Nervus vagus (X)
Vagus nerve, p. vagus , is a mixed nerve. Its sensory fibers end in the nucleus of the solitary pathway, the motor fibers start from the double nucleus (both nuclei are common with the glossopharyngeal nerve), and the vegetative fibers start from the posterior nucleus. vagus nerve. The vagus nerve innervates a wide area. The fibers emerging from the autonomic nucleus are most vagus nerve and provide parasympathetic innervation of the organs of the neck, chest and abdominal cavities. Impulses flow along the fibers of the vagus nerve, which slow down the rhythm of the heartbeat, dilate the vessels (reflexively regulate blood pressure in the vessels), narrow the bronchi, increase peristalsis and relax the intestinal sphincters, and cause increased secretion of the glands of the gastrointestinal tract.
The vagus nerve emerges from the medulla oblongata in the posterior lateral groove with several roots, which, when combined, form a single trunk heading towards the jugular foramen. In the hole 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 sensitive neurons. The peripheral processes of the neurons of these nodes go to the internal organs, the hard shell of the brain, the skin of the external auditory canal. In the jugular foramen, the internal branch of the accessory nerve approaches the trunk of the vagus nerve and connects with it.
After leaving the jugular foramen, the nerve goes down, located on the prevertebral plate of the cervical fascia behind and between the internal jugular vein and the internal carotid artery. V chest cavity the vagus nerve passes through the superior foramen chest. The right nerve is located between the subclavian artery at the back and the subclavian vein at the front. The left nerve goes 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 vagus trunks are formed. The latter, together with the esophagus, pass into the abdominal cavity and there they give up their final branches.
Topographically, the vagus nerve can be divided into 4 sections: head, cervical, thoracic and abdominal.
Head office vagus nerve is located between the beginning of the nerve and the upper node. The following branches depart from this department:
1 meningeal branch, G.meningeus, departs from the upper node and goes to the hard shell of the brain in the region of the posterior cranial fossa, including the walls of the transverse and occipital sinuses.
2 ear branch, G.auricularis, starts from the lower part of the upper node, penetrates into the jugular fossa, where it enters the mastoid canal temporal bone. Coming out of the latter through the tympanic-mastoid fissure, the ear 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 region the vagus nerve refers to that part of it that is located between the lower node and the outlet of the recurrent laryngeal nerve. branches cervical vagus nerve:
1 pharyngeal branches, rr. pharyngei [ pharingedlis], go to the wall of the pharynx, where, connecting with the branches of the glossopharyngeal nerve and the sympathetic trunk, they form pharyngeal plexus,ple xus pharyngeus [ pharyngedlis]. The pharyngeal branches innervate the mucous membrane of the pharynx, the constrictor muscles, the muscles of the soft palate, with the exception of the muscle that strains the palatine curtain.
2 Superior cervical cardiac branches, rr. cardiaci cervicles superiores, in the amount of 1-3 depart from the vagus nerve, descending along the common carotid artery, and together with the branches of the sympathetic trunk enter the cardiac plexus.
3 Superior laryngeal nerve, P.laryngeus [ laryngea- lis] superior, departs from the lower node of the vagus nerve, goes forward along the lateral surface of the pharynx and at the level of the hyoid bone is divided into external and internal branches. Outer branch, Mr.externus, innervates the cricothyroid muscle of the larynx. Inner branch, Mr.internus, accompanies the superior laryngeal artery and, together with the latter, pierces the thyroid-hyoid 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.
4 recurrent laryngeal nerve, P.laryngeus [ la- ringealis] recurrences, has a different origin on the right and left. The left recurrent laryngeal nerve begins at the level of the aortic arch and, having rounded it from below in the anteroposterior direction, rises vertically upwards 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, p.laryngealis infe rior, innervates the mucous membrane of the larynx below the glottis and all the muscles of the larynx, except for the cricothyroid. Also depart from the recurrent laryngeal nerve tracheal branches,rr. trachedles, esophageal branches,rr. esophagei [ oesophagealis] and loweruieuHbieheart branches,rr. cardiaci cervicles infe- priores, that go to the heart plexus. Also departs from the lower laryngeal nerve connecting branch(with the internal laryngeal branch of the superior laryngeal nerve), G.communicants (cum r. laryngeo interno).
Thoracic- this is the section of the vagus nerve from the level of the 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, are sent to the heart plexuses.
