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VI pair - abducens nerves
Abducens nerve (p. abducens) - motor. Abducens nerve nucleus(nucleus n. abducentis) located in the anterior part of the bottom of the fourth ventricle. The nerve leaves the brain at the posterior edge of the pons, between it and the pyramid of the medulla oblongata, and soon, outside the back of the sella turcica, it enters the cavernous sinus, where it is located along the outer surface of the internal carotid artery (Fig. 1). It then penetrates through the superior orbital fissure into the orbit and follows forward over the oculomotor nerve. Innervates the external rectus muscle of the eye.
Rice. 1. Nerves of the oculomotor system (diagram):
1 - superior oblique muscle of the eye; 2 - superior rectus muscle of the eye; 3 - trochlear nerve; 4 - oculomotor nerve; 5 - lateral rectus oculi muscle; 6 - inferior rectus muscle of the eye; 7 - abducens nerve; 8 - inferior oblique muscle of the eye; 9 - medial rectus oculi muscle
VII pair - facial nerves
(n. facialis) develops in connection with the formations of the second gill arch, so it innervates all the facial muscles (facial muscles). The nerve is mixed, including motor fibers from its efferent nucleus, as well as sensory and autonomic (gustatory and secretory) fibers belonging to the facial nerve. intermediate nerve(n. intermedius).
Motor nucleus of the facial nerve(nucleus p. facialis) is located at the bottom of the IV ventricle, in the lateral region of the reticular formation. The root of the facial nerve leaves the brain together with the root of the intermediate nerve in front of the vestibulocochlear nerve, between the posterior edge of the pons and the olive of the medulla oblongata. Next, the facial and intermediate nerves enter the internal auditory canal and enter the facial nerve canal. Here both nerves form a common trunk, making two turns according to the bends of the canal (Fig. 2, 3).
Rice. 2. Facial nerve (diagram):
1 - internal carotid plexus; 2 - elbow assembly; 3 - facial nerve; 4 - facial nerve in the internal auditory canal; 5 - intermediate nerve; 6 - motor nucleus of the facial nerve; 7 - superior salivary nucleus; 8 - nucleus of the solitary tract; 9 - occipital branch of the posterior auricular nerve; 10 - branches to the ear muscles; 11 - posterior auricular nerve; 12— nerve to the striatus muscle; 13 - stylomastoid foramen; 14 - tympanic plexus; 15 - tympanic nerve; 16—glossopharyngeal nerve; 17—posterior belly of the digastric muscle; 18— stylohyoid muscle; 19— drum string; 20—lingual nerve (from the mandibular); 21 - submandibular salivary gland; 22 - sublingual salivary gland; 23—submandibular node; 24— pterygopalatine node; 25 - ear node; 26 - nerve of the pterygoid canal; 27 - lesser petrosal nerve; 28 - deep petrosal nerve; 29 - greater petrosal nerve
Rice. 3
I - greater petrosal nerve; 2 - ganglion of the facial nerve; 3—facial canal; 4 - tympanic cavity; 5 - drum string; 6 - hammer; 7 - anvil; 8— semicircular tubules; 9 - spherical bag; 10—elliptical pouch; 11 - vestibule node; 12 - internal auditory canal; 13 - nuclei of the cochlear nerve; 14—inferior cerebellar peduncle; 15 - nuclei of the vestibular nerve; 16— medulla oblongata; 17—vestibular-cochlear nerve; 18 - motor portion of the facial nerve and intermediate nerve; 19 - cochlear nerve; 20 - vestibular nerve; 21 - spiral ganglion
First, the common trunk is positioned horizontally, heading anteriorly and laterally over the tympanic cavity. Then, according to the bend of the facial canal, the trunk turns back at a right angle, forming a genu (geniculum p. facialis) and a geniculum node (ganglion geniculi) belonging to the intermediate nerve. Having passed above the tympanic cavity, the trunk makes a second downward turn, located behind the middle ear cavity. In this area, branches of the intermediate nerve depart from the common trunk, the facial nerve leaves the canal through the stylomastoid foramen and soon enters the parotid salivary gland. The length of the trunk of the extracranial part of the facial nerve ranges from 0.8 to 2.3 cm (usually 1.5 cm), and the thickness is from 0.7 to 1.4 mm: the nerve contains 3500-9500 myelinated nerve fibers, among which thick ones predominate.
In the parotid salivary gland, at a depth of 0.5-1.0 cm from its outer surface, the facial nerve is divided into 2-5 primary branches, which are divided into secondary ones, forming parotid plexus(plexus intraparotideus)(Fig. 4).
