Overview
The
sensation to our pharynx is important for our gag reflex. The glossopharyngeal
nerve is the 9th cranial nerve, and leaves the cranial cavity
through the jugular foramen, along with cranial nerves 10 and 11. It has a
number of crucial roles, including supplying supplies taste and sensation to
the posterior one third of the tongue, and sensation to the pharynx. It also
innervates the baroreceptors in the carotid sinus, which is important for blood
pressure regulation.
Gross Anatomy
The
glossopharyngeal nerve is also known as cranial nerve 9. It arises from the
brainstem, the medulla to be precise. It emerges lateral to the olive (an
ovaloid structure responsible for pathways of motor learning and hearing). The
nerve leaves the skull through the jugular foramen, along with cranial nerves
10 and 11. It passes between the internal jugular vein and the internal carotid
artery. It will pass inferiorly, anterior to the internal carotid artery. The branchial
motor component of the nerve curves anteriorly and lies upon the
stylopharyngeus muscle (which it innervates) that elevates the pharynx during
swallowing and speech. It also innervates the middle pharyngeal constrictor.
The
general sensory component of the nerve arises from the pharyngeal branches of
the nerve, which ascends through the jugular foramen, enters the medulla, and
synapses in the anterolateral thalamus, then to the posterior limb of the
internal capsule, and then to the primary somatosensory cortex (postcentral
gyrus). It provides sensation to the posterior one third of the tongue
(including circumvallate papillae), inner surface of the tympanic membrane, pharynx,
as well as taste to the posterior one third of the tongue. The special sensory
component of the nerve (taste), follows the same course into the skull, but
synapses in the tractus solitarius and the gustatory component of the nucleus
solitarius. Next the fibers connect with the ventral posteromedial nuclei of
the thalamus, and then to the inferior third of the primary somatosensory
cortex (taste/gustatory cortex).
The visceral
component of the nerve enters the petrous portion of the temporal bone and runs
upwards to reach the tympanic cavity. It forms a plexus in the tympanic cavity,
which gives rise to the lesser petrosal nerve. This nerve will re-enter the
middle cranial fossa and will pass through the temporal bone to emerge into the
middle cranial fossa lateral to the greater petrosal nerve. The nerve will the
leave the skull via the foramen ovale along with the mandibular division of the
trigeminal nerve. The lesser petrosal nerve provides parasympathetic
innervation to the parotid gland via the otic ganglion (which is attached to
the mandibular division just as it leaves the foramen ovale), which releases
saliva into the oral cavity via its duct that opens in the cheek opposite the
second upper molar.
The
visceral sensory component collects information from carotid sinus and body.
The information ascends via the sinus nerve, and joins the glossopharyngeal
nerve to run up into the skull via the jugular foramen. Once the nerve enters
the skull it enters the lateral medulla, and descends in the tractus solitarius
and synapses in the nucleus solitarius. Here the fibers connect to the
hypothalamus and reticular formation to modulate cardiovascular and respiratory
parameters, blood pressure and serum oxygen and carbon dioxide concentrations.
Clinical Anatomy
9th nerve palsy- Symptoms
include impaired taste, often described as bitter or sour. Swallowing is also
often impaired. Clinically, the glossopharyngeal nerve is the afferent
(sensory) limb of the gag reflex, which will be absent in this patient.
Glossopharyngeal nerve neuralgia-
This is pain in the posterior third of the tongue,
pharynx, ear and tonsils due to irritation of the glossopharyngeal nerve. It is
usually causes by compression of the nerve by surrounding blood vessels,
tumours or infections.
Quick Anatomy
Key Facts
Developmental precursor for motor division- Basal plate of the medulla
oblongata (Myelencephalon- secondary brain vesicle).
Developmental precursor for sensory division- Cranial neural crest
Muscles-
Stylopharyngeus
Sensation-
Posterior one third of the tongue, Pharynx. Special sense (taste) posterior
third of the tongue.
Aide-Memoire
Summary
The
glossopharyngeal nerve is the 9th cranial nerve, and leaves the
cranial cavity through the jugular foramen. The nerve supplies taste and
sensation to the posterior one third of the tongue, and sensation to the
pharynx.
References
1.
Frank H.Netter MD: Atlas of Human Anatomy, 5th
Edition, Elsevier Saunders, Chapter 1 Head and Neck
2.
Chummy S.Sinnatamby: Last’s Anatomy Regional and
Applied, 12th Edition, Churchill Livingstone Elsevier
3.
Richard L. Drake, A. Wayne Vogl,
Adam. W.M. Mitchell:
Gray’s Anatomy for Students, 2nd Edition, Churchill Livingstone
Elsevier
4.
Elliiot L.Manchell: Gray's Clinical Neuroanatomy: The Anatomic Basis for
Clinical Neuroscience
5.
The Definitive Neurological Surgery Board Review
By Shawn P. Moore,
2005
6.
Human Neuroanatomy
By James R. Augustine,
2008