What is the function of the glossopharyngeal nerve? III branch of the trigeminal nerve

Glossopharyngeal nerve (n. Glossopharyngeus) is part of the IX pair of cranial nerves. Consists of different types of fibers: parasympathetic, motor and sensory.

Glossopharyngeal nerve anatomy

The nerve leaves the medulla oblongata usually with 4-6 roots behind the inferior olive next to the tenth and eleventh nerves. Gathering into one single nerve, they leave the skull through the jugular foramen, at this point the tympanic nerve is separated from the main trunk.

In the opening, the glossopharyngeal nerve thickens slightly, forms an upper node, immediately after exit - a lower node. The first sensory neurons are located in them and impulses from them are sent to the nucleus, which is responsible for sensitivity.

Further, the nerve descends to the internal carotid artery, passes between it and the internal jugular vein, makes a bend in the form of an arc, after which it gives one of its branches to the place of division of the carotid artery, namely to the carotid sinus. After the separation of the sinus branch, it moves to the pharynx, where it begins to branch out and gives off several branches:

• Pharyngeal two or three small branches
• Tonsil - conduct impulses from the soft palate, tonsils
• Lingual - three or four, they provide gustatory sensations, general sensitivity from the back third of the tongue

The motor part of the nerve innervates the stylopharyngeal muscle.

Parasympathetic fibers: the small petrosal nerve reaches the ear node, then the postganglionic fibers pass into the parotid salivary gland, which is innervated.

In the screenshot below, we see 3 pairs of glossopharyngeal nerve nuclei. They are all marked with different colors.

The lower salivary nucleus (highlighted in yellow) is parasympathetic.

The core of a single path is marked in green. It is responsible for the sensation of taste in the back third of the tongue. From the nucleus, information about taste enters the thalamus. Scientists learned that this nucleus is responsible for gustatory sensitivity at the end of the 19th century.

For simplicity, we can say that the fibers of the ninth nerve are connected to the middle part of the nucleus. Whereas the fibers of the seventh nerve occupy the upper third, and the tenth - the lower.

Double nucleus, marked in pink - motor. Also, the fibers of the tenth and eleventh nerves originate from it. Central motor neurons are located in the lower parts of the precentral gyrus.

Interesting fact: there is evidence that the fourth nucleus is determined - the spinal nucleus of the trigeminal nerve - and it is responsible for general sensitivity from areas such as the soft palate, throat, auditory tube and tympanic cavity. Usually it is not indicated, as very few axons go to it.

Glossopharyngeal nerve functions

Although it is mixed, one of the most important functions will be to provide taste recognition, more precisely, salty and bitter, from the back third of the tongue. This is one of the first signs, which helps a lot if you suspect a malfunction of the ninth nerve.

The second serious task is the transmission of impulses of general sensitivity from the zones where the sensitive branches approach.

Vegetative fibers provide adequate work of the secretory function of the parotid salivary gland.

A small portion of motor fibers provides innervation to the stylopharyngeal muscle, which raises the pharynx when swallowing.

Glossopharyngeal Nerve Disorders

Symptoms

One of the first symptoms is a loss of general sensitivity in the innervated zones, it is possible to change the understanding of the position of the tongue in the oral cavity, which interferes with the normal seizure and chewing of food. The definition of the taste of food also suffers, namely, salty and bitter (these zones of definition of taste are located in the region just in the last third of the tongue). It appears only if there has been a violation in the nerve itself or the nucleus responsible for the perception of taste has suffered.

It should be said that a decrease in taste perception is also possible due to diseases of the tonsils, the presence of a dense plaque on the tongue, therefore, you need to pay attention to the condition of the tongue and oral cavity when we carry out the determination of taste. It is also necessary to know about chronic diseases of a person and the drugs they take (especially antibiotics), because this can also affect the sense of taste.

In the presence of a pathological process that irritates the IX cranial nerve, sometimes there is constant or paroxysmal soreness in the throat, the back of the tongue, the back of the pharynx, the Eustachian tube, and the middle ear.

Interesting fact: there is a separate glossopharyngeal neuralgia syndrome or Sikaro-Rabino syndrome. It is characterized by acute paroxysmal soreness from the tonsil or at the root of the tongue, which radiates to the ear, neck or lower jaw. These attacks can occur when swallowing, eating cold or hot food.