Rice. 4.
a - main branches of the facial nerve, right view: 1 - temporal branches; 2 - zygomatic branches; 3 - parotid duct; 4 - buccal branches; 5 - marginal branch of the lower jaw; 6 - cervical branch; 7 - digastric and stylohyoid branches; 8 - main trunk of the facial nerve at the exit from the stylomastoid foramen; 9 - posterior auricular nerve; 10 - parotid salivary gland;
b — facial nerve and parotid gland on a horizontal section: 1 — medial pterygoid muscle; 2 - branch of the lower jaw; 3 - chewing muscle; 4 - parotid salivary gland; 5 - mastoid process; 6 - main trunk of the facial nerve;
c — three-dimensional diagram of the relationship between the facial nerve and the parotid salivary gland: 1 — temporal branches; 2 - zygomatic branches; 3 - buccal branches; 4 - marginal branch of the lower jaw; 5 - cervical branch; 6 - lower branch of the facial nerve; 7 - digastric and stylohyoid branches of the facial nerve; 8 - main trunk of the facial nerve; 9 - posterior auricular nerve; 10 - superior branch of the facial nerve
There are two forms of the external structure of the parotid plexus: reticulate and trunk. At reticulate form The nerve trunk is short (0.8-1.5 cm), in the thickness of the gland it is divided into many branches that have multiple connections among themselves, as a result of which a narrow-loop plexus is formed. Multiple connections with the branches of the trigeminal nerve are observed. At mainline form the nerve trunk is relatively long (1.5-2.3 cm), divided into two branches (superior and lower), which give rise to several secondary branches; there are few connections between the secondary branches, the plexus is broadly looped (Fig. 5).
Rice. 5.
a — network-like structure; b - main structure;
1 - facial nerve; 2 - chewing muscle
Along its path, the facial nerve gives off branches as it passes through the canal, as well as as it exits it. Inside the canal, a number of branches branch off from it:
1. Greater petrosal nerve(n. petrosus major) originates near the ganglion, leaves the canal of the facial nerve through the cleft of the canal of the greater petrosal nerve and passes along the groove of the same name to the foramen lacerum. Having penetrated the cartilage to the outer base of the skull, the nerve connects with the deep petrosal nerve, forming pterygoid nerve(p. canalis pterygoidei), entering the pterygoid canal and reaching the pterygopalatine node.
The greater petrosal nerve contains parasympathetic fibers to the pterygopalatine ganglion, as well as sensory fibers from cells of the genu ganglion.
2. Stapes nerve (p. stapedius) - a thin trunk, branches in the canal of the facial nerve at the second turn, penetrates into the tympanic cavity, where it innervates the stapedius muscle.
3. Drum string(chorda tympani) is a continuation of the intermediate nerve, separates from the facial nerve in the lower part of the canal above the stylomastoid foramen and enters through the canaliculus of the chorda tympani into the tympanic cavity, where it lies under the mucous membrane between the long leg of the incus and the handle of the malleus. Through the petrotympanic fissure, the chorda tympani exits to the outer base of the skull and merges with the lingual nerve in the infratemporal fossa.
At the point of intersection with the inferior alveolar nerve, the chorda tympani gives off a connecting branch with the auricular ganglion. The chorda tympani consists of preganglionic parasympathetic fibers to the submandibular ganglion and gustatory fibers to the anterior two-thirds of the tongue.
4. Connecting branch with tympanic plexus (r. communicans cum plexus tympanico) - thin branch; starts from the genu ganglion or from the greater petrosal nerve, passes through the roof of the tympanic cavity to the tympanic plexus.
Upon exiting the canal, the following branches depart from the facial nerve.
1. Posterior auricular nerve(n. auricularis posterior) departs from the facial nerve immediately upon exiting the stylomastoid foramen, goes back and up along the anterior surface of the mastoid process, dividing into two branches: auricular (r. auricularis), innervating the posterior auricular muscle, and occipital (r. occipitalis), innervating the occipital belly of the supracranial muscle.
2. Digastric branch(r. digasricus) arises slightly below the auricular nerve and, going down, innervates the posterior belly of the digastric muscle and the stylohyoid muscle.
3. Connecting branch with glossopharyngeal nerve (r. communicans cum nerve glossopharyngeo) branches near the stylomastoid foramen and spreads anteriorly and down the stylopharyngeal muscle, connecting with branches of the glossopharyngeal nerve.
Branches of the parotid plexus:
1. Temporal branches (rr. temporales) (2-4 in number) go up and are divided into 3 groups: anterior, innervating the upper part of the orbicularis oculi muscle, and the corrugator muscle; middle, innervating the frontal muscle; posterior, innervating the rudimentary muscles of the auricle.