2 Bronchial "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 with them enters the lung.
3 Esophageal plexus, plexus esophageus [ oeso phagealis] , is formed by the branches of the right and left vagus nerves (trunks), which are connected 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 that emerge from the esophageal plexus.
1 Front wandering 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 depart anterior gastric branches, gg.gdstrici anteriores, as well as hepatic branches,hepdtici, running between the sheets of the lesser omentum to the liver.
2 Rear wandering trunk, truncus vagdlis pos interior, from the esophagus passes to the back wall of the stomach, goes along its lesser curvature, gives posterior gastric branchesrr. gdstrici posteriores, as well as 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 large intestine 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) a sensitive nucleus of a solitary path; 2) motor - double core; 3) parasympathetic - the 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), more superficial than the double nucleus. The vagus nerve emerges from the medulla oblongata in its posterior lateral sulcus (sulcus lateralis posterior), below the glossopharyngeal nerve. Its 10-15 roots form a thick nerve trunk, which, together with the glossopharyngeal and accessory nerves, leaves the cranial cavity through anterior section jugular foramen (foramen jugulare). Through the back of the hole passes the inner jugular vein. In the jugular foramen, the sensitive part of the vagus nerve forms a small upper or jugular node (ganglion superior, PNA; g. jugulare, BNA, ZhA) .. Below the jugular foramen is another sensory fusiform node. This is the lower or knotty node (ganglion inferius, PNA; g. nodosum BNA, JNA).
Initially, in embryos 9-11 mm long, the vagus nerve is presented as a group of longitudinal bundles of nerve fibers. They can be traced to the level of the bifurcation of the trachea, 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 is quickly completed, already in embryos 14-23 mm long, 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 the thickness of the wall of the esophagus.
It should be noted that already early stages prenatal ontogenesis, the esophageal plexus is a holistic formation and the exchange of fibers between both vagus nerves is carried out in it.
After leaving the cranial cavity, the vagus nerve descends down to the neck. In the upper part of the carotid triangle, it is located between the internal carotid artery and the internal jugular vein, and in its middle and lower parts; lah - between the common carotid artery and the internal jugular vein.
This neurovascular bundle is located under the group; dino-cleidomastoid muscle. It is surrounded by a vagina formed by the parietal sheet of the fourth fascia of the neck. Inside this sheath, fixed to the transverse processes of the cervical vertebrae, there are partitions that form separate chambers for the artery, vein, and nerve.
The conductors of the general somatic afferent sensitivity arise from the neurons of the superior or jugular node of the vagus nerve. They go to the skin of the posterior wall of the outer ear canal and to the skin of the auricle. The conductors of the 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 chest and a significant part of the abdominal cavity.
Conductors of special visceral afferent sensitivity also arise from the neurons of the lower
or knotted knot. They conduct taste information from the taste buds scattered in the epithelium of the epiglottis (epiglottis).
The following branches depart from the head of the vagus nerve between its upper and lower sensory nodes: 1) sheath branch (r. meningeus), which returns through the jugular foramen to innervate the dura mater of the posterior cranial fossa; 2) ear branch (r. auricular is) - to the back wall of the external auditory canal and to the skin of the auricle. This is the only cutaneous branch of all the main nerves that are not related to the system trigeminal nerve. It goes through the mastoid canaliculus of the temporal bone (canaliculus mastoideus) from the jugular fossa (fossa jugularis) of the temporal bone, crosses the descending segment of the facial nerve canal, passes through the tympanic cavity and exits through the tympanomastoid schamp; l (fissura tymponomastoidea).
In the neck region, the pharyngeal branches of the vagus nerve, together with the branches of the glossopharyngeal nerve and the postganglionic fibers of the superior cervical node of the sympathetic trunk, form the pharyngeal plexus. From the pharyngeal branches of the vagus nerve, motor and sensory innervation upper and middle constrictors of the pharynx (m. constrictor pharyngis superior et t. constrictor pharyngis medius), muscles of the soft palate, palatopharyngeal muscle (m.palatopharyngeus) and palatoglossal muscle (t. palatoglossus). The pharyngeal plexus also gives sensitive fibers to the mucous membrane of the pharynx. 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 direction and, behind the internal and external carotid arteries, gives off the external branch (ramus extemus) to the lower constrictor of the pharynx (m. constrictor pharyngis inferior) and the cricothyroid muscle (m. cricothyreoideus). Further, 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 shield-hyoid 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 her vagina. It forms connections with the branches of the cervical sympathetic trunk and is involved in the formation of cardiac nerve plexuses. The superior laryngeal nerve also gives a connecting branch to the inferior laryngeal nerve (r. 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 outer branch of the accessory nerve in embryos 15 mm long is divided into two branches that reach the anlages 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 dorso-laterally from the nucleus of the olive and slightly below the double nucleus. Pars cerebralis continues directly into the spinal cord (Cj-Cb). Here the motor nucleus is called its spinal part (pars spinalis). The roots of the brain 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 (Sx-Sb) and partly between the anterior roots of the three upper cervical segments spinal cord.
