connecting branch(with the internal laryngeal branch of the superior laryngeal nerve), G.communications (cum r. laryngeo interno).
Thoracic region- this is the section of the vagus nerve from the level of origin of the recurrent nerves to the level of the esophageal opening of the diaphragm. Branches of the thoracic vagus nerve:
1 Thoracic cardiac branches, rr. cardiaci thordcici, directed to the cardiac plexuses.
2Bronchial branches, /t. bronchidles, go to the root of the lung, where together with the sympathetic nerves they form pulmonary plexus,plexus pulmondlis, which surrounds the bronchi and, together with them, enters the lung.
3 Esophageal plexus, plexus esophageus [ oeso phagealis] , formed by the branches of the right and left vagus nerves (trunks), connecting to each other on the surface of the esophagus. Branches extend from the plexus to the wall of the esophagus.
Abdominal The vagus nerve is represented by the anterior and posterior trunks, which emerge from the esophageal plexus.
1Anterior vagus trunk, truncus vagdlis anterior, passes from the anterior surface of the esophagus to the anterior surface of the stomach near its lesser curvature. From this wandering trunk they depart anterior gastric branches, gg.gdstrici anteriores, and hepatic branches, g.hepdtici, running between the leaves of the lesser omentum to the liver.
2 Posterior vagus trunk, truncus vagdlis pos terior, from the esophagus it passes to the posterior wall of the stomach, runs along its lesser curvature, gives off posterior gastric branches,rr. gdstrici posteriores, and celiac branches,rr. coeliaci. The celiac branches go down and back and reach the celiac plexus along the left gastric artery. The fibers of the vagus nerves, together with the sympathetic fibers of the celiac plexus, go to the liver, spleen, pancreas, kidney, small intestine and colon to the descending colon.
The vagus nerve develops from the 4th and subsequent visceral arches. It is the longest of the cranial nerves. The vagus nerve - mixed” has 3 nuclei: 1) the sensitive nucleus of the solitary tract; 2) motor - double core; 3) parasympathetic - posterior nucleus of the vagus nerve (nucleus dorsalis neri vagi). The parasympathetic nucleus is located in the medulla oblongata between the nucleus of the hypoglossal nerve and the nucleus of the solitary tract, in the triangle of the vagus nerve (trigonum n. vagi), superficial to the double nucleus. The vagus nerve exits the medulla oblongata in its posterior lateral sulcus (sulcus lateralis posterior), below the glossopharyngeal nerve. Its 10-15 roots form a thick nerve trunk, leaving the cranial cavity together with the glossopharyngeal and accessory nerves through anterior section jugular foramen (foramen jugulare). An internal jugular vein. In the jugular foramen, the sensitive part of the vagus nerve forms a small superior or jugular node (ganglion superior, PNA; g. jugulare, BNA, VA). Below the jugular foramen there is another spindle-shaped sensory node. This is the lower or nodular node (ganglion inferius, PNA; g. nodosum BNA, JNA).
Initially, in embryos 9-11 mm in length, the vagus nerve is presented as a group of longitudinal bundles of nerve fibers. They can be traced to the level of the trachea bifurcation, then the stomach and further to the small intestine.
Quite early in embryos 12 mm long, bundles of vagus nerve fibers begin to form the esophageal plexus (plexus esophageus). This process quickly ends, already in embryos 14-23 mm in length with the formation of the anterior and posterior vagal trunks (truncus vagalis anterior et truncus vagalis posterior). From the formed food plexus, thin nerve branches are formed that penetrate into the thickness of the wall of the esophagus.
It should be noted that already at early stages During prenatal ontogenesis, the esophageal plexus is an integral formation and there is an exchange of fibers between both vagus nerves.
After leaving the cranial cavity, the vagus nerve descends down to the neck. In the upper section of the carotid triangle, it is located between the internal carotid artery and the internal jugular vein, and in the middle and lower sections; lah - between the common carotid artery and the internal jugular vein.
This neurovascular bundle is located under the group; dinocleidomastoid muscle. It is surrounded by a vagina formed by the parietal layer of the fourth fascia of the neck. Inside this vagina, fixed to the transverse processes of the cervical vertebrae, there are partitions that form separate chambers for the artery, vein and nerve.
Conductors of general somatic afferent sensitivity arise from neurons of the superior or jugular ganglion of the vagus nerve. They are directed to the skin of the posterior wall of the outer ear canal and to the skin area of the auricle. Conductors of general visceral afferent sensitivity arise from the neurons of the inferior or nodular ganglion and go to the dura mater of the posterior cranial fossa, to the pharynx, larynx, trachea, esophagus, as well as to the organs and vessels of the thoracic and significant parts of the abdominal cavity.
Conductors of special visceral afferent sensitivity also arise from neurons of the lower
or nodular node. They conduct taste information from taste buds scattered in the epithelium of the epiglottis (epiglottis).