2. Zygomatic branches (rr. zygomatici) (3-4 in number) extend forward and upward to the lower and lateral parts of the orbicularis oculi muscle and the zygomatic muscle, which innervate.
3. Buccal branches (rr. buccales) (3-5 in number) run horizontally anteriorly along the outer surface of the masticatory muscle and supply branches to the muscles around the nose and mouth.
4. Marginal branch of the mandible(r. marginalis mandibularis) runs along the edge of the lower jaw and innervates the muscles that lower the angle of the mouth and lower lip, the mental muscle and the laughter muscle.
5. The cervical branch (r. colli) descends to the neck, connects to the transverse nerve of the neck and innervates the so-called platysma.
Intermediate nerve(p. intermedins) consists of preganglionic parasympathetic and sensory fibers. Sensitive unipolar cells are located in the genu ganglion. The central processes of the cells ascend as part of the nerve root and end in the nucleus of the solitary tract. The peripheral processes of sensory cells go through the chorda tympani and the greater petrosal nerve to the mucous membrane of the tongue and soft palate.
Secretory parasympathetic fibers originate in the superior salivary nucleus in the medulla oblongata. The root of the intermediate nerve leaves the brain between the facial and vestibulocochlear nerves, joins the facial nerve and runs in the facial nerve canal. The fibers of the intermediate nerve leave the facial trunk, passing into the chorda tympani and the greater petrosal nerve, reaching the submandibular, sublingual and pterygopalatine nodes.
VIII pair - vestibulocochlear nerves
(n. vestibulocochlearis) - sensitive, consists of two functionally different parts: vestibular and cochlear (see Fig. 3).
Vestibular nerve (p. vestibularis) conducts impulses from the static apparatus of the vestibule and semicircular canals of the labyrinth of the inner ear. Cochlear nerve (n. cochlearis) ensures the transmission of sound stimuli from the spiral organ of the cochlea. Each part of the nerve has its own sensory nodes containing bipolar nerve cells: the vestibular part - vestibular ganglion, located at the bottom of the internal auditory canal; cochlear part - cochlear ganglion (spiral ganglion of the cochlea), ganglion cochleare (ganglion spirale cochleare), which is located in the cochlea.
The vestibular node is elongated and has two parts: upper (pars superior) and lower (pars inferior). The peripheral processes of the cells of the upper part form the following nerves:
1) elliptical saccular nerve(n. utricularis), to the cells of the elliptical sac of the vestibule of the cochlea;
2) anterior ampullary nerve(p. ampulis anterior), to the cells of the sensitive stripes of the anterior membranous ampulla of the anterior semicircular canal;
3) lateral ampullary nerve(p. ampulis lateralis), to the lateral membranous ampulla.
From the lower part of the vestibular ganglion, the peripheral processes of cells go in the composition spherical saccular nerve(n. saccularis) to the auditory spot of the saccule and in the composition posterior ampullary nerve(n. ampulis posterior) to the posterior membranous ampulla.
The central processes of the cells of the vestibular ganglion form vestibule (upper) root, which exits through the internal auditory foramen behind the facial and intermediate nerves and enters the brain near the exit of the facial nerve, reaching the 4 vestibular nuclei in the pons: medial, lateral, superior and inferior.
From the cochlear ganglion, the peripheral processes of its bipolar nerve cells go to the sensitive epithelial cells of the spiral organ of the cochlea, collectively forming the cochlear part of the nerve. The central processes of the cells of the cochlear ganglion form the cochlear (lower) root, which goes together with the upper root into the brain to the dorsal and ventral cochlear nuclei.
IX pair - glossopharyngeal nerves
(n. glossopharyngeus) - nerve of the third branchial arch, mixed. Innervates the mucous membrane of the posterior third of the tongue, palatine arches, pharynx and tympanic cavity, parotid salivary gland and stylopharyngeal muscle (Fig. 6, 7). The nerve contains 3 types of nerve fibers:
1) sensitive;
2) motor;
3) parasympathetic.
Rice. 6.
1 - elliptical saccular nerve; 2 - anterior ampullary nerve; 3 - posterior ampullary nerve; 4 - spherical-saccular nerve; 5 - lower branch of the vestibular nerve; 6 - superior branch of the vestibular nerve; 7 - vestibular node; 8 - root of the vestibular nerve; 9 - cochlear nerve
Rice. 7.
