Glossopharyngeal nerve injury

Introduction to glossopharyngeal nerve injury The glossopharyngeal nerve is a mixed nerve that contains motor and sensory fibers. After passing through the cranial fossa in the jugular foramen, the pharyngeal wall is reached between the internal and external carotid arteries. The sensory fiber is the sensory afferent nerve of the pharynx, and the motor branch is responsible for soft palate function, parasympathetic fiber. The secretion of the salivary glands, the glossopharyngeal nerve belongs to the posterior group of cranial nerves, the chance of traumatic injury is relatively small, mostly due to the fracture line and the jugular foramen, but the lesion of the jugular vein in the posterior cranial fossa is easy to cause glossopharyngeal nerve damage. The damage and injury of the glossopharyngeal nerve are often involved in the cranial nerve of the posterior group. The clinical diagnosis of the glossopharyngeal nerve alone is extremely rare. It is characterized by the loss or disappearance of the 1/3 of the posterior tongue of the affected side, and the general feeling of the upper part of the pharynx is reduced or lost. Drooping, more conservative treatment. basic knowledge The proportion of illness: 0.003%--0.007% Susceptible people: no special people Mode of infection: non-infectious Complications:

Causes of glossopharyngeal nerve injury

(1) Causes of the disease

1. Individual damage to the pharyngeal nerve of the firearm is extremely rare. Occasionally due to small shrapnel injury, in the mandibular posterior space firearm injury, the pharyngeal god is often injured together with the vagus nerve and the accessory nerve, and the mandibular horizontal branch is injured. The nerve is also often injured at the same time as the vagus nerve and facial nerve.

2. Surgical injury to carotid artery surgery, cervical anterior approach, thyroid surgery, etc. can often accidentally injure the extracranial segment of the glossopharyngeal nerve; the posterior cranial jugular foramen can be accidentally injured in the intracranial segment of the glossopharyngeal nerve and the jugular foramen.

3. Fracture of the skull base fracture line through the occipital condyle involving the jugular foramen, contusion or squeeze the tongue and throat.

4. Tumor compression and infiltration can also cause damage and damage to the glossopharyngeal nerve, such as jugular bulbar tumor in the jugular foramen of the skull base and its vicinity, giant acoustic neuroma, brain (spinal) tumor, epithelioid cyst, notochord Tumor, skull tumor and malignant tumor of the skull base metastasis; posterior cranial jugular vein area tumor, tumor outside the skull base.

5. The deformity of the cranial-cervical junction area is trapped in the skull base, the flat skull base, and the cerebellar tonsil malformation.

6. Nuclear injury Acute nuclear injury is common in brain stem vascular disease, brain stem polio, etc. Chronic injury is common in medullary water, brain stem and high neck segment intramedullary tumor and multiple sclerosis.

(two) pathogenesis

Currently there are no related content description.

Glossopharyngeal nerve injury prevention

The iatrogenic glossopharyngeal nerve injury caused by the posterior cranial fossa, skull base and carotid artery surgery should focus on prevention. The primary disease should be performed under the microscope. The exposure should be sufficient. The nerve should be carefully identified under the operating microscope. The cotton piece is protected to prevent electrocautery and clamp accidental injury. At the same time, it is necessary to avoid excessive pulling of the nerve. For the removal of the tumor, the tumor should be removed from the capsule first, and then the tumor capsule is separated from the nerve to avoid accidental injury or Aggravation of the original nerve damage, such as tumor capsule and nerve adhesion is tight, separation is difficult, it should be retained with the nerve adhesion tight part of the tumor capsule, and should not be forced to separate it, during surgery must also pay attention to prevent damage to the nerve supply artery.

Glossal nerve injury complications Complications

For example, if the accessory nerve injury is combined, the patient may have the sternocleidomastoid muscle and the trapezius muscle spasm at the same time: the sublingual nerve injury is accompanied by atrophy of the semitonal tongue muscle and bilateral swallowing nerve injury.

Symptoms of glossopharyngeal nerve damage Common symptoms pharyngeal reflex disappears Tongue pharyngeal nerve damage Tongue is located at the bottom of the mouth can not stretch out the voice hoarseness and pharynx

1. One side of the glossopharyngeal nerve is characterized by loss of 1/3 of the taste of the ipsilateral tongue, and the painfulness of the tongue and pharyngeal area disappears (because of its self-feeling, so there is no pharyngeal reflex and swallowing reflex disorder), ipsilateral pharynx The muscle strength is weak and the parotid gland secrete obvious obstacles. Clinically, the glossopharyngeal nerve alone is rare in the injury. It often occurs simultaneously with the posterior group. When one side of the pharyngeal vagus, the vagus nerve or its nerve nucleus is damaged, the ipsilateral soft palsy may occur. Pharyngeal sensation diminished or disappeared, pharyngeal reflex disappeared, cough and hoarseness.

2. Patients with bilateral glossopharyngeal nerve injury have serious obstacles in eating, swallowing, and pronunciation. In severe cases, when the patient makes an "ah" sound, the soft palate and the uvula are biased to the healthy side, and even can not be pronounced and swallowed, saliva outflow, etc. Ball paralysis.

Examination of glossopharyngeal nerve injury

1. Skull base X-ray film Sometimes it can show the enlargement of the jugular foramen and the destruction of the skull base, but it is not easy to show the linear fracture of the skull base.

2. MRI can clearly show the posterior cranial fossa, the internal and external jugular vein and the large occipital space occupying lesions and congenital malformations, is also the most ideal examination method for the brain stem and high cervical spinal cord disease, axial position, coronal position, The combination of sagittal and enhanced scans can clarify the location, origin, size, relationship with surrounding structures and brain stem compression, and can also make a qualitative diagnosis of most lesions, but MRI changes the skull base. The display is not as good as CT.

3. CT posterior fossa and skull base CT thin-slice scan can also clearly show the site of space-occupying lesions, especially the skull base window and three-dimensional reconstruction technology, can clearly show the skull base bone changes, the skull Bottom line fractures can also be clearly shown.

Diagnosis and differential diagnosis of glossopharyngeal nerve injury

Diagnosis can usually be made based on clinical manifestations, combined with medical history and CT, MRI and other imaging studies.

It is extremely rare to damage the glossopharyngeal nerve alone. In one side, the cranial nerves are involved at the same time or at the same time as the vagus nerve.

Differential diagnosis

1. Jugular vein syndrome (Vernet syndrome) IX, X, XI cranial nerve palsy.

2. Collet-Sicard syndrome IX, X, XI, XII cranial nerve palsy, or unilateral skull base syndrome.

3. Most of the occipital macroporous syndrome is lesions in the large area of the occipital bone.

4. Brain stem lesions are often manifested as bilateral multiple brain damage.

The material in this site is intended to be of general informational use and is not intended to constitute medical advice, probable diagnosis, or recommended treatments.