The following branches depart from the head of the vagus nerve between its superior and inferior sensory nodes: 1) the meningeal branch (g. meningeus), which returns through the jugular foramen to innervate the dura mater of the posterior cranial fossa; 2) auricular branch (g. auricular is) - to the posterior wall of the external auditory canal and to the area of the skin of the auricle. This is the only cutaneous branch of all the main nerves not related to the system trigeminal nerve. It goes through the mastoid canal of the temporal bone (canaliculus mastoideus) from the jugular fossa (fossa jugularis) of the temporal bone, crosses the descending segment of the canal of the facial nerve, passes through the tympanic cavity and exits through the tympanomastoid cavity (fissura tymponomastoidea).
In the neck area, the pharyngeal branches of the vagus nerve, together with the branches of the glossopharyngeal nerve and postganglionic fibers of the superior cervical ganglion of the sympathetic trunk, form the pharyngeal plexus. From the pharyngeal branches of the vagus nerve, motor and sensory innervation the upper and middle constrictors of the pharynx (m. constrictor pharyngis superior et t. constrictor pharyngis medius), muscles of the soft palate, palatopharyngeus muscle (m. palatopharyngeus) and palatoglossus muscle (t. palatoglossus). The pharyngeal plexus also provides sensory fibers to the pharyngeal mucosa. In the carotid triangle, deeper than the internal and external carotid arteries, the superior laryngeal nerve (n. laryngeus superior) departs from the vagus nerve. It passes in an oblique transverse direction and behind the internal and external carotid arteries it gives off an external branch (ramus extemus) to the lower constrictor of the pharynx (m. constrictor pharyngis inferior) and the cricothyroid muscle (m. cricothyreoideus). Next, the nerve called the internal branch (ramus intemus) goes anteriorly along with the superior laryngeal artery (a.
laryngea superior) and a branch of the superior thyroid artery. It pierces the thyrohyoid membrane downward from the large horn of the hyoid bone and innervates with its branches the mucous membrane of the larynx above the glottis, the mucous membrane of the root of the tongue and epiglottis, as well as the thyroid gland. The external branch of the superior laryngeal nerve is also involved in the formation of the so-called depressor cardiac nerve or superior cardiac branches (n. depressor cordis, BNA; rr. cardiaci superiores, PNA). The depressor nerve runs along the wall of the common carotid artery in the thickness of its vagina. It forms connections with the branches of the cervical sympathetic trunk and participates in the formation of cardiac nerve plexuses. The superior laryngeal nerve also gives off a connecting branch to the inferior laryngeal nerve (g. communicans cum n. laryngeo interiore). The lower laryngeal nerve (n. laryngeus interior) is a branch of the recurrent laryngeal nerve (n. laryngeus recurrens). It innervates the mucous membrane of the larynx below the glottis, as well as all the internal muscles of the larynx and the thyroid gland.
In the cervical part, a connecting branch departs from the vagus nerve to the IX pair of cranial nerves (r.communicans cum n. glossopharyngeo).
- Accessory nerve (n. accessorius)
The external branch of the accessory nerve in embryos 15 mm long is divided into two branches that reach the anlage of the sternocleidomastoid and trapezius muscles.
The motor nucleus of the accessory nerve is divided into two parts: cerebral and spinal (pars cerebralis et pars spinalis). Pars cerebralis is located in the medulla oblongata dorsolateral to the olivary nucleus and slightly below the nucleus ambiguus. Pars cerebralis directly continues into the spinal cord (Cj-Cb). Here the motor nucleus is called its spinal part (pars spinalis). The roots of the medullary part (radices craniales) emerge from the medulla oblongata below the vagus nerve, in the posterolateral groove, behind the olive. The roots from the spinal part (radicis spinales) are formed between the anterior and posterior roots of the spinal nerves (Cx-Sb) and partly between the anterior roots of the three upper cervical segments spinal cord.
Then the roots of the spinal part rise upward, enter through the foramen magnum (foramen magnum) into the cranial cavity and join the roots of the medullary part. Together they exit the skull through the anterior jugular foramen along with the glossopharyngeal and vagus nerves. Then the accessory nerve enters the posterior part of the peripharyngeal space and is located inward from the internal jugular vein, lateral from the internal carotid artery and posterior to the glossopharyngeal nerve.
The accessory nerve is divided into internal (g. internus) and external (g. extemus) branches. The sternocleidomastoid muscle is innervated and pierced by the external branch of the accessory nerve. This branch then emerges at the posterior edge of the muscle approximately 1.5 cm above its middle. Located further under the second fascia of the neck on the muscle that lifts the scapula (m.levator scapulae), the external branch of the accessory nerve is directed obliquely downwards, under the anterior edge of the trapezius muscle (m. trapezius) and innervates it. The presence of a single source of innervation for the sternoclavicular
mastomastoid and trapezius muscles indicate
about their common origin. The internal branch of the accessory nerve joins the vagus nerve and is part of its branches. In this case, the fibers from the medullary part of the accessory nerve go as part of the recurrent laryngeal nerve (n. laryngeus recurrens) and then its final branch, the lower laryngeal nerve (n. laryngeus inferion). The laryngeal nerves innervate the muscles of the larynx, while fibers coming from the spinal part of the accessory nerve in the pharyngeal branches (rami pharyngei) innervate the muscles of the pharynx.