1 - tympanic nerve; 2 - genu of the facial nerve; 3 - lower salivary nucleus; 4 - double core; 5 - nucleus of the solitary tract; 6 - nucleus of the spinal tract; 7, 11 - glossopharyngeal nerve; 8 - jugular foramen; 9 - connecting branch to the auricular branch of the vagus nerve; 10 - upper and lower nodes of the glossopharyngeal nerve; 12 - vagus nerve; 13 - superior cervical ganglion of the sympathetic trunk; 14 - sympathetic trunk; 15 - sinus branch of the glossopharyngeal nerve; 16 - internal carotid artery; 17 - common carotid artery; 18 - external carotid artery; 19 - tonsil, pharyngeal and lingual branches of the glossopharyngeal nerve (pharyngeal plexus); 20 - stylopharyngeal muscle and the nerve to it from the glossopharyngeal nerve; 21 - auditory tube; 22 - tubal branch of the tympanic plexus; 23 - parotid salivary gland; 24 - auriculotemporal nerve; 25 - ear node; 26 - mandibular nerve; 27 - pterygopalatine node; 28 - lesser petrosal nerve; 29 - nerve of the pterygoid canal; 30 - deep petrosal nerve; 31 - greater petrosal nerve; 32 - carotid-tympanic nerves; 33 - stylomastoid foramen; 34 - tympanic cavity and tympanic plexus
Sensitive fibers- processes of afferent cells of the upper and lower nodes (ganglia superior et inferior). The peripheral processes follow as part of the nerve to the organs where they form receptors, the central ones go to the medulla oblongata, to the sensory nucleus of the solitary tract (nucleus tractus solitarii).
Motor fibers begin from nerve cells common to the vagus nerve double nucleus (nucleus ambiguous) and pass as part of the nerve to the stylopharyngeal muscle.
Parasympathetic fibers originate in the autonomic parasympathetic inferior salivatory nucleus (nucleus salivatorius superior), which is located in the medulla oblongata.
The root of the glossopharyngeal nerve emerges from the medulla oblongata behind the exit site of the vestibulocochlear nerve and, together with the vagus nerve, leaves the skull through the jugular foramen. In this hole the nerve has its first extension - superior node (ganglion superior), and upon exiting the hole - a second expansion - lower node (ganglion inferior).
Outside the skull, the glossopharyngeal nerve lies first between the internal carotid artery and the internal jugular vein, and then in a gentle arc bends around the stylopharyngeal muscle behind and outside and approaches from the inside of the hyoglossus muscle to the root of the tongue, dividing into terminal branches.
Branches of the glossopharyngeal nerve.
1. The tympanic nerve (n. tympanicus) branches off from the lower ganglion and passes through the tympanic canaliculus into the tympanic cavity, where it forms together with the carotid-tympanic nerves tympanic plexus(plexus tympanicus). The tympanic plexus innervates the mucous membrane of the tympanic cavity and the auditory tube. The tympanic nerve leaves the tympanic cavity through its superior wall as lesser petrosal nerve(n. petrosus minor) and goes to the ear node. Preganglionic parasympathetic secretory fibers, which are part of the lesser petrosal nerve, are interrupted in the ear node, and postganglionic secretory fibers enter the auriculotemporal nerve and reach the parotid salivary gland in its composition.
2. Branch of the stylopharyngeal muscle(r. t. stylopharyngei) goes to the muscle of the same name and the mucous membrane of the pharynx.
3. Sinus branch (r. sinus carotid), sensitive, branches in the carotid glomus.
4. Almond branches(rr. tonsillares) are directed to the mucous membrane of the palatine tonsil and arches.
5. Pharyngeal branches (rr. pharyngei) (3-4 in number) approach the pharynx and, together with the pharyngeal branches of the vagus nerve and sympathetic trunk, form on the outer surface of the pharynx pharyngeal plexus(plexus pharyngealis). Branches extend from it to the muscles of the pharynx and to the mucous membrane, which, in turn, form intramural nerve plexuses.
6. Lingual branches (rr. linguales) - terminal branches of the glossopharyngeal nerve: contain sensitive taste fibers to the mucous membrane of the posterior third of the tongue.
Human anatomy S.S. Mikhailov, A.V. Chukbar, A.G. Tsybulkin
There are a huge number of diseases in modern neurology, and most of them are associated with inflammation or pinched nerves. This article will discuss the cranial nerve, which is called the glossopharyngeal nerve, its anatomy, functions, types of damage and treatment methods. However, first things first...
The glossopharyngeal nerve (GN) is cranial and is considered the IX pair. From an anatomical point of view, it does not have the most complex structure, but it is not the simplest either. So, the anatomy of the glossopharyngeal nerve:
The nerve contains motor, parasympathetic and sensory fibers. The YAN consists of three sections:
- Tympanic nerve.
