Tympanic nerve. Treatment of glossopharyngeal neuralgia, signs and symptoms of the disease. Anatomy and function of the nerve

The glossopharyngeal nerve is mixed. It contains motor and sensory fibers for the pharynx and middle ear, as well as gustatory fibers and autonomic parasympathetic fibers.

Motor pathway IX pairs two-neuron. Central neurons are located in lower sections front central gyrus, their axons as part of the corticonuclear pathway approach the double nucleus (n. ambiguus) of their own and the opposite side, common with the X pair, where the peripheral neuron is located. Its axons, as part of the glossopharyngeal nerve, innervate the stylopharyngeal muscle, which elevates the upper part of the pharynx during swallowing.

Sensitive part The nerve is divided into general and gustatory. Sensory pathways consist of three neurons. The first neurons are located in the cells of the superior node, located in the region of the jugular foramen. The dendrites of these cells are directed to the periphery, where they innervate the posterior third of the tongue, soft palate, pharynx, pharynx, anterior surface of the epiglottis, auditory tube and tympanic cavity. The axons of the first neuron end in the nucleus of the gray wing (n. alae cinereae), where the second neuron is located. The core is common with the X pair. The third neurons for all types of sensitivity are located in the nuclei of the thalamus, the axons of which, passing through the internal capsule, go to the lower part of the posterior central gyrus.

Taste sensitivity. The taste sensitivity pathways are also three-neuron. The first neurons are located in the cells of the inferior ganglion, whose dendrites provide taste to the posterior third of the tongue. The second neuron is located in the nucleus of the solitary tract in the medulla oblongata, common with facial nerve, both their own and the opposite side. Third neurons are located in the ventral and medial nuclei of the thalamus. The axons of the third neurons end in the cortical sections of the taste analyzer: mediobasal sections temporal lobe(insula, hippocampal gyrus).

Parasympathetic autonomic fibers begin in the lower salivary nuclei (n. salivatorius inferior), located in the medulla oblongata and receiving central innervation from the anterior parts of the hypothalamus. Preganglionic fibers first follow as part of the glossopharyngeal nerve, pass through the jugular foramen and then enter the tympanic nerve, forming the tympanic plexus in the tympanic cavity, exit the tympanic cavity under the name of the small petrosal nerve (n. petrosus superficialis minor) and enter the ear node, where and end. Postganglionic salivary fibers of the cells of the auricular ganglion join the auriculotemporal nerve and innervate the parotid salivary gland.

Research methodology

The study of the function of the glossopharyngeal nerve is carried out in conjunction with the study of the function vagus nerve(see below).

Symptoms of the lesion

There may be a taste disorder in the posterior third of the tongue (hypogeusia or ageusia), decreased sensitivity in the upper half of the pharynx, and decreased pharyngeal and palatal reflexes on the affected side.

Irritation of the glossopharyngeal nerve is manifested by pain in the root of the tongue, tonsil, radiating to the throat, velum, soft palate, ear (occurs with neuralgia of the glossopharyngeal nerve).

X pair - vagus nerve (n. vagus)

The vagus nerve is mixed, containing motor, sensory and autonomic fibers.

Engine part The vagus nerve consists of two neurons. The central neurons are located in the lower parts of the anterior central gyrus, the axons of which go to the double nucleus of both sides, common with the glossopharyngeal nerve. Peripheral motor fibers in the vagus nerve exit through the jugular foramen and then are directed to the striated muscles of the pharynx, soft palate, uvula, larynx, epiglottis and upper esophagus.

Sensitive part The vagus nerve system, like all sensory pathways, consists of three neurons. The first neurons of general sensitivity are located in two nodes: in the upper node, located in the jugular foramen, and the lower node, located after the seal exits the jugular foramen. The dendrites of these cells form the peripheral sensory fibers of the vagus nerve. The first branch to form is to the dura mater of the posterior cranial fossa.