Vagus nerve (lat. nervus vagus, nervus vagus, vagal nerve) is the tenth of twelve pairs of cranial nerves, descending into the thoracic, cervical and abdominal spine.
They respond to the innervation of various organs and systems. The nerve got its name due to the fact that it is through it that the signal from the brain is transmitted to almost all the most important organs.
Anatomy and function of the vagus nerve
The main functions of the vagus nerve include:
- innervation of the mucous membrane of the lower part of the pharynx and larynx, the area of skin located behind the ear, part of the eardrum, external auditory canal, dura mater of the cranial fossa;
- innervation of the muscles of the lungs, intestines, esophagus, stomach, heart;
- influence on the secretion of the pancreas and stomach;
- motor innervation of muscles soft palate, muscles of the esophagus, larynx, pharynx.
Thus, the vagal nerve is responsible for regulating:
- breathing:
- cough;
- heartbeat;
- swallowing;
- stomach work;
- vomiting.
As a result of disturbances in the functioning of the vagus nerve, cardiac arrest and, accordingly, death can occur.
Everything about the vagus nerve: where it is located, its anatomy, functions, possible violations and treatment methods:
Anatomy and functions of the branches of the vagus nerve
Causes of vagal dysfunction
Disturbances in the functioning of the vagus nerve can occur for many reasons. The most common:
Typical clinical picture
If the vagus nerve is damaged, the symptoms of the disorder will depend on the location of the lesion, its depth and degree:
Establishing diagnosis
If you have the above symptoms, you should immediately seek medical help.
First of all, during your appointment, the doctor will pay attention to the sound of your voice. If it is low, the ligaments may not be able to close close enough. Also, clarity, sound and timbre can be symptoms that indicate problems with the vagus nerve.
It is important to note that the patient will not be able to cough on purpose if there is a problem.
If the nerve is damaged, weakening of various vagal reflexes will be observed, for example, the pharyngeal and palatine reflexes will not fully manifest themselves. The doctor may give a glass of water to assess the ability to swallow: if it is difficult, pathology is present.
After the examination, a number of studies are performed:
- laryngoscopy: using the study, the condition of the vocal cords is determined;
- X-ray of the skull and chest.
Set of measures
The most striking manifestations of problems in the functioning of the vagus nerve are the following diseases:
- : as a result, there are problems with the peripheral part of the central nervous system and brain, the patient feels dizziness and hearing loss;
- : episodic attacks of severe headache;
- : the patient’s character is characterized by increased temper, the upper, lower limbs and some areas of the face turn pale and become cold, all this occurs as a result of a disorder of the nervous system as a whole.
It is important to know that nerve fibers are very difficult to treat, so if you have the slightest disorder of the nervous system or if you have symptoms of problems with the vagus nerve, you should immediately contact a specialist in a medical facility.
Treatment of disorders of the vagus nerve and concomitant diseases is most often carried out with medication and usually consists of prescribing the following medications:
To improve the effect drug treatment should be supplemented with physiotherapy. The treatment worked well. Currents directed to the location of pain relieve pain syndromes, muscle inflammation, used in migraine therapy, stimulates muscles.
In cases where the patient's condition causes concern among doctors, plasmapheresis or electrical stimulation may be relevant. Thus, at the cellular level, blood purification occurs through special devices.
Folk remedies
You can also perform a set of therapeutic measures at home.
To take a bath, prepare a mixture of herbs: pine buds, yarrow, oregano, calamus root. Each herb requires 5 large spoons.
All this is poured with 10 liters of boiling water and left for about 6 hours. After this, the infusion is poured into the bath, the water temperature is at 
which is not higher than 33 degrees Celsius. Now you can take a bath, lie in it for 15 minutes. For maximum effect, the body must be completely relaxed.
Another option will help treat the entire nervous system in general and the vagus nerve in particular. To do this, you need to take half a glass of sage herb and the same amount of valerian root.
The raw materials are poured with 8 liters of boiling water and left for 3-4 hours. After this, the infusion is poured into a bath of water at a comfortable temperature. The procedure takes 15-20 minutes. The most effective remedy for migraines.
Nerve strengthening agents
A specially prepared balm made from infusions of thyme, yarrow, hop cones, peppermint, motherwort, and blackberry leaves will help strengthen and restore the nerves. 