- Lesser petrosal nerve.
- Tympanic plexus.
In addition, like any cranial nerve, it has several branches, including:
- pharyngeal branches (innervation of the pharynx occurs together with the branches of the same name);
- carotid branch (innervates the carotid glomus);
- branch of the stylopharyngeal muscle (innervates this muscle);
- branches of the tonsils (innervate the tonsils, respectively, are located near them, are considered the shortest branches);
- lingual branches (located in the posterior third of the tongue and are responsible for the taste and general sensitivity of the tongue).
The carotid glomus is an anatomical formation located near the carotid artery, which is designed to regulate blood pressure. Dysfunction of this formation can lead to health problems.
The nuclei of the glossopharyngeal nerve are located at the back of the tongue and include:
- Salivary nucleus (parasympathetic).
- Nucleus of the solitary tract (responsible for taste).
- Double nucleus (motor).
An interesting feature of the topography of the nerve nuclei is the fact that not only the nerve fibers originate in them, but also in other, no less important cranial nerves. For example, the accessory nerve (the accessory nerve innervates the muscles responsible for turning the head and the trapezius muscles) or the vagus (innervates a large number of internal organs).
Anatomy of a nerve
The nerve circuit is quite simple, but the same cannot be said about the functions.
The main function of the glossopharyngeal nerve is undoubtedly the determination of taste, however, it is not the only one, since it was previously indicated that the nerve contains both motor and parasympathetic fibers.
The motor function consists of innervation of the stylopharyngeal muscle, which raises and lowers the pharynx. As for parasympathetic function, these fibers contribute to the production of the salivary glands.
Also, a simple function includes the sensitivity of some areas inside the mouth (tonsils, palate, tympanic cavity, Eustachian tube).
Causes of neuralgia
Like any other, this nerve is predisposed to damage, and most of the reasons indicate the peripheral nature of the ailments (that is, not related to the central nervous system).
Main reasons
There are two subtypes of illnesses:
- Primary (hereditary predisposition, often an independent disease).
- Secondary (occurs as a result of a concomitant disease, does not develop independently).
Neuropathy or neuralgia of the glossopharyngeal nerve can occur under the influence of the following factors and diseases:
- atherosclerosis;
- ENT diseases (otitis, tonsillitis, sinusitis);
- infectious diseases (flu, acute respiratory infections);
- compression of the nerve at any stage of its passage (a tumor or wound may contribute to this);
- general intoxication of the body;
- vascular aneurysms;
- oncology in the larynx;
- pinched or damaged tonsils;
- vegetative-vascular dystonia.
In some cases, when the cause of the disease cannot be determined, the doctor makes a diagnosis of idiopathic neuralgia of the glossopharyngeal nerve. Treatment in such a situation is no different from usual.
Clinical manifestations
Glossopharyngeal neuralgia (neuritis) occurs more often in men over the age of 40 and has several characteristic symptoms, including:
- one-sided severe pain syndrome (paroxysm), which lasts up to three seconds (as a rule, the painful sensation begins to diverge from the root of the tongue, gradually moving to the tonsils, pharynx and ears);
- it is possible that the pain will radiate to the eyes, neck or lower jaw;
- dry mouth (this symptom is not permanent, but only at the time of the attack, and after the pain passes, strong salivation is observed. Depending on the human body, this condition may not manifest itself, if other secretory glands are working well, then the compression of the parotid gland will go unnoticed );
- problems with chewing or swallowing saliva (in most cases it goes unnoticed);
- loss of sensitivity to the position of the tongue in the mouth;
- loss of consciousness;
- tinnitus;
- dizziness;
- “flies” before the eyes;
- weakness in the body.
Autonomic symptoms are also present, including:
- Redness of the skin (on the neck and chin).
- The feeling of the presence of a foreign body in the throat (a rare manifestation), because of this sensation, the patient begins to be afraid to eat, as it seems to him that there is a foreign body in the throat. In this regard, mental disorders are possible.
A provoking factor for the development of internal pain syndrome can be:
- sudden movement of the head or tongue;
- irritation of the tongue from an excessively hot or cold drink;
- coughing;
- chewing food;
- conducting a conversation;
- yawn.
One of the hallmark symptoms of YAN is a change in taste. For example, the patient often begins to feel bitterness in the mouth.
The clinical picture mistakenly indicates to the doctor that the patient has cholecystitis and he refers him for a gastroenterological examination, instead of a neurological one.