Then the roots of the spinal part rise up, enter through the large occipital foramen (foramen magnum) into the cranial cavity and join the roots of the brain 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 inside it from the internal jugular vein, outward 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 perforated by the external branch of the accessory nerve. Then this branch comes out at the posterior edge of the muscle about 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 goes obliquely down, under the anterior edge of the trapezius muscle (m. trapezius) and innervates it. The presence of a single source of innervation for the sternocleidomastoid
chico-mastoid and trapezius muscles indicates
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 brain 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 the fibers coming from the spinal part of the accessory nerve as part of the pharyngeal branches (rami pharyngei) innervate the muscles of the pharynx.
The vagus nerve (lat. nervus vagus, nervus vagus, vagus nerve) is the tenth of the 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 functions 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 the skin located behind the ear, part of the tympanic membrane, the external auditory canal, the 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;
- work of the stomach;
- vomiting.
As a result of violations of the vagus nerve, cardiac arrest and, accordingly, death are possible.
Everything about the vagus nerve: where is it located, its anatomy, functions, possible violations and methods of treatment:
Anatomy and functions of the branches of the vagus nerve
Causes of disruption in the work of the vagus
Vagus nerve disorders can occur for a variety of reasons. The most common:
Characteristic clinical picture
If the vagus nerve is damaged, then 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, at the appointment, the doctor will pay attention to the sound of the voice. If it is lowered, the ligaments may not be able to close close enough. Also, clarity, sound and timbre can become symptoms that indicate the presence of 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.
When the nerve is damaged, weakening of various vagal reflexes will be observed, for example, the pharyngeal and palatine reflexes will not be fully manifested. The doctor may give a glass of water to assess the possibility of swallowing: if it is difficult, the pathology is present.
After the examination, a number of studies are carried out:
- laryngoscopy: with the help of a study, the state of the vocal cords is determined;
- x-ray of the skull, chest.
Package of measures
The most striking manifestations of problems in the work of the vagus nerve are the following diseases:
- : as a result, there are problems with the peripheral part of the central nervous system and the brain, while the patient feels dizzy, hearing loss;
- : episodic attacks of severe headache;
- : the nature of the patient is characterized by increased irascibility, the upper, lower limbs and some parts of the face turn pale, while becoming 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, therefore, with the slightest disorder of the nervous system or if there are symptoms of vagus nerve problems, you should immediately contact a specialist in a medical institution.
Treatment of disorders in the area of the vagus nerve and concomitant diseases is most often carried out with medication and usually consists in prescribing such drugs:
To improve the effect drug treatment should be supplemented with physiotherapy. The treatment worked well. The currents directed to the place of localization of pain remove pain syndromes, muscle inflammation, used in migraine therapy, stimulate 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 is purified by means of special devices.
Folk remedies
At home, you can also perform a set of therapeutic measures.
For taking a bath, a mixture of herbs is prepared: pine buds, yarrow, oregano, calamus root. Each herb needs 5 large spoons.
All this is poured with 10 liters of boiling water and aged for about 6 hours. After that, the infusion is poured into the bath, the water temperature in 
which is not higher than 33 degrees Celsius. Now you can take a bath, lying in which you need 15 minutes. For maximum effect, the body must be completely relaxed.
Another option will help in the treatment of 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 material is poured with 8 liters of boiling water and aged for 3-4 hours. After that, 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 Strengtheners
A specially prepared balm made from tinctures of thyme, yarrow, hop cones, peppermint, motherwort, blackberry leaves will help strengthen and restore nerves. 
All components are taken in 100 milliliters. After that, 150 milliliters of crushed cyanosis rhizomes are added. The ingredients are mixed and taken internally, one large spoonful every morning for three months.