Fibers from top node innervate the skin of the posterior wall of the external auditory canal, and also anastomose with the posterior auricular nerve (branch of the facial nerve). The dendrites of the cells of the lower node, connecting with the branches of the glossopharyngeal nerve, form the pharyngeal plexus, from which branches extend to the mucous membrane of the pharynx.

Fibers from bottom node They also form the superior laryngeal and recurrent laryngeal nerves, innervating the larynx, epiglottis and partly the root of the tongue. Fibers are also formed from the lower node, providing general sensitivity to the trachea and internal organs.

The axons of the cells of the upper and lower nodes enter the cranial cavity through the jugular foramen, penetrate into the medulla oblongata into the nucleus of general sensitivity (nucleus of the gray wing), common with the IX pair (second neuron). The axons of the second neuron are directed to the thalamus (third neuron), the axons of the third neuron end in the cortical sensitive area - the lower parts of the postcentral gyrus.

Vegetative parasympathetic fibers start from the posterior nucleus of the vagus nerve (n. dorsalis n. vagi) and innervate the heart muscle, smooth muscles of internal organs, interrupting in the intramural ganglia and, to a lesser extent, in the cells of the plexus of the thoracic and abdominal cavities. The central connections of the posterior nucleus of the vagus nerve come from the anterior nuclei of the hypothalamic region. The function of the parasympathetic fibers of the vagus nerve is manifested in a slowdown in cardiac activity, narrowing of the bronchi, and increased activity of the gastrointestinal tract.

Research methodology

IX - X pairs are studied simultaneously. The patient's voice, the purity of pronunciation of sounds, the condition of the soft palate, swallowing, the pharyngeal reflex and the soft palate reflex are examined. It should be borne in mind that a bilateral decrease in the pharyngeal reflex and the soft palate reflex can also occur normally. Their decrease or absence on one side is an indicator of damage to the IX - X cranial nerves. The swallowing function is checked by swallowing water, the taste on the back third of the tongue is examined for bitter and salty (function of the IX pair). To study the function vocal cords laryngoscopy is performed. The pulse, breathing, and activity of the gastrointestinal tract are checked.

Symptoms of the lesion

When the vagus nerve is damaged due to paralysis of the muscles of the pharynx and esophagus, swallowing is impaired (dysphagia), which is manifested by choking while eating and the entry of liquid food into the nose through the nasal part of the pharynx as a result of paralysis of the palatine muscles. The examination reveals a write-off of the soft palate on the affected side. The pharyngeal reflex and the reflex from the soft palate decrease, the uvula deviates to the healthy side.

With unilateral damage to the medulla oblongata in the region of the nuclei of the IX and X cranial nerves, alternating syndromes:

- Wallenberg - Zakharchenko - on the affected side there is paralysis (paresis) of the soft palate and vocal cord, a sensitivity disorder in the pharynx, larynx and on the face of a segmental type, Bernard-Horner syndrome, nystagmus, ataxia, on the opposite side - hemianesthesia, less often hemiplegia. For large lesions involving the surrounding cranial nerves reticular formation, along with this, respiratory and cardiovascular disorders are observed;

- Avellisa - on the affected side - peripheral paralysis of the IX and X nerves, on the opposite side - hemiplegia or hemiparesis.

Symptoms of damage to the vagus nerve include respiratory, gastrointestinal and, more often, cardiac problems:

Tachycardia is detected when its functions are lost and, conversely, bradycardia is detected when it is irritated. With unilateral lesions, the described symptoms may be mild.

Bilateral damage to the vagus nerve leads to severe disturbances in breathing, cardiac activity, swallowing, and phonation. When the sensory branches of the vagus nerve are involved, a disorder of the sensitivity of the mucous membrane of the larynx, pain in it and the ear occurs. Complete bilateral damage to the vagus nerves leads to cardiac and respiratory arrest.

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 oncological diseases in the area of the larynx.

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.

Call painful sensations Palpation of the tonsils, pharynx, or back of the tongue is also possible. Sometimes they radiate to the ear, palate, neck and jaw.

For this reason, idiopathic neuralgia trigeminal nerve(trigeminal) is so similar to inflammation of the glossopharyngeal neural pathway. They can only be distinguished using instrumental examination methods.