There may not be severe dryness in the oral cavity, but this is not a reliable and not permanent sign, because the weak function of one salivary gland can be replaced by the work of others.

Another sign of glossopharyngeal nerve damage is weakness when checking the palatine and pharyngeal reflexes on the affected side. It should be remembered that the IX and X pairs are very closely related, which means that when checking the above reflexes, revealing their weakness, you need to think not only about the glossopharyngeal nerve, but also remember about the vagus one.

Test: different types of solutions are dripped alternately: sweet, salty, sour and bitter - on symmetrical areas of the tongue surface separately in each third of it. Substances are applied using a pipette or moistened filter paper. The liquid should not be allowed to spread over the mucous membrane. After each solution, rinse your mouth thoroughly for more accurate sample results.

Glossopharyngeal nerve treatment

To treat a malfunction of this nerve, it is necessary to find out the root cause that causes the appearance of certain symptoms. Perhaps this is the bend and compression of the nerve root by a crowded inferior cerebellar or vertebral artery, the presence of inflammatory, tumor formations, as well as aneurysms in the skull region where the glossopharyngeal nerve comes to the surface.

Glossopharyngeal nerve is rarely affected. Parasympathetic fiber neuralgia is diagnosed in 16 patients out of 10 million. With the defeat of the glossopharyngeal nerve, paroxysmal pain occurs, localized in the area of ​​the tonsils, pharynx, soft palate. Disturbances of taste in the posterior third of the tongue, pharyngeal reflex and a number of other symptoms are also noted. Treatment for this type of neuralgia is mainly medication, supplemented by physiotherapy procedures.

What is glossopharyngeal neuralgia?

Glossopharyngeal neuralgia is a non-inflammatory unilateral lesion of the ninth cranial nerve. The disease is more often diagnosed in men over 40 years of age. Neuralgia of this type is characterized by symptoms that manifest itself with damage to the facial nerve, which complicates the diagnosis and treatment.

The disease is classified into two types: idiopathic (primary) and symptomatic (secondary). The latter option is typical for infectious pathologies affecting the posterior cranial fossa, or processes in which compression of parasympathetic fibers occurs.

Anatomy

The anatomy of the glossopharyngeal nerve has a rather complex structure. Its initial branch is located near the nuclei of the medulla oblongata. It is further divided into:

1. Motor fibers. Responsible for the innervation of the stylopharyngeal muscle, which raises the pharynx.
2. Sensitive fibers. Provide the sensitivity of the auditory tube, tongue, tonsils, palate, pharynx, tympanic cavity.
3. Flavoring fibers (a type of sensitive fiber). Responsible for the gustatory perception of the posterior third of the tongue and epiglottis.
4. Parasympathetic fibers. Provide salivation by innervating the parotid gland.

Sensory and motor fibers, together with the vagus nerve, provide reflexes to the palate and pharynx. In addition, the former are responsible for gustatory perception in the remainder of the tongue.

Parasympathetic fibers begin near the lower core, which provides salivation. Further, they run along the tympanic and stony nerves, reaching the aural autonomic ganglion. The parasympathetic branch then intertwines with the trigeminal nerve and reaches the parotid gland.

Due to the commonality of the nuclei of the glossopharyngeal nerve and the vagus, the symptoms are the same when one or both branches are affected.

Causes of the disease

It is not always possible to explain the appearance of symptoms of glossopharyngeal neuralgia. In such cases, they talk about the course of the idiopathic form of pathology. The probable causes of damage to these fibers include:

• atherosclerosis;
• otitis media, chronic pharyngitis and other diseases of the hearing and respiratory system;
• acute or chronic intoxication of the body;
• viral diseases.

The secondary form of lesion of the glossopharyngeal nerve is observed when:

• infectious infections of the brain near the posterior cranial fossa (encephalitis, arachnoiditis);
• traumatic brain injury;
• systemic pathologies (diabetes mellitus, hyperthyroidism) affecting metabolism;
• compression of fibers.

The fibers of the glossopharyngeal nerve are compressed when:

• artery aneurysm;
• hematomas and brain tumors;
• hypertrophy of the styloid process;
• overgrowth of osteophytes under the cranium and other similar anomalies.