Honey is used for various disorders of the nervous system. Its use is also relevant in the treatment of vagus. To do this, mix honey and beet juice in equal proportions. After that, 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 grave consequences up to and including death.
cannot be completely trusted and folk remedies. They may be optional, but by no means essential.
How to prevent vagus disorder
In order to protect the vagus nerve from diseases, it is necessary:
- eat as many vegetables and fruits as possible;
- reduce the 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 symptoms of diseases, 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, taking an active part in the regulation of a wide variety of processes that bind together the work of the body and brain, 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
Active influence of the vagus nerve (or X pair cranial nerves) on our well-being consists in:
-increased stress resistance and accelerated 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 (which was originally called "vagus substance", "vagustoff" from 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 detection of inflammatory markers such as cytokines and markers of tumor necrosis. If this mechanism is disrupted, the development of autoimmune diseases, 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 smooth muscles of the internal organs. The gut contains 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 mental processes. A measure of vagal tone (i.e., its ability to respond and affect the heart) correlates with the likelihood of developing heart disease and diabetes, as well as with emotional stability and anxiety levels.
VAGA NERVE ELECTRICAL STIMULATION
Vagus nerve electrical stimulation is a procedure for implanting a generator electrical impulses in the neck area for constant stimulation of the vagus nerve. Despite the dreaded word "implantation", EBN therapy is not complete surgical operation on the brain. Device implantation is a simple surgical procedure which will require only a short stay in the hospital. Electrical stimulation of the vagus nerve is performed by a pulse generator installed 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 wires are not visible from the outside. They travel under the skin from the pulse generator to the vagus nerve in the neck.
EBN has been successfully used to treat epilepsy, migraine, and drug-resistant depression. Research is under way to investigate the effects of EBN on patients with anxiety disorders, Alzheimer's disease, fibromyalgia, obesity, and tinnitus.
However, EBN therapy is a very risky measure, implying the possibility of complications (eg 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 a lengthening of the expiratory 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 relationship with the function of the vagus nerve, motor and emotional), improved bowel health, exercise and adequate rest, and, most importantly, the fight against stress and anxiety.
However, from a pragmatic point of view, massage therapists and manual therapists the question often arises: "How can I affect this nerve through touch, and what will it lead to?"
VAGA NERVE AND HUMAN EAR
The human ear is the only place where the vagus nerve reaches the surface of the body (by the auricular, ear 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 is composed of sensory neurons, therefore, sensory stimulation of the parts of the ear innervated by the vagus nerve (Figure 3) stimulates vagus nerve activity. In most therapeutic cases, deactivation of the sympathetic nervous system is required. Gentle, delicate touches of medium intensity (Fig. 4) demonstrate the greatest effectiveness. A study on the effect of massage on the vagus nerve in infants found that this nerve responded better to moderate-intensity touch than to light or high-intensity touch. For many clients, inclusion in a session with the ears 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 be as pronounced and fast as with direct continuous electrical stimulation, however, studies show that 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. Ear work is especially helpful for headaches and temporomandibular joint dysfunction, due to the vagus nerve's ability to relax both the body and the emotional component of a person.
VAGUS NERVE TECHNIQUE(Illustrations - fig.4, fig.5) 
PURPOSE
Increased activity of the vagus nerve with gentle stimulation to increase sensation.
INDICATIONS FOR USE
Headache, migraine
Dysfunction of the temporomandibular joint.
Stress, anxiety, hyperexcitability 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, applying moderate pressure, or light traction on the pinna to increase the sensitivity of the areas of the ear innervated by the vagus nerve.
For migraines and temporomandibular joint dysfunction, find areas hypersensitivity and use active jaw work techniques.
VERBAL HELP
“Exhale as slowly as possible, push all the air out of the lungs”
"Try to relax your tongue"
“Try humming your favorite song while keeping your neck and jaw relaxed.”
For migraines:
“Rotate your eyeballs, looking alternately to the right and left”
For TMJ dysfunction:
"Gently open your mouth, trying to keep your lower jaw gone as far as possible from the ears.
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X pair - vagus nerves
(n. vagus), mixed, develops in connection with the fourth or fifth gill arches, is widely distributed due to which it got its name. It 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. one.