Another symptomatic mistake can occur directly with the neurologist. Thus, the pain that is characteristic of glossopharyngeal neuralgia can easily be confused with idiopathic, and it is possible to distinguish these two diseases only with the use of instrumental diagnostics.
Diagnostics
Since the nerve can become inflamed, either for unclear reasons or due to the presence of a secondary disease, diagnostic options may differ slightly.
So, if we are talking about the primary type of illness, then the doctor carries out an external examination of the patient, asks him about his condition, where and what hurts, the intensity and nature of the pain. Thus, the doctor collects anamnesis (signs of illness). It is important not to make a mistake in making a diagnosis, so as not to prescribe the wrong treatment to the patient.
At the second stage, the doctor proceeds to palpation (the parotid region, the area where the tonsils are located) is felt and pays attention to the patient’s reaction to certain pressures, in order to thus differentiate the disease from another.
In the case when the illness is caused by a concomitant disease and there are signs of this disease, the doctor proceeds to instrumental diagnostic methods, which include:
- echoencephalography;
- electroencephalography;
- electroneuromyography;
- computed tomography;
- magnetic resonance imaging;
- consultation with other specialists (ENT doctor, dentist, ophthalmologist).
Ultrasound of the larynx
The nervous nature of the disease can arise as a result of inflammation of other nerves, or the formation of other diseases, so the disease has common symptoms with such ailments as:
- neuralgia of the ear canal;
- Oppenheim syndrome;
- occipital abscess;
- tumor of the ear canal.
Treatment
Glossopharyngeal neuralgia is treated in several ways, including:
- Medication.
- Surgical.
Additionally, it is possible to use traditional medicine recipes. However, home treatment methods should not be used instead of drugs prescribed by the doctor, but together with them, in this case the therapeutic effect will be higher.
During the recovery period, it is possible to use physiotherapeutic procedures. It is also possible to use physiotherapy in conjunction with drug therapy. 
Conservative treatment
Treating a patient with pills is not always bad, since conservative treatment causes less harm to the body, despite the fact that it takes longer. As a rule, a patient with glossopharyngeal neuralgia is prescribed:
- painkillers (the most important drug in therapy, since acute pain can drive you crazy. To eliminate pain, the patient is shown a 10% solution of cocaine, which is rubbed into the root, and if this does not help, novocaine 1–2% is injected under the root of the tongue. In addition In addition, they may additionally prescribe non-narcotic painkillers that are taken orally);
- sedatives, hypnotics, antidepressants and antipsychotics (prescribed for severe pain);
- anticonvulsants (carbamazepine, phenytoin);
- immunostimulating medications (the body absolutely needs support);
- vitamin complexes (traditionally, B vitamins are necessary for the nervous system, and a multivitamin complex, iron, etc. would also be useful).
As for physiotherapy, the following procedures have a good effect:
- diadynamic therapy (treatment with pulsed current 50–100 Hz);
- SMT therapy for the larynx and tonsils (modulated alternating current therapy);
- galvanization (exposure to direct current 50 mA);
- electrophoresis.
Surgical intervention
The main condition for surgical intervention is the lack of effect from conservative treatment. Inflammation of the glossopharyngeal nerve can take quite a long time to be treated, but after some time it will become clear to the doctor whether there are positive results or not.
There is only one correct operation - resection of the hypertrophied styloid process or removal of tissue that has grown over the nerve and thereby compressed it. This type of surgery is performed under general anesthesia.
As for the treatment of neuralgia in a child, there are no special differences, with the exception of a reduced dosage of medications and the exclusion of some drugs from the course.
ethnoscience
As you know, the best remedy for treating any disease (in fact, not all) is home medicine. In the case of inflammation of the lingual nerve, this rule applies. Below are several recipes that can be used in parallel with the main treatment, after consulting with your doctor.
Willow bark decoction
10 g of bark is boiled for 20 minutes, then cooled and taken up to five times a day, one tablespoon
Rare ointment
As you know, radish horseradish is not sweeter, so any vegetable will do for rubbing into the affected area. It is necessary to grate any of the vegetables on a fine grater and simply rub it into the place where the problem is felt.
Valerian tincture
1 tablespoon of valerian root (can be replaced with rue) is infused in boiled hot water for at least 30 minutes. You need to take the tincture once a day, one glass.
Salt compress
Dissolve two tablespoons of salt in warm water and from the resulting solution you can make salt compresses on the site of pain.
Prevention
What can cause the disease? Concomitant diseases. Accordingly, the best means of prevention is to harden the body and prevent infection from entering the body.