Due to the fact that the fibers of the glossopharyngeal nerve innervate the mucous membranes of the oral cavity, experts do not exclude the likelihood of this form of neuralgia in cancer of the larynx or pharynx.

Symptoms of glossopharyngeal nerve neuropathy

The defeat of the glossopharyngeal nerve is characterized by acute paroxysmal pains, which are first localized in the area of ​​the root of the tongue or tonsils, and then spread towards the organs of hearing, palate or pharynx. Sometimes this symptom radiates to the eye, neck or lower jaw.

An important sign of this type of neuralgia is that pain appears exclusively on one side of the skull.

The duration of each attack is 1-3 minutes. Any load on the muscles of the face (chewing food, talking and other actions) can provoke the appearance of pain. Because of this feature, patients often have to go to bed on the other side, since during sleep, saliva flows into the pharynx, as a result of which a reflex is triggered, and the patient swallows liquid. And this, in turn, provokes the onset of pain.

Dry mouth is usually felt during each attack. After the patient's condition is restored, profuse salivation is noted. Moreover, the gland that is located on the opposite side of the affected nerve works more actively. The saliva secreted is more viscous.

During seizures, a decrease in blood pressure is also possible, which causes dizziness or temporary loss of consciousness, darkening in the eyes.

Injury to the glossopharyngeal nerve causes frequent and prolonged seizures that can be troublesome throughout the year. As the pathological process progresses, the intensity of the general symptoms increases. In some cases, patients lose control of themselves due to pain and start screaming.

Over time, neuralgia becomes permanent. Pain in such cases bothers the patient constantly. With such lesions, the sensitivity of those zones is disturbed, for the innervation of which the glossopharyngeal nerve is responsible. These disorders, in the absence of adequate treatment, also progress, resulting in problems with chewing and swallowing food.

Diagnostic measures

Diagnostic activities begin with the collection of information about the patient's condition. Not only the presence of pain is considered important, but also its nature, localization, causes and frequency of occurrence. In favor of the inflammation of the glossopharyngeal nerve is the fact that the symptoms appear exclusively on one side.

Also, a diagnostic indicator is a decrease in sensitivity and movement disorders (tissues and muscles, respectively) in the oral cavity and larynx.

More accurate information about the patient's condition can be obtained using the following examination methods:

• echo and electroencephalogram;
• electroneuromyography;
• CT or MRI of the brain.

Before choosing methods of treatment for neuritis (medications, electrophoresis or other physiotherapeutic procedures), it is necessary to exclude other diseases characterized by similar symptoms:

• inflammation of the facial nerves (trigeminal, vagus, etc.);
• glossalgia (pain in the area of ​​the tongue of different etiology);
• retropharyngeal abscess;
• tumors of the pharynx;
• Oppenheim's syndrome.

Making an accurate diagnosis often requires the participation of narrowly specialized doctors. In particular, the help of an endocrinologist may be required if diabetes mellitus is suspected.

Traditional therapy

Idiopathic neuralgia is difficult to treat. With this form of the disease, the efforts of doctors are focused on restoring the patient's condition and preventing further attacks. Due to the fact that in glossopharyngeal neuralgia, symptoms and treatment are determined depending on the causative factor, the chosen therapy regimen is often adjusted.

Basically, with this pathology, the following drugs are used:

1. "Novocaine". It is used for intractable pain syndrome. In such cases, a 1-2% solution of the drug is injected under the root of the tongue.
2. Local pain relievers (lidocaine and others). These drugs are placed at the root of the tongue.
3. Non-narcotic analgesics. Basically, for neuralgia, non-steroidal anti-inflammatory drugs such as "Diclofenac" or "Ibuprofen" are used in the form of tablets or solutions for injections.

Depending on the patient's condition and the characteristics of the causative factor, the treatment of neuralgia is supplemented by:

• B vitamins;
• anticonvulsant drugs ("Carbamazepine", "Finlepsin");
• multivitamin complexes;
• neuroleptics ("Aminazin");
• immunostimulating drugs.

With severe pain syndrome, antidepressants, hypnotics or sedatives are indicated.