Other no less important symptom Glossopharyngeal neuralgia is a distorted perception of taste. The patient can feel constant bitterness in the mouth and this sign 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. Typically this manifestation is observed in the neck and jaw area. In more rare cases, patients complain of a feeling foreign body in the throat area. Against this background, difficulties in swallowing, coughing and neuroses develop. Because of such discomfort, a person often refuses to eat, which leads to exhaustion.

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 methods examinations:

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 organism;
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 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.

GLOSPHARYNGEAL NERVE - paired (IX pair), mixed cranial nerve. Sensitive fibers of the glossopharyngeal nerve innervate the mucous membrane of the posterior third of the tongue, including taste buds, mucous membrane of the pharynx, tympanic cavity, Eustachian (auditory) tube, cells mastoid process, palatine tonsils and palatine arches, carotid sinus and carotid glomus; motor fibers - the stylopharyngeal muscle and, through the pharyngeal plexus, together with the vagus nerve, the constrictors of the pharynx and the muscles of the soft palate; autonomic parasympathetic secretory fibers - parotid gland.

The glossopharyngeal nerve has three nuclei located in the medulla oblongata (see). The sensitive nucleus is the nucleus of the solitary tract (nucl. tractus solitarii), common with the vagus and facial nerves, located in the area medulla oblongata. The axons of afferent neurons of the superior and inferior ganglia of the nerve (gangl. superius et inferius) approach the cells of this nucleus; their peripheral processes have receptors in the mucous membrane of the pharynx, palatine tonsils, palatine arches, in the mucous membrane of the posterior third of the tongue, tympanic cavity, eustachian tube, mastoid cells, in the carotid (carotid, T.) sinus and carotid (carotid, T.) glomus. The superior node of the glossopharyngeal nerve is located in the region of the jugular foramen (foramen jugulare), the lower node is in the stony fossa (fossula petrosa) on bottom surface pyramids of the temporal bone.

The motor nucleus is the double nucleus (nucl. ambiguus), also common with the vagus nerve, located in the region of the reticular formation (see) of the medulla oblongata. Neurons of the motor nucleus innervate the stylopharyngeus muscle and pharyngeal constrictors.

The vegetative nucleus - the lower salivary nucleus (nucl. salivatorius inferior) consists of cells scattered in the reticular formation. Its secretory, parasympathetic fibers go to the ear node, and after switching in it - to parotid gland(cm.).

The root of the glossopharyngeal nerve is formed as a result of the fusion of all three types of fibers and appears at the base of the brain in the region of the posterior lateral sulcus of the medulla oblongata behind the olive and exits the cranial cavity through the jugular foramen along with the vagus nerve (see) and the accessory nerve (see). In the neck, the nerve goes down between the inner jugular vein and the internal carotid artery, bends around the stylopharyngeal muscle from behind, turns anteriorly, forming a gentle arc, and approaches the root of the tongue, where it is divided into terminal lingual branches (rr. linguales), containing sensory fibers going to the mucous membrane of the posterior third of the tongue, including taste, innervating the circumvallate papillae (Fig. 1).

The lateral branches of the glossopharyngeal nerve are: the tympanic nerve (n. tympanicus), which contains sensory and parasympathetic fibers. It originates from the cells of the lower node (Fig. 2) and penetrates the tympanic cavity through the tympanic tubule (canaliculus tympanicus), forming on it medial wall together with the carotid-tympanic nerves (nn. caroticotympanici) of the internal carotid plexus, the tympanic plexus (plexus tympanicus). Sensitive branches extend from this plexus to the mucous membrane of the tympanic cavity, eustachian tube and cells of the mastoid process, and preganglionic parasympathetic fibers form the lesser petrosal nerve (n. petrosus minor), which leaves the tympanic cavity through the cleft of the canal of this nerve and through the stony-squamous fissure (fissura petrosquamosa) reaches the ear node (gangl. oticum). After switching in the node, parasympathetic post-ganglionic fibers approach the parotid gland as part of the auriculotemporal nerve (n. auriculotemporalis), which is a branch of the mandibular nerve (n. mandibular is, the third branch of the trigeminal nerve). In addition to the tympanic nerve, the lateral branches of the glossopharyngeal nerve are the branch of the stylopharyngeal muscle (ramus m. stylopharyngei), which innervates the muscle of the same name; tonsil branches (rr. tonsillares), going to the mucous membrane of the palatine tonsils and palatine arches; pharyngeal branches (rr. pharyngei), going to the pharyngeal plexus; sinus branch (r. sinus carotici) - sensory nerve of the sinocarotid reflexogenic zone; connecting branches (rr. communicantes) with the auricular and meningeal branches of the vagus nerve and with the chorda tympanum of the intermediate nerve, which is part of the facial nerve (see).