1 - dorsal nucleus of the vagus nerve; 2 - the core of a single path; 3 - the nucleus of the spinal tract of the trigeminal nerve; 4 - double core; 5 - cranial root of the accessory nerve; 6 - vagus nerve; 7 - jugular opening; 8 - the upper node of the vagus nerve; 9 - the 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 - the upper 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 — average constrictor of a throat; 23 - stylo-pharyngeal muscle; 24 - upper constrictor of the pharynx; 25 - palatopharyngeal muscle; 26 - muscle that raises the palatine curtain, 27 - auditory tube; 28 - ear 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 ganglions inside the trunk.
Sensory nerve fibers of the vagus nerve originate from afferent pseudo-unipolar nerve cells, whose clusters 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 cells go to the medulla oblongata to the sensitive nucleus - single path core (nucleus tractus solitary), and peripheral - 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 double core.
Parasympathetic fibers originate from the autonomic dorsal nucleus(nucleus dorsalis nervi vagi) and spread as part of the nerve to the muscle of the heart, the muscle tissue of the membranes of the vessels and the viscera. Impulses traveling along the parasympathetic fibers reduce the heart rate, dilate blood vessels, constrict the bronchi, and increase the 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 nodes 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 retains connections with these nerves, as well as with the hypoglossal nerve and the sympathetic trunk through connecting branches.
The vagus nerve emerges from the medulla oblongata behind the olive in numerous roots that merge into common trunk, which leaves the skull through the jugular foramen. Further, 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 upper aperture of the chest, the vagus nerve enters the posterior mediastinum between the subclavian vein and artery on the right and anterior to 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 near the esophageal opening of the diaphragm forms 2 wandering trunk: anterior (tractus vagalis anterior) and posterior (tractus vagalis posterior) corresponding to the left and right vagus nerves. Both trunks leave the chest cavity through the esophageal opening, give branches to the stomach and end in a number of terminal branches in celiac plexus. From this plexus, the fibers of the vagus nerve spread along its branches. Throughout the vagus nerve, branches depart from it.
Branches of the head of the vagus nerve.
1. Meningeal branch (r. meningeus) starts from the upper node and through the jugular foramen reaches the dura mater of the posterior cranial fossa.
2. ear branch (r. auricularis) goes from the upper node along the anterolateral surface of the bulb of the jugular vein 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 at or just below the lower node. They take thin branches from the upper cervical node of the sympathetic trunk and penetrate between the external and internal carotid arteries 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 off 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 the branches from the superior cervical node of the sympathetic trunk and goes along the posterior edge of the thyroid cartilage to the cricoid muscle and the inferior constrictor of the pharynx, and also gives off branches to the arytenoid and lateral cricoarytenoid muscles inconsistently. In addition, branches depart from it to the mucous membrane of the pharynx and the thyroid gland. Internal branch thicker, sensitive, pierces the thyroid-hyoid 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 lower laryngeal nerve.
Rice. 2.
a - right side view: 1 - superior laryngeal nerve; 2 - internal branch; 3 - outer branch; 4 - lower constrictor of the pharynx; 5 - crico-pharyngeal part of the lower constrictor of the pharynx; 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 lower laryngeal nerve; 4 - recurrent laryngeal nerve
3. Superior cervical cardiac branches (rr. cardiaci cervicales superiors) - variable in thickness and level of branches, usually thin, originate between the superior and recurrent laryngeal nerves and go down to the thoracic 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) departs from the vagus nerve as it enters the chest cavity. The right recurrent laryngeal nerve goes around the subclavian artery from below and behind, and the left one - the aortic arch. Both nerves rise in the groove between the esophagus and trachea, giving off branches to these organs. terminal 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 depart from the recurrent laryngeal nerve to the trachea, esophagus, thyroid and parathyroid glands.
2. Thoracic cardiac branches (rr. cardiaci thoracici) start 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 go to the bronchi.
5. Esophageal branches approach the thoracic esophagus.
6. Pericardial branches innervate the pericardium.
Within the cavities of the neck and chest, branches of wandering, recurrent and sympathetic trunks form the cervicothoracic nerve plexus, which includes organ plexuses: thyroid, tracheal, esophageal, pulmonary, cardiac:
Branches of wandering trunks (abdominal 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 depart from the posterior trunk and form the posterior gastric plexus;
3)celiac branches depart 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
(n. accessories) is mainly motor, separated in the process of development from the vagus nerve. It begins in two parts - vagus and spinal - 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 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 - a large hole; 6 - jugular opening; 7 - the upper node of the vagus nerve; 8 - accessory nerve; 9 - the lower node of the vagus nerve; 10 - the first spinal nerve; 11 - sternocleidomastoid muscle; 12 - the 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 posterior 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 a common nerve trunk.