In some cases, conservative therapy is unable to cope with neuralgia and requires microvascular decompression of the glossopharyngeal and vagus nerves. Such treatment, in particular, is necessary for hypertrophy of the styloid process. As part of a surgical procedure, the doctor excises tissue that is compressing nerve fibers.

Physiotherapy

Treatment of neuroses and other nervous disorders is often complemented by physiotherapy procedures. In case of damage to the glossopharyngeal nerve, the following is recommended:

1. Influence of fluctuating currents on the upper sympathetic nodes. Each session lasts 5-8 minutes, during which the patient experiences slight vibrations near the lower jaw. The procedures are repeated daily. To restore the functions of the glossopharyngeal nerve, at least 8-10 sessions are required.
2. The impact of sinusoidal modulated currents on the cervical sympathetic nodes. The duration of one session is 8-10 minutes. The procedures are repeated for 10 days.
3. Ultrasound therapy or phonophoresis with anesthetic drugs. As part of these procedures, the occipital region is affected. It will take up to 10 sessions in total.
4. Electrophoresis with "Gangleron". During the procedure, the cervical and thoracic vertebrae are affected. The total duration of electrophoresis treatment is 10-15 days.
5. Magnetotherapy. Also affects the thoracic and cervical vertebrae. The total duration of the course of treatment with an alternating magnetic field is 10-20 days.
6. Decimeter therapy. The algorithm of exposure does not differ from that used in magnetotherapy.

In addition to these physiotherapeutic procedures for glossopharyngeal neuralgia, it is recommended to carry out laser puncture and massage of the cervical-collar zone.

Thanks to such interventions, it is possible to reduce the intensity of the manifestation of pain syndrome and accelerate blood circulation in the problem area, improve the nutrition of local tissues.

Preventive measures

Neuralgia, like neuritis, often develops for unknown reasons. Therefore, it is not always possible to prevent the disorder of the innervation of the fibers for which the glossopharyngeal nerve is responsible.

To reduce the likelihood of such violations occurring, it is recommended:

• avoid hypothermia;
• timely treat pathologies of the hearing and respiratory system;
• observe the principles of proper nutrition and oral hygiene;
• treat dental diseases on time;
• avoid contact with carriers of the infection during the period of manifestation (exacerbation) of their disease.

It is important from the point of view of the prevention of neuralgia to see a doctor in a timely manner in the event of frequent pain in the oral cavity. This symptom can be the primary sign of cancer growing from the tissues of the larynx or pharynx.

Glossopharyngeal nerve neuralgia is a disease characterized by a unilateral lesion of the non-inflammatory nature of the IX pair of cranial nerves. Its symptomatology is similar to the manifestations of trigeminal neuralgia, and therefore there is a high probability of errors in the diagnosis. However, this pathology develops much less often than the latter: 1 person per 200 thousand of the population falls ill with it, about 70-100 nerve lesions per 1 case of glossopharyngeal nerve neuralgia. Persons of mature and old age, mainly men, suffer from it.

From our article you will learn about why this disease occurs, what are its clinical manifestations, as well as the principles of diagnosis and treatment of glossopharyngeal nerve neuralgia. But first, so that the reader understands why certain symptoms occur, we will briefly consider the anatomy and functions of the IX pair of cranial nerves.

Anatomy and function of the nerve

As mentioned above, the term "glossopharyngeal nerve" (in Latin - nervus glossopharyngeus) refers to the IX pair of cranial nerves. There are two of them, left and right. Each nerve consists of motor, sensory and parasympathetic fibers that originate in the nuclei of the medulla oblongata.

• Its motor fibers provide movement of the stylopharyngeal muscle, which raises the pharynx.
• Sensory fibers spread to the area of ​​the mucous membrane of the tonsils, pharynx, soft palate, tympanic cavity, auditory tube and tongue and provide sensitivity to these zones. Its taste fibers, being a type of sensitive, are responsible for the taste sensations of the posterior third of the tongue and the epiglottis.
• Together, the sensory and motor fibers of the glossopharyngeal nerve form reflex arches of the pharyngeal and palatine reflexes.
• Parasympathetic autonomic fibers of this nerve regulate the functions of the parotid gland (responsible for salivation).