Pathology includes sensory, autonomic and motor disorders. With neuritis (neuropathy) of the glossopharyngeal nerve, symptoms of prolapse develop: anesthesia of the mucous membrane of the upper half of the pharynx, unilateral taste disorder (ageusia) on the posterior third of the tongue (see Taste), reduction or cessation of salivation by the parotid gland; on the affected side there may be difficulty swallowing (see Dysphagia). The reflex from the mucous membrane of the pharynx on the affected side fades away. Dry mouth is usually insignificant due to the compensatory activity of other salivary glands, paresis of the pharyngeal muscles may be absent, since they are innervated mainly by the vagus nerve. With bilateral damage to the glossopharyngeal nerve movement disorders may be one of the manifestations of bulbar palsy (see), which occurs with combined damage to the nuclei, roots or trunks of the glossopharyngeal, vagus and hypoglossal cranial nerves (IX, X, XII pairs). With bilateral damage to the corticonuclear pathways running from the cerebral cortex to the nuclei of these nerves, manifestations of pseudobulbar palsy occur (see). Isolated lesions of the glossopharyngeal nerve nuclei, as a rule, do not occur. Usually they occur together with damage to other nuclei of the medulla oblongata and its pathways and are included in the clinical picture of alternating syndromes (see).

When the glossopharyngeal nerve is irritated, a spasm of the pharyngeal muscles develops - pharyngospasm. It can occur with inflammatory or tumor diseases of the pharynx, esophagus, hysteria, neurasthenia, etc.

Symptoms of irritation of the glossopharyngeal nerve include neuralgia of the glossopharyngeal nerve (see Sicara syndrome). There are two forms of neuralgia of the glossopharyngeal nerve: neuralgia of predominantly central (idiopathic) and predominantly peripheral origin. In the development of neuralgia of the glossopharyngeal nerve, predominantly central genesis Metabolic disorders, atherosclerotic changes in cerebral vessels, and also chronic tonsillitis, sore throat, flu, allergies, intoxication (for example, tetraethyl lead poisoning), etc. Neuralgia of the glossopharyngeal nerve of predominantly peripheral origin occurs when the glossopharyngeal nerve is irritated at the level of its first neuron, for example, due to injury to the bed of the palatine tonsil by the elongated styloid process, ossification of the stylohyoid ligament, and also for tumors in the area cerebellopontine angle(see), carotid artery aneurysm, laryngeal cancer.

Neuralgia of the glossopharyngeal nerve is manifested by attacks of unilateral pain that occur when swallowing (especially excessively hot or cold food), rapid speech, intensive chewing or yawning. The pain is localized in the area of the root of the tongue or the palatine tonsil, spreads to the velum, pharynx, ear, and sometimes radiates to the angle of the lower jaw, eye, and neck. The attack can last 1-3 minutes. Patients develop a fear of repeat attacks when eating, and develop speech disorders (unarticulated speech) as a manifestation of “sparing.” Sometimes dry paroxysmal cough. Before an attack of pain, there is often a feeling of numbness in the palate and short-term increased salivation, sometimes a painful sensation of deafness. Attacks of pain may be accompanied by syncope with bradycardia and a drop in systemic blood pressure. The development of these conditions is due to the fact that the glossopharyngeal nerve innervates the carotid sinus and carotid glomus.