All components are taken in 100 milliliters. After this, 150 milliliters of crushed cyanosis rhizome is added. The ingredients are mixed and taken orally, one large spoonful every morning for three months.
Honey is used for various nervous system disorders. Its use is also relevant in the treatment of vagus. To do this, mix honey and beet juice in equal proportions. After this, you can use two large spoons of the product after meals.
The vagal nerve is very important for the entire central nervous system and the human body as a whole, given its functions. Accordingly, ignoring the diagnosis and treatment of diseases associated with nerve pathologies can lead to severe consequences, even death.
Can't be completely trusted folk remedies. They may be additional, but by no means basic.
How to prevent vagal disorders
In order to protect the vagus nerve from diseases it is necessary:
- eat as many vegetables and fruits as possible;
- reduce consumption of fatty, salty, smoked, spicy foods;
- play sports (light);
- accept cold and hot shower in the mornings and evenings;
- monitor your nervous system;
- at the slightest manifestation of disease symptoms, seek the help of a qualified specialist.
The vagus nerve is an extremely interesting structure. This nerve is not just a passive transmitter of nerve impulses. Its sensory and motor neurons work together to actively regulate a wide variety of processes that link body and brain function, human biology and psychology, health and dysfunction. We, massage therapists and chiropractors, are able to stimulate the vagus nerve with competent touch. How does stimulation of this kind affect the functioning of this nerve?
HANDYMAN
The active influence of the vagus nerve (or X pair cranial nerves) on our well-being is:
-increasing stress resistance and accelerating recovery.
When the vagus nerve is exposed to stress hormones such as cortisol and adrenaline, the motor neurons of its branches (Fig. 1) secrete the neurotransmitter acetylcholine (originally called “vagal substance”, “vagustoff” from the Latin nervus vagus - vagus nerve), and such hormone like oxytocin. Thus, it deactivates the sympathetic nervous system, helping to recover faster from stress.
- Control of inflammation and immunity.
The vagus nerve inhibits inflammation by releasing neurotransmitters in response to the detection of inflammatory markers such as cytokines and tumor necrosis markers. If this mechanism is disrupted, autoimmune diseases may develop, such as rheumatoid arthritis, and chronic pain.
- Mood regulation
The vagus nerve is the most important link between the brain and the enteric nervous system, which regulates the functioning of the smooth muscles of the internal organs. The gut is home to 100 million neurons, 30 neurotransmitters, and 95 percent of all serotonin found in the human body. The enteric nervous system sends great amount information to the brain through sensory neurons. This information, in simple terms, regulates our mood and the course of mental processes. A measure of vagal tone (i.e., its ability to respond and influence the heart) correlates with the likelihood of developing heart disease and diabetes, as well as with emotional stability and anxiety levels.
ELECTROSTIMULATION OF THE VAGUS NERVE
Electrical vagus nerve stimulation is a procedure where a generator is implanted electrical impulses in the neck area for constant stimulation of the vagus nerve. Despite the scary word “implantation,” EBN therapy is not complete surgery on the brain. Implantation of the device is simple surgical procedure, which will require only a short hospital stay. Electrical stimulation of the vagus nerve is performed with a pulse generator placed under the skin, under the left collarbone or near the armpit. A small incision is made in the neck to attach two thin wires (electrodes) to the left vagus nerve. The wiring is not visible from the outside. They pass under the skin from the impulse generator to the vagus nerve in the neck.
EBN has been successfully used to treat epilepsy, migraine and drug-resistant depression. Research is currently being conducted to study the effect of EBN on the condition of patients with anxiety disorders, Alzheimer's disease, fibromyalgia, obesity and tinitus.
However, EBN therapy is a very risky measure, implying the likelihood of complications (for example, infection). In addition, the long-term effects of EBN on the human body have not yet been studied.
Of course, there are other, less invasive and safer ways to stimulate the vagus nerve. For example, controlled breathing (with prolongation of the exhalation phase), meditation, special movements and relaxation of the tongue, for example, when singing and speaking (stimulation occurs due to the innervation of the larynx and tongue by the vagus nerve), facial gymnastics (facial expressions have a double connection with the function of the vagus nerve, motor and emotional), improving intestinal health, exercise and adequate rest and, most importantly, combating stress and anxiety.
However, from the pragmatic point of view of massage therapists and chiropractors The question often arises: “How can I influence this nerve through touch, and what will this lead to?”
THE VAGUS NERVE AND THE HUMAN EAR
The human ear is the only place where the vagus nerve reaches the surface of the body (auricular, auricular branch, Fig. 2). Transcutaneous stimulation of this branch can be used to treat a variety of diseases associated with the vagus nerve. In Europe, this method is used to treat epilepsy, migraine and chronic pain.