It is important to know that the glossopharyngeal nerve passes in the immediate vicinity of the vagus nerve, in this regard, in many cases, their combined lesion is determined.

Etiology (causes) of glossopharyngeal neuralgia

Depending on the causative factor, two forms of this pathology are distinguished: primary (or idiopathic, since its cause cannot be reliably determined) and secondary (otherwise, symptomatic).

In most cases, glossopharyngeal neuralgia occurs in the following situations:

• lesions of the posterior cranial fossa (it is there that the medulla oblongata is localized) of an infectious nature - arachnoiditis, and others;
• diseases of the endocrine system (with, diabetes mellitus, and so on);
• in case of irritation or compression of the nerve itself in any part of it, more often in the region of the medulla oblongata (with tumors - meningioma, hemangioblastoma, cancer in the nasopharynx and others, hemorrhages in the brain tissue, carotid artery aneurysm, styloid hypertrophy and in a number of others situations);
• in the case of malignant neoplasms of the pharynx or larynx.

Also, risk factors for the development of this disease are acute viral (in particular, influenza), acute and chronic bacterial (tonsillitis, pharyngitis, otitis media, sinusitis and others) infections and atherosclerosis.

Clinical manifestations

This pathology proceeds in the form of acute attacks of pain, which originates at the root of the tongue or one of the tonsils, and then spreads to the soft palate, pharynx and ear structures. In some cases, pain can be given to the eye area, the corner of the lower jaw, and even to the neck. The pain is always one-sided.

Such attacks last for 1-3 minutes, provoke their movements of the tongue (during meals, loud conversation), irritation of the tonsil or the root of the tongue.

Patients are often forced to sleep exclusively on the healthy side, since in the lying position on the side of the lesion, saliva flows, and the patient is forced to swallow it in a dream, and this provokes night attacks of neuralgia.

In addition to pain, a person is worried about dry mouth, and at the end of the attack - the release of a large amount of saliva (hypersalivation), which, however, is less from the side of the lesion than from the healthy side. In addition, the saliva secreted by the affected gland is characterized by increased viscosity.

In some patients, during a painful attack, the following symptoms may also occur:

• darkening in the eyes;
• lowering blood pressure;
• loss of consciousness.

Most likely, such manifestations of the disease are associated with irritation of one of the branches of the glossopharyngeal nerve, which leads to inhibition of the vasomotor center in the brain, and, consequently, to a drop in pressure.

Neuralgia proceeds with alternating periods of exacerbations and remissions, and the duration of the latter in some cases is up to 12 months or more. However, over time, seizures occur more often, remissions become shorter, and the pain syndrome also becomes more intense. In some cases, the pain is so strong that the patient moans or screams, opens his mouth wide and actively rubs his neck at the angle of the lower jaw (under the soft tissues of this area is the pharynx, which, in fact, hurts).

Patients with experience often complain of pain not of a periodic, but of a permanent nature, which become stronger when chewing, swallowing, talking. They may also have a violation (decrease) of sensitivity in the areas innervated by the glossopharyngeal nerve: in the posterior third of the tongue, tonsil, pharynx, soft palate and ear, taste disturbance in the area of ​​the tongue root, and a decrease in the amount of saliva. In symptomatic neuralgia, sensitivity disorders progress over time.

The consequence of sensitivity disorders in some cases becomes difficulty in chewing food and swallowing it.

Diagnostic principles

The primary diagnosis of glossopharyngeal neuralgia is based on the doctor's collection of complaints from the patient, his life history and current disease. Everything matters: the location, the nature of the pain, when it occurs, how long it lasts and how the attack ends, how the patient feels between attacks, other symptoms that bother the patient (they may indicate pathology - a potential cause of neuralgia), concomitant neurological diseases , endocrine, infectious or other nature.

Then the doctor will conduct an objective examination of the patient, during which he will not reveal any significant changes in his condition. Is that pain can be detected when probing (palpation) of soft tissues above the angle of the lower jaw and in certain areas of the external auditory canal. Often in such patients, pharyngeal and palatine reflexes are reduced, the mobility of the soft palate is impaired, and the sensitivity of the posterior third of the tongue is impaired (the patient feels all tastes as bitter). All changes are not two-sided, but are detected only from one side.