A special form of neuralgia of the glossopharyngeal nerve is neuralgia of the tympanic nerve (tympanic plexus syndrome, painful tic of the tympanic or Jacobson nerve, Reichert's syndrome), first described by F. L. Reichert in 1933. This form of neuralgia of the glossopharyngeal nerve is manifested by attacks of shooting pain in the area of the external ear canal, sometimes accompanied unilateral pain in the face and behind the ear. Precursors of an attack may be discomfort in the area of the external auditory canal, occurring mainly when talking on the phone (the “handset” phenomenon). There is pain on palpation of the external auditory canal.

The diagnosis of neuralgia of the glossopharyngeal nerve is established on the basis of characteristic complaints and data from the wedge and examination. Palpation reveals tenderness of the angle of the lower jaw and certain areas of the external auditory canal, decreased pharyngeal reflex, weakened mobility of the soft palate, hypergeusia (increased taste sensations) to bitter on the back third of the tongue. With a prolonged course of neuralgia, symptoms of prolapse may occur, characteristic of neuritis of the glossopharyngeal nerve. In this case, the pain becomes constant (especially in the root of the tongue, pharynx, upper pharynx and ear), and periodically intensifies. During the examination, hypoesthesia and taste disturbance are noted in the posterior third of the tongue, hypoesthesia in the area of the palatine tonsil, velum and the upper part of the pharynx, decreased salivation on the side of the lesion of the glossopharyngeal nerve.

Neuralgia of the glossopharyngeal nerve should be differentiated from trigeminal neuralgia (see), however, the latter has a fairly clear clinical picture.

Treatment is usually conservative, but in some cases surgical intervention is resorted to (see below). To relieve a painful attack, the root of the tongue and pharynx are lubricated with a 5% solution of cocaine; prescribe injections of 1-2% novocaine solution into the root of the tongue, non-narcotic analgesics, synthetic derivatives salicylic acid, pyrazolone, etc. To treat the underlying disease, anti-inflammatory drugs, antipsychotics, and restoratives are used. Diadynamic or sinusoidal modulated currents to the parotid-masticatory region, tonsils, and larynx are effective. If there is no effect from conservative treatment and in case of enlargement of the styloid process, surgical intervention is resorted to.

Surgical treatment is carried out mainly for neuralgia of the glossopharyngeal nerve, predominantly of central origin, or in cases of involvement of the nerve trunk in the process with inoperable tumors of the pharynx, tonsils, and tumors of the base of the skull. Three types of operations are performed: extracranial transection of the glossopharyngeal nerve, intracranial transection of the branches of the glossopharyngeal nerve and bulbar tractotomy (see). Transection of the glossopharyngeal nerve in the neck is rarely performed due to the risk of damage to adjacent cranial nerves and vessels and the inability to access the nerve in case of locally advanced tumors of the nasopharynx and tumors of the base of the skull. Intracranial transection of the branches of the glossopharyngeal nerve is carried out at the site of their exit from the medulla oblongata or in the area of the internal jugular foramen. Tractotomy is performed at the level of the medulla oblongata, at the site of the spinal tract of the trigeminal nerve (see), which includes fibers and the glossopharyngeal nerve. In contrast to tractotomy for trigeminal neuralgia, the site of dissection of the descending tract is medial to the projection of the trigeminal nerve root and lateral to Burdach’s bundle. The location of the intended cut of the conductors is determined by the patient’s reaction to mechanical irritation of the sensitive conductor. After extracranial or intracranial transection of the glossopharyngeal nerve, sensory disturbances occur in the area of its innervation. After tractotomy, in patients with advanced tumors and in cases of neuralgia of the glossopharyngeal nerve of predominant central origin, pain usually disappears. At the same time, tachycardia disappears, the area of sensitivity disturbances outside the zone of innervation of the glossopharyngeal nerve is reduced. Complications during surgical interventions are rare; paralysis of the soft palate and pharyngeal muscles is possible. According to some researchers, tractotomy is a more physiological treatment method than cutting the fibers of the glossopharyngeal nerve.