The auricular branch of the vagus nerve consists of sensory neurons, therefore, sensory stimulation of the parts of the ear innervated by the vagus nerve (Fig. 3) stimulates the activity of the vagus nerve. In most therapeutic cases, deactivation of the sympathetic nervous system is required. Neat, delicate touches of medium intensity (Fig. 4) demonstrate the greatest effectiveness. A study of the effects of massage on the vagus nerve in infants found that the nerve responded better to moderate-intensity touch than low- or high-intensity touch. For many clients, including ear work in a session may come as a surprise - first ask permission, explain the essence and purpose of your manipulations. 
Does manual therapy have a positive effect on the vagus nerve? Of course it is. Of course, the effect will not be as pronounced and rapid as with direct long-term electrical stimulation, but studies show that in in this case there is certainly a clinically significant effect on vagal tone. Understanding the function and structure of the vagus nerve stimulates your imagination and creativity as a therapist. Working with the ears is especially useful for headaches and dysfunction of the temporomandibular joint, due to the ability of the vagus nerve to relax both the body and the emotional component of a person.
TECHNIQUES FOR WORKING WITH THE VAGUS NERVE(Illustrations – Fig. 4, Fig. 5) 
TARGET
Increasing vagus nerve activity through gentle stimulation to increase sensitivity.
INDICATIONS FOR USE
Headache, migraine
Dysfunction of the temporomandibular joint.
Stress, anxiety, increased excitability of the sympathetic nervous system
Possible positive effect in the treatment of tinnitus, mood disorders, digestive problems, work disorders immune system and autoimmune diseases.
INSTRUCTIONS
Use gentle touch, medium-intensity pressure, or light traction on the pinna to increase sensitivity in the areas of the ear innervated by the vagus nerve.
For migraines and temporomandibular joint dysfunction, find areas hypersensitivity and use active jaw techniques.
VERBAL ASSISTANCE
“Exhale as slowly as possible, pushing all the air out of your lungs.”
"Try to relax your tongue"
“Try humming your favorite song while keeping your neck and jaw relaxed.”
For migraines:
“Rotate your eyeballs, alternately looking left and right.”
For TMJ dysfunction:
“Gently open your mouth, trying to lower jaw went as far from my ears as possible.”
14333 0
X pair - vagus nerves
(n. vagus), mixed, develops in connection with the fourth and fifth gill arches, and is widely distributed due to which it got its name. Innervates the respiratory organs, organs of the digestive system (up to the sigmoid colon), thyroid and parathyroid glands, adrenal glands, kidneys, and participates in the innervation of the heart and blood vessels (Fig. 1).
Rice. 1.
1 - dorsal nucleus of the vagus nerve; 2 - nucleus of the solitary tract; 3 - nucleus of the spinal tract of the trigeminal nerve; 4 - double core; 5 - cranial root of the accessory nerve; 6 - vagus nerve; 7 - jugular foramen; 8 - superior node of the vagus nerve; 9 - lower node of the vagus nerve; 10 - pharyngeal branches of the vagus nerve; 11 - connecting branch of the vagus nerve to the sinus branch of the glossopharyngeal nerve; 12 - pharyngeal plexus; 13 - superior laryngeal nerve; 14 - internal branch of the superior laryngeal nerve; 15 - external branch of the superior laryngeal nerve; 16 - superior cardiac branch of the vagus nerve; 17 - lower cardiac branch of the vagus nerve; 18 - left recurrent laryngeal nerve; 19 - trachea; 20 - cricothyroid muscle; 21 - lower constrictor of the pharynx; 22 - middle pharyngeal constrictor; 23 - stylopharyngeal muscle; 24 - superior pharyngeal constrictor; 25 - velopharyngeal muscle; 26 - muscle that lifts the velum palatine, 27 - auditory tube; 28 - auricular branch of the vagus nerve; 29 - meningeal branch of the vagus nerve; 30 - glossopharyngeal nerve
The vagus nerve contains sensory, motor and autonomic parasympathetic and sympathetic fibers, as well as small intra-stem nerve ganglia.
Sensory nerve fibers of the vagus nerve originate from afferent pseudounipolar nerve cells, clusters of which form 2 sensitive nodes: upper (ganglion superior), located in the jugular foramen, and lower (ganglion inferior), lying at the exit from the hole. The central processes of the cells go into the medulla oblongata to the sensitive nucleus - nucleus of the solitary tract (nucleus tractus solitarii), and peripheral ones - as part of the nerve to the vessels, heart and viscera, where they end with receptor apparatus.
Motor fibers for the muscles of the soft palate, pharynx and larynx originate from upper cells motor dual core.
Parasympathetic fibers originate from the autonomic dorsal nucleus(nucleus dorsalis nervi vagi) and spread as part of the nerve to the heart muscle, muscle tissue of the membranes of blood vessels and viscera. Impulses traveling along parasympathetic fibers reduce the heart rate, dilate blood vessels, narrow the bronchi, and increase peristalsis of the tubular organs of the gastrointestinal tract.