In addition, our physiology really loves it when the body is comfortable, but it is worth remembering that not every comfort will be beneficial. For example, walking in the fresh air in clothes that are out of season can lead to illness, which will subsequently result in neuralgia. And the recovery will be quite painful. Therefore, it is better to prevent than to prevent.
A healthy lifestyle, proper nutrition and giving up bad habits, no matter how trivial it may sound, are the best friends of a healthy person.
In addition, the phenomenon of toothache and diseases associated with teeth is not the best companion for the glossopharyngeal nerve; treat your teeth in a timely manner. The infection can appear in the teeth, but be much deeper. 
It is also better to ward off any diseases associated with the throat from a person, for the same reason as with teeth. Throat damage is even more dangerous, since it is located even closer to the lingual nerve.
So, glossopharyngeal neuralgia is a serious disease that can develop in any person, regardless of sex or gender. If the first signs appear, do not delay your visit (although the nature of the pain is unlikely to allow you to do this). Take care of yourself and your nerves, don’t get sick!
Glossopharyngeal nerve (nervus glossopharyngeus) - IX pair of cranial nerves. It is a mixed nerve: it contains sensory, motor and parasympathetic fibers (Fig.). Sensitive fibers of the glossopharyngeal nerve originate from two nodes: the superior (ganglion superius), located in the upper part of the jugular foramen, and the inferior (ganglion inferius), lying in the stony fossa on the lower surface of the pyramid of the temporal bone.
Topography n. glossopharyngeus:
1 - n. hypoglossus;
2 - n. lingualis;
3 - n. glossopharyngeus;
4 - chorda tympani;
5 - n. facialis.
Afferent fibers of taste sensitivity begin in the cells of the inferior ganglion. Their peripheral branches are directed to the taste buds of the posterior third of the tongue; The central branches (axons of ganglion cells) as part of the root of the glossopharyngeal nerve enter the medulla oblongata, where they run in the solitary fasciculus (tractus solitarius) and end in its nuclei.
Afferent fibers related to general sensitivity begin in the cells of both nodes. The peripheral processes of the cells of these nodes branch in the posterior third of the tongue, in the tonsil, on the upper surface of the epiglottis, in the pharynx, in the auditory tube, in the tympanic cavity, and also give a branch to the carotid sinus (r. sinus carotici). The axons of these cells go to the medulla oblongata and, together with the gustatory cells, enter the solitary fasciculus. The motor nucleus of the glossopharyngeal nerve is the anterior sections of the double nucleus (nucleus ambiguus). The glossopharyngeal nerve, together with the vagus nerve, exits through the jugular foramen from the skull, then goes between the internal jugular vein and the internal carotid artery, then between the two carotid arteries along the stylopharyngeal muscle and, bending anteriorly and upward, approaches the tongue and here it is divided into terminal branches (rr linguales). Motor branches take part in the innervation of the muscles of the pharynx (ramus m. stylopharyngei). In addition to motor and sensory fibers, the glossopharyngeal nerve contains parasympathetic secretory fibers for the parotid gland. The inferior salivatory nucleus (nucleus salivatorius inferior) lies in the medulla oblongata. Fibers from the nucleus go to the glossopharyngeal nerve, then enter the tympanic nerve (n. tympanicus) and, as part of the small petrosal nerve (n. petrosus minor), go to the ear node (ganglion oticum), and then from this node go to the parotid gland.
Diseases of the glossopharyngeal nerve can be caused by various processes in the posterior cranial fossa (meningitis, neoplasms, hemorrhage, and intoxication). Damage to the glossopharyngeal nerve manifests itself in a taste disorder in the posterior third of the tongue, in impaired sensitivity of the upper half of the larynx, in some swallowing disorder due to partial paralysis of the muscles of the pharynx, in the extinction of reflexes from the mucous membrane of the pharynx.
There are 12 pairs of cranial nerve tracts that arise from the brain stem. Due to them, a person can use facial expressions, see, smell, etc. The glossopharyngeal nerve is number XI, and it is responsible for taste perception, sensitivity and motor innervation of the pharynx, oral cavity and ear apparatus.
Neuralgia of the glossopharyngeal nerve (glossopharyngeal) manifests itself in the form of pain in the pharynx. Unlike neuritis, as the pathological process develops, sensory disturbances and motor failures do not occur. The nature of the pain is paroxysmal, and predominantly men over 40 years of age suffer from this disease.
Glossopharyngeal neuralgia has many causes and they are all divided into 2 types:
- Primary form (idiopathy). This form of the disease appears independently and the main factor influencing the development of the pathology is hereditary predisposition;
- Secondary. It is a consequence of other diseases or pathological processes in the brain. Sometimes secondary neuralgia of the glossopharyngeal nerve occurs against the background of the appearance of a formation in the larynx.