The prognosis for neuralgia of the glossopharyngeal nerve is generally favorable. However, both with neuralgia and especially with neuritis, long-term persistent adequate treatment is required.

Bibliography: Gabibov G. A. and Labutin V. V. On the issue surgical treatment neuralgia of the glossopharyngeal nerve, Question* neurosurgeon., c. 3, p. 15, 1971; Guba G. P. Handbook of neurological semiology, p. 36, 287, Kyiv, 1983; K r o-lM. B. and FedorovaE. A. Basic neuropathological syndromes, p. 135, M., 1966; Kunz 3. Treatment of essential neuralgia of the glossopharyngeal nerve with bulbospinal tractotomy, Vopr. neurosurgeon, c. 6, p. 7, 1959; Pulatov A. M. and N i k i f o r o v A. S. Handbook on the semiotics of nervous diseases, Tashkent, 1983; Sinelnikov R.D. Atlas of human anatomy, vol. 3, p. 154, M", 1981; Triumphov A.V. Topical diagnosis of diseases nervous system, L., 1974; Clara M. Das Nervensys-tem des Menschen, Lpz., 1959; The cranial nerves, ed. by M. Samii a. P. J. Jannetta,B.-N. Y., 1981; Handbook of clinical neurology, ed. by P. J. Vinken a. G.W< Bruyn, v. 2, Amsterdam - N. Y., 1975; White I. C. a. S w e e t W. H. Pain. Its mechanisms and neurosurgical control, Springfield, 1955.

V. B. Grechko; V. S. Mikhailovsky (hir.), F. V. Sudzilovsky (an.).

Unilateral lesion IX cranial nerve, manifested by paroxysms of pain in the root of the tongue, tonsils, pharynx, soft palate and ear. Accompanied by impaired taste perception of the posterior 1/3 of the tongue on the affected side, impaired salivation, decreased pharyngeal and palatal reflexes. Diagnosis of pathology includes examination by a neurologist, otolaryngologist and dentist, an MRI or CT scan of the brain. Treatment is mainly conservative, consisting of analgesics, anticonvulsants, sedative and hypnotic medications, vitamins and restoratives, physiotherapeutic techniques.

General information

Neuralgia of the glossopharyngeal nerve is a fairly rare disease. There are approximately 16 cases per 10 million people. People usually suffer after the age of 40, men more often than women. The first description of the disease was given in 1920 by Sicard, and therefore the pathology is also known as Sicard syndrome.

Secondary neuralgia of the glossopharyngeal nerve can occur when infectious pathology posterior cranial fossa (encephalitis, arachnoiditis), traumatic brain injury, metabolic disorders(diabetes mellitus, hyperthyroidism) and compression (irritation) of the nerve at any part of its passage. The latter is possible with intracerebral tumors of the cerebellopontine angle (glioma, meningioma, medulloblastoma, hemangioblastoma), intracerebral hematomas, nasopharyngeal tumors, hypertrophy of the styloid process, aneurysm of the carotid artery, ossification of the stylohyoid ligament, proliferation of osteophytes of the jugular foramen. A number of clinicians say that in some cases, neuralgia of the glossopharyngeal nerve may be the first symptom of laryngeal or pharynx cancer.

Symptoms

Neuralgia of the glossopharyngeal nerve is clinically manifested by unilateral painful paroxysms, the duration of which varies from a few seconds to 1-3 minutes. Intense pain begins at the root of the tongue and quickly spreads to the soft palate, tonsils, pharynx and ear. Possible irradiation into lower jaw, eyes and neck. Painful paroxysm can be provoked by chewing, coughing, swallowing, yawning, eating excessively hot or cold food, or normal conversation. During an attack, patients usually feel a dry throat, and after it - increased salivation. However, dry throat is not a constant sign of the disease, since in many patients the secretory insufficiency of the parotid gland is successfully compensated by other salivary glands.