Autonomous postganglionic sympathetic fibers enter the vagus nerve along its connecting branches with the sympathetic trunk from the cells of the sympathetic ganglia and spread along the branches of the vagus nerve to the heart, blood vessels and viscera.
As noted, the glossopharyngeal and accessory nerves are separated from the vagus nerve during development, so the vagus nerve maintains connections with these nerves, as well as with the hypoglossal nerve and the sympathetic trunk through connecting branches.
The vagus nerve leaves the medulla oblongata behind the olive with numerous roots merging into common trunk, which leaves the skull through the jugular foramen. Next, the vagus nerve goes down as part of the cervical neurovascular bundle, between the internal jugular vein and the internal carotid artery, and below the level of the upper edge of the thyroid cartilage - between the same vein and the common carotid artery. Through the superior thoracic aperture, the vagus nerve penetrates the posterior mediastinum between the subclavian vein and artery on the right and in front of the aortic arch on the left. Here, by branching and connections between the branches, it forms in front of the esophagus (left nerve) and behind it (right nerve) esophageal nerve plexus(plexus oesophagealis), which forms 2 near the esophageal opening of the diaphragm wandering trunk: anterior (tractus vagalis anterior) And posterior (tractus vagalis posterior), corresponding to the left and right vagus nerves. Both trunks exit the chest cavity through the esophageal opening, give branches to the stomach and end with a number of terminal branches in celiac plexus. From this plexus, fibers of the vagus nerve spread along its branches. Throughout the entire length of the vagus nerve, branches extend from it.
Branches of the cerebral vagus nerve.
1. Meningeal branch (r. meningeus) starts from the superior node and through the jugular foramen reaches the dura mater of the posterior cranial fossa.
2. Auricular branch (r. auricularis) goes from the superior node along the anterolateral surface of the jugular vein bulb to the entrance to the mastoid canal and further along it to the posterior wall of the external auditory canal and part of the skin of the auricle. On its way it forms connecting branches with the glossopharyngeal and facial nerves.
Branches of the cervical vagus nerve.
1. Pharyngeal branches (rr. pharyngeales) originate from the bottom node or immediately below it. They receive thin branches from the upper cervical ganglion of the sympathetic trunk and, between the external and internal carotid arteries, penetrate to the lateral wall of the pharynx, on which, together with the pharyngeal branches of the glossopharyngeal nerve and the sympathetic trunk, they form the pharyngeal plexus.
2. Superior laryngeal nerve (rr. laryngeus superior) branches from the lower node and descends down and forward along the lateral wall of the pharynx medially from the internal carotid artery (Fig. 2). At the greater horn, the hyoid bone is divided into two branches: external (r. externus) And internal (r. internus). The external branch connects with branches from the superior cervical ganglion of the sympathetic trunk and runs along the posterior edge of the thyroid cartilage to the cricothyroid muscle and the inferior constrictor of the pharynx, and also intermittently gives branches to the arytenoid and lateral cricoarytenoid muscles. In addition, branches extend from it to the mucous membrane of the pharynx and the thyroid gland. Internal branch thicker, more sensitive, pierces the thyrohyoid membrane and branches in the mucous membrane of the larynx above the glottis, as well as in the mucous membrane of the epiglottis and the anterior wall of the nasal pharynx. Forms a connecting branch with the inferior laryngeal nerve.
Rice. 2.
a — right view: 1 — superior laryngeal nerve; 2 - internal branch; 3 - outer branch; 4 - lower pharyngeal constrictor; 5 - cricopharyngeal part of the lower pharyngeal constrictor; 6 - recurrent laryngeal nerve;
b — the plate of the thyroid cartilage is removed: 1 — the internal branch of the superior laryngeal nerve; 2 - sensitive branches to the mucous membrane of the larynx; 3 - anterior and posterior branches of the inferior laryngeal nerve; 4 - recurrent laryngeal nerve
3. Superior cervical cardiac branches (rr. cardiaci cervicales superiors) - branches varying in thickness and level, usually thin, originate between the superior and recurrent laryngeal nerves and go down to the thoracic nerve plexus.
4. Inferior cervical cardiac branches (rr. cardiaci cervicales inferiors) depart from the laryngeal recurrent nerve and from the trunk of the vagus nerve; participate in the formation of the cervicothoracic nerve plexus.
Branches of the thoracic vagus nerve.
1. Recurrent laryngeal nerve (n. laryngeus recurrens) arises from the vagus nerve as it enters the chest cavity. The right recurrent laryngeal nerve bends around the subclavian artery from below and behind, and the left one around the aortic arch. Both nerves ascend in the groove between the esophagus and trachea, giving branches to these organs. Final branch - inferior laryngeal nerve(n. laryngeus inferior) approaches the larynx and innervates all the muscles of the larynx, with the exception of the cricothyroid, and the mucous membrane of the larynx below the vocal cords.
