Overview
The Vagus
nerve consists of sensory and motor fibers and supplies parasympathetic
innervation to the thoracic and abdominal viscera as far distally as the
splenic flexure. Peristalsis of the oesophagus, and bowels is in part
coordinated by the vagus nerves, as is phonation and the efferent limb of the
gag reflex.
Gross Anatomy
The word
vagus comes from the Latin word for wanderer. This name is apt, as the 10th
cranial nerve provides parasympathetic innervation to all of the viscera as far
as the splenic flexure of the colon. The vagus nerve is also known as cranial
nerve 10. It arises from the brainstem, the medulla to be precise, below the
glossopharyngeal nerve. It emerges lateral to the olive (an ovaloid structure
responsible for pathways of motor learning and hearing) and above the inferior
cerebellar peduncle. The nerve leaves the skull through the jugular foramen,
along with cranial nerves 9 and 11. It is responsible for coordinating
peristalsis along with the enteric nervous system, and also enables us to
speak, and is the efferent limb of the gag reflex. The vagus nerve has numerous
branches that provide motor sensory and taste innervation.
The
nucleus ambiguus gives rise to the pharyngeal branches, as well as the inferior
and superior laryngeal nerves. The pharyngeal branch consists mainly of the
cranial accessory nerve fibers, and gives off notable branches such as the
recurrent laryngeal nerve (innervates the muscles of the larynx), and the
superior laryngeal nerve (external branch supplies the cricothyroid muscle,
internal branch supplies the laryngeal mucosa).
These
nerves coordinate phonation and swallowing by innervating the muscles of the
pharynx. The dorsal motor nucleus of the vagus nerve supplies parasympathetic
innervation to the heart, lungs, oesophagus, stomach, muscles and glands of the
digestive tract. The superior and inferior cervical cardiac and thoracic
cardiac branches achieve cardiac innervation. The vagus nerve also gives
branches to the pulmonary plexus and oesophageal plexus, which supply their
respective reasons. The anterior and posterior vagal trunk run in front and
behind the lesser curvature of the stomach. The Hering-Breur reflex is also
mediated by the vagus nerve and is triggered to prevent over inflation of the
alveoli during inspiration. The nucleus spinal tract synapses with the superior
vagal ganglion, and gives rise to the auricular branch, which supplies
sensation to the external ear, tympanic membrane and meatus. Finally the nucleus
tractus solitarius, which synapses with the inferior ganglion, and gives rise
to visceral sensing e.g. the carotid and aortic bodies, as well as the cervical,
thoracic and abdominal fibers of the nerve. It also has branches, which
provides taste sensation to the epiglottis and taste buds.
Clinical Anatomy
Vagus nerve Stimulation- This
is a procedure that involves the implantation of an electronic device in the
chest that stimulates the left vagus nerve (the right is not stimulated as it
innervates the heart). This technique is used to treat epilepsy and treatment
resistant depression.
Superior laryngeal nerve palsy- This
results from damage to the superior laryngeal nerve. The external branch
supplies the cricothyroid, which becomes denervated and the pitch of the voice
cannot be changed.
Gag reflex- The
vagus nerve provides the afferent (motor) limb of the gag reflex. Dysfunction
of the nerve therefore leads to a weak or bovine cough.
Aortic sinus baroreceptors- Signals
from the baroreceptors (pressure sensitive stretch receptors) in the arch of
the aorta travel via the vagus nerve. They travel up the nerve and ultimately
terminate in the nucleus tractus solitarius
Quick Anatomy
Key Facts
Developmental precursor- Myelencephalon (secondary vesicle)
Branches-
Auricular nerve, superior laryngeal nerve, recurrent laryngeal nerve,
pharyngeal nerve, superior and inferior cervical cardiac branches, thoracic
cardiac branches, recurrent laryngeal nerve, pulmonary plexus branches,
oesophageal plexus branches, anterior and posterior vagal trunks.
Aide-Memoire
Vagus means wanderer, and the nerve wanders as far down as
the splenic flexure of the colon to supply parasympathetic innervation
Recall the nagus nerve is the efferent limb of the gag
reflex
Recall the vagus neve is the nerve of phonation, va its
recurrent and seuperior laryngeal branches
Summary
The Vagus
nerve is the 10th cranial nerve. It consists of sensory and motor
fibers and supplies parasympathetic innervation to the thoracic and abdominal
viscera as far distally as the splenic flexure.