Swallowing disorders associated with paresis of the levator pharyngeal muscle are not clinically expressed, since the role of this muscle in the act of swallowing is insignificant. Along with this, there may be difficulties in swallowing and chewing food associated with a violation various types sensitivity, including proprioceptive - responsible for feeling the position of the tongue in the oral cavity.

Often, neuralgia of the glossopharyngeal nerve has a wave-like course with exacerbations in autumn and winter periods of the year.

Diagnostics

Neuralgia of the glossopharyngeal nerve is diagnosed by a neurologist, although consultation with a dentist and otolaryngologist, respectively, is required to exclude diseases of the oral cavity, ear and throat. A neurological examination reveals the absence of pain sensitivity (analgesia) in the area of the base of the tongue, soft palate, tonsils, and upper parts of the pharynx. A test of taste sensitivity is carried out, during which a special taste solution is applied to symmetrical areas of the tongue with a pipette. It is important to identify an isolated unilateral disorder of taste sensitivity of the posterior 1/3 of the tongue, since a bilateral taste disorder can be observed in pathology of the oral mucosa (for example, in chronic stomatitis).

The pharyngeal reflex (the occurrence of swallowing, sometimes coughing or gagging movements, in response to touching the back wall of the pharynx with a paper tube) and the palatine reflex (touching the soft palate accompanied by elevation of the palate and its uvula). The unilateral absence of these reflexes speaks in favor of damage to n. glossopharyngeus, however, it can also be observed with pathology of the vagus nerve. During examination of the pharynx and pharynx, identification of rashes typical of herpetic infection, suggests ganglionitis of the nodes of the glossopharyngeal nerve, which has symptoms almost identical to neuritis of the glossopharyngeal nerve.

In order to establish the cause of secondary neuritis, they resort to neuroimaging diagnostics -

Rice. 989. Nerves of the tympanic cavity and auditory tube, left (photo. Preparation by D. Rosengauz). (The tympanic cavity and auditory tube were opened from the outside, the squamous part and part of the mastoid process of the temporal bone were removed.)

Glossopharyngeal nerve, n. glossopharyngeus (IX pair) (Fig. , , , , ; see Fig. , , , ), mixed in nature.

It contains sensory, motor and parasympathetic secretory fibers.

Fibers of different natures represent axons of different nuclei, and some nuclei are common with the vagus nerve.

The nuclei of the glossopharyngeal nerve lie in the posterior parts of the medulla oblongata. They highlight sensitive nucleus tractus solitarius; motor double nucleus, nucleus ambiguus; parasympathetic (secretory) inferior salivatory nucleus(see fig.,).

On the surface of the rhomboid fossa, these nuclei are projected in the posterior part of the medulla oblongata: motor core– in the region of the triangle of the vagus nerve; sensitive nucleus - outward from the border sulcus; vegetative nucleus - corresponding to the border sulcus, medial to the nucleus ambiguus.

The glossopharyngeal nerve appears on the lower surface of the brain with 4–6 roots behind the olive, below the VIII pair. It is directed outward and forward and exits the skull through the anterior part of the jugular foramen. In the area of the foramen, the nerve thickens somewhat due to the upper node, ganglion rostralis. Having exited through the jugular foramen, the nerve thickens for the second time due to inferior node, ganglion caudalis, lying in a stony fossa on the lower surface of the pyramid of the temporal bone.

Sensitive (afferent) fibers are processes of cells of the upper and lower nodes of the glossopharyngeal nerve, with the peripheral ones following as part of the nerve to the organs, and the central ones forming a single tract, around which the nerve cells are collected in the nucleus of the solitary tract (sensitive). Some fibers pass to the upper part of the posterior nucleus of the vagus nerve.

Motor (efferent) fibers are axons nerve cells somatic nucleus ambiguus, located in the posterior part of the medulla oblongata. These fibers constitute the nerve to the stylopharyngeal muscle.

Parasympathetic (secretory) fibers originate in the autonomic inferior salivatory nucleus, nucleus salivatorius caudalis, which lies somewhat anterior and medial to the somatic nucleus ambiguus.