Branches from the recurrent laryngeal nerve extend to the trachea, esophagus, thyroid and parathyroid glands.
2. Thoracic cardiac branches (rr. cardiaci thoracici) begin from the vagus and left laryngeal recurrent nerves; participate in the formation of the cervicothoracic plexus.
3. Tracheal branches go to the thoracic trachea.
4. Bronchial branches are directed to the bronchi.
5. Esophageal branches approach the thoracic esophagus.
6. Pericardial branches innervate the pericardium.
Within the cavities of the neck and chest, the branches of the vagus, recurrent and sympathetic trunks form the cervicothoracic nerve plexus, which includes the following organ plexuses: thyroid, tracheal, esophageal, pulmonary, cardiac:
Branches of the vagus trunks (ventral part).
1) anterior gastric branches start from the anterior trunk and form the anterior gastric plexus on the anterior surface of the stomach;
2) posterior gastric branches originate from the posterior trunk and form the posterior gastric plexus;
3)celiac branches originate mainly from the posterior trunk and take part in the formation of the celiac plexus;
4) hepatic branches are part of the hepatic plexus;
5) renal branches form renal plexuses.
XI pair - accessory nerve
(p. accessories) is mainly motor, separated during development from the vagus nerve. It begins in two parts - the vagus and the spinal cord - from the corresponding motor nuclei in the medulla oblongata and spinal cord. Afferent fibers enter the trunk through the spinal part from the cells of the sensory nodes (Fig. 3).
Rice. 3.
1 - double core; 2 - vagus nerve; 3 - cranial root of the accessory nerve; 4 - spinal root of the accessory nerve; 5 - large hole; 6 - jugular foramen; 7 - superior node of the vagus nerve; 8 - accessory nerve; 9 - lower node of the vagus nerve; 10 - first spinal nerve; 11 - sternocleidomastoid muscle; 12 - second spinal nerve; 13 - branches of the accessory nerve to the trapezius and sternocleidomastoid muscles; 14 - trapezius muscle
The wandering part comes out cranial root(radix cranialis) from the medulla oblongata below the exit of the vagus nerve, the spinal part is formed spinal root (radix spinalis), emerging from the spinal cord between the dorsal and anterior roots.
The spinal part of the nerve rises to the large foramen, enters through it into the cranial cavity, where it connects with the vagus part and forms the common trunk of the nerve.
In the cranial cavity, the accessory nerve divides into two branches: internal And external.
1. Internal branch (r. internus) approaches the vagus nerve. Through this branch, motor nerve fibers are included in the vagus nerve, which leave it through the laryngeal nerves. It can be assumed that sensory fibers also pass into the vagus and further into the laryngeal nerve.
2. Outer branch (r. externus) exits the cranial cavity through the jugular foramen to the neck and goes first behind the posterior belly of the digastric muscle, and then from inside the sternocleidomastoid muscle. Perforating the latter, the external branch goes down and ends in the trapezius muscle. Connections are formed between the accessory and cervical nerves. Innervates the sternocleidomastoid and trapezius muscles.
XII pair - hypoglossal nerve
(n. hypoglossus) predominantly motor, is formed as a result of the fusion of several primary spinal segmental nerves innervating the hypoglossal muscles.
The nerve fibers that make up the hypoglossal nerve extend from its cells motor nucleus located in the medulla oblongata. The nerve emerges from it between the pyramid and the olive with several roots. The formed nerve trunk passes through the canal of the hypoglossal nerve to the neck, where it is located first between the external (outside) and internal carotid arteries, and then descends under the posterior belly of the digastric muscle in the form of an open upward arc along the lateral surface of the hyoglossus muscle, constituting the upper side of Pirogov's triangle (lingual triangle) (Fig. 4); branches into terminal lingual branches(rr. linguales), innervating the muscles of the tongue.
Rice. 4.
1 - hypoglossal nerve in the canal of the same name; 2 - nucleus of the hypoglossal nerve; 3 - lower node of the vagus nerve; 4 - anterior branches of the 1st-3rd cervical spinal nerves (form the cervical loop); 5 - superior cervical ganglion of the sympathetic trunk; 6 - upper root of the neck loop; 7 - internal carotid artery; 8 - lower root of the neck loop; 9 - neck loop; 10 - internal jugular vein; 11—common carotid artery; 12—lower belly of the omohyoid muscle; 13 - sternothyroid muscle; 14 - sternohyoid muscle; 15 - upper belly of the omohyoid muscle; 16 - thyrohyoid muscle; 17 - hypoglossus muscle; 18 - geniohyoid muscle; 19—genioglossus muscle; 20—own muscles of the tongue; 21 - styloglossus muscle
From the middle of the nerve arch goes down along the common carotid artery superior root of the cervical loop (radix superior ansae cervicalis), which connects with her lower root (radix inferior) from the cervical plexus, resulting in the formation neck loop (ansa cervicalis). Several branches extend from the cervical loop to the neck muscles located below the hyoid bone.