To establish the causes of secondary neuralgia, the doctor will refer the patient for an additional examination, which will include some of these methods:

• echoencephalography;
• computed or magnetic resonance imaging of the brain;
• consultation of related specialists (in particular, an ophthalmologist, with a mandatory examination of the fundus - ophthalmoscopy).

Differential diagnosis

Some diseases have symptoms similar to those of glossopharyngeal neuralgia. In each case of a patient's treatment with such signs, the doctor conducts a thorough differential diagnosis, because the nature of these pathologies is different, which means that the treatment has its own characteristics. So, painful attacks in the face area are accompanied by such diseases:

• trigeminal neuralgia (occurs much more often than others);
• ganglionitis (inflammation of the nerve ganglion) of the pterygopalatine ganglion;
• ear node neuralgia;
• the different nature of glossalgia (pain in the area of ​​the tongue);
• Oppenheim's syndrome;
• neoplasms in the pharyngeal region;
• retropharyngeal abscess.

Treatment tactics

As a rule, glossopharyngeal neuralgia is treated conservatively, combining patient medication and physiotherapy procedures. Sometimes it is impossible to do without surgery.

Drug treatment

The leading goal of treatment in this situation is to eliminate or at least significantly alleviate the pain that causes the patient to suffer. To do this, apply:

• local anesthetic drugs (dicaine, lidocaine) on the root of the tongue;
• local anesthesia injections (novocaine) - when topical agents do not have the desired effect; the injection is carried out directly into the root of the tongue;
• non-narcotic analgesics (non-steroidal anti-inflammatory drugs) for oral administration or injection: ibuprofen, diclofenac and others.

Also, the patient can be assigned:

• B vitamins (milgamma, neurobion and others) in the form of tablets and solution for injection;
• (finlepsin, diphenin, carbamazepine, etc.) in tablets;
• (in particular, chlorpromazine) for injection;
• multivitamin complexes (Complivit and others);
• drugs that stimulate the body's defenses (ATP, FiBS, ginseng preparations and others).

Physiotherapy

In the complex treatment of glossopharyngeal nerve neuralgia, physiotherapy techniques play an important role. They are carried out in order to:

• reduce the intensity of pain attacks and their frequency;
• improve blood flow in the affected area;
• improve tissue nutrition in the areas innervated by this nerve.

The patient is prescribed:

• fluctuating currents to the upper sympathetic nodes (more precisely, to the area of ​​their projection); the first electrode is placed 2 cm back from the corner of the lower jaw, the second - 2 cm above this anatomical formation; apply a current by force until the patient feels moderate vibration; the duration of such exposure is, as a rule, from 5 to 8 minutes; procedures are carried out every day in a course of 8-10 sessions; the course of treatment is repeated 2-3 times in 2-3 weeks;
• sinusoidal modulated currents on the projection area of ​​the cervical sympathetic nodes (the indifferent electrode is placed on the back of the patient's head, and the bifurcated ones - on the sternocleidomastoid muscles; the session lasts 8-10 minutes, procedures are carried out once a day, with a course of up to 10 effects, which is repeated three times with an interval of 2 -3 weeks);
• ultrasound therapy or phonophoresis of painkillers (in particular, analgin, anesthesin) drugs or aminophylline; affect the occipital region, on both sides of the spine; the session lasts 10 minutes, they are carried out 1 time in 1-2 days in a course of 10 procedures;
• medicinal electrophoresis of gangleron paravertebrally on the cervical and upper thoracic vertebrae; the duration of the session is from 10 to 15 minutes, they are repeated daily, in a course of 10-15 impacts;
• magnetotherapy with an alternating magnetic field; the apparatus "Pole-1" is used, they act by means of a rectangular inductor on the vertebrae of the cervical and upper thoracic spine; the duration of the session is 15-25 minutes, they are carried out once a day in a course of 10 to 20 procedures;
• decimetwave therapy (by means of a rectangular radiator of the "Wave-2" apparatus on the collar area of ​​the patient; the air gap is 3-4 cm; the procedure lasts up to 10 minutes, they are repeated once every 1-2 days in a course of 12-15 sessions);
• laser puncture (affect the biological points of the IX pair of cranial nerves, the exposure is up to 5 minutes per point, procedures are carried out every day in a course of 10 to 15 sessions);
• therapeutic massage of the cervical-collar zone (it is carried out daily, the course of treatment includes 10-12 procedures).