From the base of the skull, the glossopharyngeal nerve goes down, goes between the internal carotid artery and the internal jugular vein, forming an arch, follows forward, slightly upward and enters the thickness of the root of the tongue.

Along its course, the glossopharyngeal nerve gives off a number of branches.

I. Branches starting from the bottom node:

Tympanic nerve, n. tympanicus(see Fig.,), in its composition it is afferent and parasympathetic. It arises from the inferior ganglion of the glossopharyngeal nerve, enters the tympanic cavity and runs along its medial wall. Here the tympanic nerve forms a small tympanic thickening [nodule], intumescentia tympanica, and then splits into branches, which in the mucous membrane of the middle ear make up tympanic plexus, plexus tympanicus.

The next section of the nerve, which is a continuation of the tympanic plexus, exits the tympanic cavity through the cleft of the canal of the lesser petrosal nerve called lesser petrosal nerve, n. petrosus minor. The latter is approached by a connecting branch from the greater petrosal nerve. Leaving the cranial cavity through the sphenoid-petallosal fissure, the nerve approaches the ear node (see Fig.), where parasympathetic fibers switch.

All three sections: the tympanic nerve, the tympanic plexus and the lesser petrosal nerve connect the inferior ganglion of the glossopharyngeal nerve with the auricular ganglion.

The tympanic nerve or tympanic plexus has connections with the facial nerve (with its branch - the greater petrosal nerve) and with the sympathetic plexus of the internal carotid artery through sleepily-tympanic nerves, nn. caroticotympanici.

The tympanic nerve gives off the following branches:

1) pipe branch, r. tubarius, to the mucous membrane of the auditory tube;

2) connecting branch with the auricular branch of the vagus nerve, r. communicans (cum ramo auriculi n. vagi).

In addition, there are 2–3 thin tympanic branches to the mucous membrane covering eardrum from the side of the tympanic cavity, and to the cells of the mastoid process, as well as small branches to the window of the vestibule and the window of the cochlea.

II. Branches starting from the trunk of the glossopharyngeal nerve:

1. Pharyngeal branches, rr. pharyngei, - these are 3-4 nerves, starting from the trunk of the glossopharyngeal nerve where the latter passes between the external and internal carotid arteries. The branches are directed to the lateral surface of the pharynx, where, connecting with the branches of the vagus nerve of the same name (branches from the sympathetic trunk also come here), they form pharyngeal plexus, plexus pharingeus.

2. Sinus branch, r. sinus carotid, one or two thin branches, enter the wall of the carotid sinus and the thickness of the carotid glomus.

3. Branch of the stylopharyngeal muscle, r. musculi stylopharyngei, goes to the corresponding muscle and enters it with several branches.

4. Almond branches, rr. tonsillares, extend from the main trunk in 3–5 branches in the place where it passes near the tonsil. These branches are short, directed upward and reach the mucous membrane of the palatine arches and tonsils.

5. Lingual branches, rr. linguales, are the terminal branches of the glossopharyngeal nerve. They pierce the thickness of the root of the tongue and are divided into thinner, interconnected branches. The terminal branches of these nerves, carrying both taste fibers and fibers of general sensitivity, end in the mucous membrane of the posterior third of the tongue, occupying the area from the anterior surface of the epiglottic cartilage to the grooved papillae of the tongue inclusive (see Fig.,).

Before reaching the mucous membrane, these branches are connected along midline tongue with the branches of the same name on the opposite side, as well as with the branches of the lingual nerve (from the trigeminal nerve).

Sensory fibers of the glossopharyngeal nerve, ending in the mucous membrane of the posterior third of the tongue, conduct taste stimuli through the peripheral nodes of the glossopharyngeal nerve to the nucleus of the solitary tract. The fibers of the intermediate nerve (corda tympani) and the vagus nerve also bring taste stimulation here. Subsequently, the stimulation reaches the thalamus and is believed to reach the area of the hook (see Fig.).