In the cranial cavity, the accessory nerve divides into two branches: internal and outer.
1. Internal branch (r. internus) approaches the vagus nerve. Through this branch, motor nerve fibers are included in the composition of 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 the inside of the sternocleidomastoid muscle. Perforating the last, 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) is predominantly motor, is formed as a result of the fusion of several primary spinal segmental nerves that innervate the hyoid muscles.
Nerve fibers that make up the hypoglossal nerve depart from its cells motor nucleus located in the medulla oblongata. The nerve leaves it between the pyramid and the olive with several roots. The formed nerve trunk passes through the hypoglossal nerve canal 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 arc open upward along the lateral surface of the hyoid-lingual muscle, making up the upper side of the Pirogov triangle (lingual triangle) (Fig. 4); branches into terminal lingual branches(rr. linguales) that innervates the muscles of the tongue.
Rice. 4.
1 - hypoglossal nerve in the canal of the same name; 2 - the nucleus of the hypoglossal nerve; 3 - the lower node of the vagus nerve; 4 - front branches of the 1st-3rd cervical spinal nerves (form a cervical loop); 5 - the upper cervical node of the sympathetic trunk; 6 - the upper spine of the neck loop; 7 - internal carotid artery; 8 - the lower spine of the neck loop; 9 - neck loop; 10 - internal jugular vein; 11 - common carotid artery; 12 - lower belly of the scapular-hyoid muscle; 13 - sternothyroid muscle; 14 - chest-but-hyoid muscle; 15 - the upper abdomen of the scapular-hyoid muscle; 16 - shield-hyoid muscle; 17 - hyoid-lingual muscle; 18 - chin-hyoid muscle; 19 - chin-lingual muscle; 20 - own muscles of the tongue; 21 - styloid muscle
From the middle of the arc of the nerve down along the common carotid artery goes superior root of the cervical loop (radix superior ansae cervicalis), which connects with her lower spine (radix inferior) from the cervical plexus, resulting in the formation cervical loop (ansa cervicalis). Several branches depart from the cervical loop to the neck muscles located below the hyoid bone.
The position of the hypoglossal nerve in the neck can be different. In people with a long neck, the arc formed by the nerve lies relatively low, and in people with a short neck, it is high. This is important to consider when operating on a nerve.
Other types of fibers also pass through the hypoglossal nerve. Sensitive 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 node of the sympathetic trunk.
Areas of innervation, fiber composition and names of the cranial nerve nuclei are presented in Table. one.
Table 1. Areas of innervation, fiber composition and names of cranial nerve nuclei
|
Pair |
Nerve |
Fiber composition (preferential) |
The names of the nuclei located in brain stem |
Innervated organs |
|
Nervus terminalis |
Sympathetic (?) |
|
Blood vessels and glands of the nasal mucosa |
|
|
Nerviolfactorii |
sensitive |
|
Regio olfactoria nasal mucosa |
|
|
sensitive |
|
Retina of the eyeball |
||
|
Motor |
Nucleus n. oculomotorii |
M. Levator palpebrae superioris, t. rectus medialis, t. rectus superior, t. 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 |
The skin of the frontal and temporal parts of the head, the skin of the face. Mucous membranes of the nasal and oral cavities, anterior 2/3 tongues, teeth, salivary glands, orbital organs, dura mater 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 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, pharyngis, 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 region of the posterior cranial fossa, skin of the external auditory canal. Organs of the neck, chest and abdomen (excluding the left side of the large intestine) |
||
|
Parasympathetic |
Nucleus dorsalis n. vagi |
Smooth muscles and glands of the thoracic and abdominal cavity(excluding the left side of the colon) |
||
|
Nervus accessorius |
Motor |
Nuclei nervi accessorii (nucl. accessorius) |
M. sternocleidomastoideus, t. trapezius |
|
|
Nervus hypoglossus |
Motor |
Nucleus n. hypoglossy |
Muscles of the tongue, musculi infrahyoids |
Human Anatomy S.S. Mikhailov, A.V. Chukbar, A.G. Tsybulkin
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