The position of the hypoglossal nerve in the neck can vary. In people with long necks, the arc formed by the nerve lies relatively low, while in people with short necks it lies high. This is important to consider when performing nerve operations.
The hypoglossal nerve also contains other types of fibers. Sensory nerve fibers come from the cells of the inferior ganglion of the vagus nerve and, possibly, from the cells of the spinal ganglia along the connecting branches between the hypoglossal, vagus and cervical nerves. Sympathetic fibers enter the hypoglossal nerve along its connecting branch with the superior ganglion of the sympathetic trunk.
The areas of innervation, fiber composition and names of the cranial nerve nuclei are presented in Table. 1.
Table 1. Areas of innervation, fiber composition and names of cranial nerve nuclei
|
Pair |
Nerve |
Fiber composition (predominant) |
Names of nuclei located in brain stem |
Innervated organs |
|
Nervus terminalis |
Sympathetic(?) |
|
Blood vessels and glands of the nasal mucosa |
|
|
Nervi olfactorii |
Sensitive |
|
Regio olfactoria of the nasal mucosa |
|
|
Sensitive |
|
Retina of the eyeball |
||
|
Motor |
Nucleus n. oculomotorii |
M. Levator palpebrae superioris, m. rectus medialis, m. rectus superior, m. rectus inferior, m. obliquus inferior |
||
|
Parasympathetic |
Nucleus n. oculomotorius accessorius |
M. ciliaris, m. sphincterpupillae |
||
|
Nervus trochlearis |
Motor |
Nucleus n. trochlearis |
M. obliquus superior |
|
|
Nervus trigeminus |
Motor |
Nucleus motorius n. trigemini |
Mm. masticatorii, m. tensoris veli palatini, m. tensor tympani, venter anterior m. digastrici |
|
|
Sensitive |
Nucleus mesence-phalicus n. trigemini |
Skin of the frontal and temporal parts of the head, facial skin. Mucous membranes of the nasal and oral cavities, anterior 2/3 of the tongue, teeth, salivary glands, organs of the orbit, dura mater of the brain in the region of the anterior and middle cranial fossae |
||
|
Sensitive |
Nucleus pontinus n. trigemini |
|||
|
Sensitive |
Nucleus spinalis n. trigemini |
|||
|
Motor |
Nucleus n. abducentis |
M. rectus lateralis |
||
|
Motor |
Nucleus n. facialis |
Mm.faciales, t. platysma, venter posterior t. digastrici, m. styloideus, m. stapedius |
||
|
Nervus intermedius |
Sensitive |
Nucleus solitarius |
Taste sensitivity of the anterior 2/3 of the tongue |
|
|
Parasympathetic |
Nucleus salivatorius superior |
Glandula lacrimalis, tunica mucosa oris, tunica mucosa nasi (glands), gl. sublingualis, gl. submandibularis, glandulae salivatoria minores |
||
|
Nervus vestibulo-cochlearis |
Sensitive |
Nervus cochlearis: nucl. cochlearis anterior, nucl. cochlearis posterior |
Organon spirale, spiral organ |
|
|
Nervus vestibularis: nucl. vestibularis medialis, nucl. vestibularis superior, nucl. inferior |
Crista ampullares. Macula urticuli, macula sacculi, membranous labyrinth inner ear |
|||
|
Nervus glossopharyngeus |
Motor |
Nucleus ambiguus |
M. stylopharingeus, muscles of the pharynx |
|
|
Sensitive |
Nucleus solitarius |
Cavum tympani, tuba auditiva, tunica mucosa radicis linguae, pharingis, tonsilla palatina, glomus caroticus, auditory tube |
||
|
Parasympathetic |
Nucleus salivatorius inferior |
Glandula parotidea |
||
|
Motor |
Nucleus ambiquus |
Tunica muscutarispharingis, m. levator velipalatini, m. uvulae, m. palatoglossus, m. palatopharyngeus, mm. laryngis |
||
|
Sensitive |
Nucleus solitarius |
Dura mater encephali in the area of the posterior cranial fossa, skin of the external auditory canal. Organs of the neck, chest and abdomen (excluding the left side of the colon) |
||
|
Parasympathetic |
Nucleus dorsalis n. vagi |
Smooth muscles and glands of the thoracic and abdominal cavities(except for the left side of the colon) |
||
|
Nervus accessorius |
Motor |
Nuclei nervi accessorii (nucl. accessorius) |
M. sternocleidomastoideus, T. trapezius |
|
|
Nervus hypoglossus |
Motor |
Nucleus n. hypoglossi |
Muscles of the tongue, musculi infrahyoids |
Human anatomy S.S. Mikhailov, A.V. Chukbar, A.G. Tsybulkin
Loading...