The glossopharyngeal nerve is damaged mainly due to the following factors:
- Pinching of the tonsils by muscle tissue;
- Development of atherosclerosis;
- General intoxication of the body;
- Damage to the tonsils;
- Diseases of the ENT organs;
- Aneurysms (protrusion of the vessel wall);
- Abnormally large size of the spinous process;
- The appearance of calcifications (sand) in the area of the stylohyoid plexus;
- Development of cancer in the larynx area.
Symptoms
The damaged nerve usually manifests itself as neuralgic symptoms. The most obvious sign is paroxysmal pain, which manifests itself in the form of short but very sharp impulses. It can be triggered by yawning, swallowing, and even simply opening the mouth, making it difficult for patients to say or eat anything.
Palpation of the tonsils, pharynx, or back of the tongue can also cause pain. Sometimes they radiate to the ear, palate, neck and jaw.
For this reason, idiopathic trigeminal neuralgia (trigeminal) is so similar to inflammation of the glossopharyngeal nerve tract. They can only be distinguished using instrumental examination methods.
Another equally important symptom of glossopharyngeal neuralgia is a distorted perception of taste. The patient may feel a constant bitterness in the mouth and this symptom is often confused with the manifestation of cholecystitis. That is why a person is often referred primarily to a gastroenterologist, and only after an examination the real cause of the problem is revealed.
This disease is characterized by impaired salivation. During an attack, the patient feels dryness in the mouth, but after it, saliva synthesis becomes significantly higher than normal.
Among the autonomic symptoms characteristic of neuralgia of the glossopharyngeal nerve, redness of the skin can be identified.
The innervated area of the glossopharyngeal nerve is extensive, so the patient may feel a general deterioration in the condition:
- Low pressure;
- Tinnitus;
- Loss of consciousness;
- General weakness;
- Dizziness.
Diagnostics
A neurologist can recognize glossopharyngeal neuralgia, but diagnosing the presence of pathology will not be so easy, because some symptoms are similar to the manifestations of other diseases. Initially, the doctor will interview and examine the patient, and then, to accurately differentiate the diagnosis, prescribe instrumental examination methods:
- Radiography. It is used to determine the size of the styloid process;
- Tomography (computer and magnetic resonance imaging). It is used to identify pathologies in the brain;
- Electroneuromyography. This research method is used to determine the degree of nerve damage;
- Ultrasonography. It is carried out to identify vascular pathologies.
It takes 1-2 days to complete all the studies, but after them the doctor will be able to accurately diagnose, name the cause of the pathology and draw up a treatment plan.
Course of therapy
Treatment should be aimed at eliminating the cause of the pathology, for example, in case of an aneurysm or tumor, surgery is performed. After eliminating the main factor provoking the development of the disease, the inflammation gradually eliminates itself. To speed up the recovery process, it is recommended to follow the rules of prevention:
- Strengthen the immune system. To do this, you need to take vitamin complexes and eat right. It is also advisable to cure chronic inflammatory processes in the body;
- Do not overcool the body. This rule especially applies to periods of outbreaks of epidemics, for example, influenza, since you need to protect yourself from possible diseases;
- Follow a diet. During treatment, it is recommended not to overuse spices and eat food at room temperature;
- Control metabolic processes in the body. This cannot be done directly, but you can take tests for cholesterol levels in the blood once every six months to prevent the development of atherosclerosis.
Symptomatic therapy is no less important, since it is necessary to eliminate acute pain attacks that bother the patient. For this purpose, Dicaine is usually injected into the root of the tongue. In severe cases, treatment is supplemented with other analgesics and applications. B vitamins, anticonvulsants and antidepressants can speed up the relief of pain.
Physiotherapeutic procedures are used to complement the main course of treatment. Galvanization is usually used, that is, treatment with current (diadynamic and sinusoidal).
If the usual methods of eliminating a pain attack do not help, the doctor will recommend surgery. This radical method is used in difficult situations when a person cannot eat or speak. The surgical intervention is performed primarily on the outside of the skull and its purpose is to eliminate the factor that irritates the nerve. After the procedure, there is a long recovery period, but pain in most cases is completely eliminated.
Damage to the glossopharyngeal nerve leads to acute attacks of pain that can threaten the patient's life. To eliminate the pathological process, you will have to be completely examined to find its cause and eliminate it. While undergoing a course of therapy, it is advisable to follow the rules of prevention to speed up recovery and prevent relapses.