Surgery

In some situations, in particular, with hypertrophy of the styloid process, one cannot do without surgical intervention in the volume of resection of a part of this anatomical formation. The purpose of the operation is to eliminate the compression of the nerve from the outside or irritation of the surrounding tissues.

Conclusion

Glossopharyngeal nerve neuralgia, although it happens rarely enough, can deliver a person suffering from it, real torment. The disease is idiopathic (primary) and symptomatic (secondary). It is manifested by attacks of pain in the innervation zones of the IX by a pair of cranial nerves, a pre-fainting state. It proceeds with alternating exacerbation and remission, however, over time, attacks occur more often, pains become more intense, and remissions are shorter and shorter. It is important to correctly diagnose this pathology, since in some cases it is a manifestation of serious diseases that require urgent treatment.

Treatment of neuralgia itself may include taking medications by the patient, physiotherapy, or surgery (fortunately, it is relatively rarely necessary).

The prognosis for recovery from this pathology is usually favorable. Nevertheless, its treatment is long-term, persistent: it lasts up to 2-3 years and even longer.

Channel One, the program "Living Healthy" with Elena Malysheva, the heading "About Medicine" on the topic "Neuralgia of the glossopharyngeal nerve":

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

It contains sensory, motor and parasympathetic secretory fibers.

Fibers of different nature are axons of various nuclei, and some nuclei are common with the vagus nerve.

The nuclei of the glossopharyngeal nerve lie in the posterior regions of the medulla oblongata. Allocate the sensitive core of a single path, nucleus tractus solitarius; motor double nucleus , nucleus ambiguus; parasympathetic (secretory) lower salivary nucleus, nucleus salivatorius inferior.

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

Glossopharyngeal nerve appears on the lower surface of the brain with 4-6 roots behind the olive, below the VIII pair. It goes outward and forward and exits the skull through the anterior part of the jugular foramen. In the area of ​​the hole, the nerve thickens somewhat due to the upper node located here, ganglion rostralis (superius).

Coming out through the jugular foramen, the nerve thickens again due to the lower node, ganglion caudalis (inferius), which lies in the petrous fossa on the lower surface of the temporal bone pyramid.

Sensitive (afferent) the fibers are processes of the 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 path, around which the nerve cells are collected in the nucleus of a single path (sensitive). Some of the fibers extend to the upper part of the posterior nucleus of the vagus nerve.

Motor (efferent) the fibers are the axons of the nerve cells of the somatic double nucleus, which lies in the posterior part of the medulla oblongata. These fibers make up the nerve to the stylopharyngeal muscle.

Parasympathetic (secretory) fibers originate in the vegetative lower salivary nucleus, nucleus salivatorius caudalis (inferior), which lies somewhat anterior and medial to the somatic double nucleus.

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

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

I. Branches starting from the lower node:

Tympanic nerve, n. tympanicus, in its composition is afferent and parasympathetic. It departs from the lower node of the glossopharyngeal nerve, enters the tympanic cavity and goes along its medial wall. Here, the tympanic nerve forms a small tympanic thickening (node), intumescentia (ganglion) tympanica, and then splits into branches, which in the mucous membrane of the middle ear make up the tympanic plexus, plexus tympanicus.

The next section of the nerve, which is a continuation of the tympanic plexus, leaves the tympanic cavity through the cleft of the canal of the lesser petrosal nerve called the lesser petrosal nerve, n. petrosus minor... A connecting branch from a large stony nerve approaches the latter. Leaving the cranial cavity through the wedge-shaped-stony cleft, the nerve comes to the ear node, where the parasympathetic fibers are switched.

All three sections: the tympanic nerve, the tympanic plexus, and the petrous petrosal nerve, connect the inferior glossopharyngeal nerve node to the ear node.
The tympanic nerve or tympanic plexus has connections with the facial nerve (with its branch - the large petrosal nerve) and with the sympathetic plexus of the internal carotid artery through the carotid 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 the tympanic membrane 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, start from the trunk of the glossopharyngeal nerve where the latter passes between the external and internal carotid arteries. The branches go to the lateral surface of the pharynx, where, connecting with the branches of the same name of the vagus nerve (branches from the sympathetic trunk are also suitable here), they form the pharyngeal plexus, plexus pharingeus.

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

3 ... A branch of the stylopharyngeal muscle, r. musculi stylopharyngei, goes to the corresponding muscle and enters it in several branches.

4 ... Amygdala branches, rr. tonsillares, depart from the main trunk with 3-5 branches in the place where it passes near the amygdala. 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 in it into thinner, connecting 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 region from the anterior surface of the epiglottis cartilage to the grooved papillae of the tongue, inclusive.

Before reaching the mucous membrane, these branches are connected along the midline of the tongue with the same branches of 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 pathway.

Gustatory stimuli of the fibers of the intermediate nerve (tympanic string) and the vagus nerve are also brought here. Subsequently, irritations reach the thalamus and are believed to reach the hook region.

Unilateral lesion of the IX cranial nerve, manifested by paroxysms of pain in the root of the tongue, tonsils, pharynx, soft palate and ear. It is accompanied by impaired taste perception of the posterior 1/3 of the tongue on the side of the lesion, impaired salivation, decreased pharyngeal and palatal reflexes. Diagnosis of pathology includes examination by a neurologist, otolaryngologist and dentist, MRI or CT of the brain. Treatment is mainly conservative, consisting of analgesics, anticonvulsants, sedatives and hypnotics, vitamins and general tonic, physiotherapy techniques.

General information

Glossopharyngeal neuralgia is a rare disease. There are approximately 16 cases per 10 million people. Usually people over the age of 40 are affected, men more often than women. The first description of the disease was given in 1920 by Sicard, in connection with which the pathology is also known as Sicard's syndrome.

Secondary neuralgia of the glossopharyngeal nerve can occur with infectious pathology of the posterior cranial fossa (encephalitis, arachnoiditis), craniocerebral trauma, metabolic disorders (diabetes mellitus, hyperthyroidism) and compression (irritation) of the nerve in any part of its passage. The latter is possible with intracerebral tumors of the pontine-cerebellar angle (glioma, meningioma, medulloblastoma, hemangioblastoma), intracerebral hematomas, nasopharyngial tumors, hypertrophy of the styloid process, aneurysm of the carotid artery, ossified ligament of the awl. A number of clinicians say that in some cases glossopharyngeal neuralgia may be the first symptom of laryngeal cancer or pharyngeal cancer.

Symptoms

Glossopharyngeal nerve neuralgia is clinically manifested by unilateral painful paroxysms, the duration of which varies from several 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 to the lower jaw, eyes and neck. Painful paroxysm can be provoked by chewing, coughing, swallowing, yawning, eating excessively hot or cold food, and ordinary conversation. During an attack, patients usually experience a dry throat followed by increased salivation. However, dry throat is not a permanent 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 pharynx 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 of various types of sensitivity, including proprioceptive - responsible for the sensation of the position of the tongue in the oral cavity.

Often, neuralgia of the glossopharyngeal nerve has an undulating course with exacerbations in the autumn and winter seasons.

Diagnostics

Glossopharyngeal neuralgia is diagnosed by a neurologist, although to rule out diseases of the oral cavity, ear and throat, consultation with a dentist and an otolaryngologist, respectively, is required. Neurological examination determines the absence of pain sensitivity (analgesia) in the area of ​​the base of the tongue, soft palate, tonsils, and upper pharynx. A taste sensitivity study is carried out, during which a special taste solution is applied to the symmetrical areas of the tongue with a pipette. It is important to identify an isolated unilateral taste sensitivity disorder 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 is checked (the occurrence of swallowing, sometimes coughing or gagging, in response to touching the back wall of the throat with a paper tube) and palatine reflex (touching the soft palate is accompanied by raising the palate and its uvula). The unilateral absence of these reflexes speaks in favor of the defeat of n. glossopharyngeus, but it can also be observed with pathology of the vagus nerve. The detection during examination of the pharynx and pharynx of rashes typical of herpetic infection suggests ganglionitis of the glossopharyngeal nerve nodes, which has symptoms almost identical to the neuritis of the glossopharyngeal nerve.

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