The vagus nerve is the 10th cranial nerve (CN X).

It The vagus nerve originates from the medulla of the

is a functionally diverse nerve, offering many brainstem. It exits the cranium via the jugular

different modalities of innervation. It is associated foramen, with the glossopharyngeal and accessory

with the derivatives of the fourth and sixth nerves (CN IX and XI respectively).

pharyngeal arches.
Within the cranium, the auricular branch arises.

Overview This supplies sensation to the posterior part of the

external auditory canal and external ear.

 Sensory: Innervates the skin of the external

acoustic meatus and the internal surfaces of In the Neck

the laryngopharynx and larynx. Provides

visceral sensation to the heart and

abdominal viscera.

 Special Sensory: Provides taste sensation

to the epiglottis and root of the tongue.

 Motor: Provides motor innervation to the

majority of the muscles of the pharynx, soft

palate and larynx.

 Parasympathetic: Innervates the smooth

muscle of the trachea, bronchi and gastro-

intestinal tract and regulates heart rhythm.

Anatomical Course/Pathway

The vagus nerve has the longest course of all the

Fig 1.0 - Overview of the major branches of the vagus nerve
cranial nerves, extending from the head to the
In the neck, the vagus nerve passes into the carotid
abdomen. Its name is derived from the Latin
sheath, travelling inferiorly with the internal jugular
‘vagary’ – meaning wandering. It is sometimes
vein and common carotid artery. At the base of the
referred to as the wandering nerve.
neck, the right and left nerves have differing
In the Head
pathways:
The right vagus nerve passes anterior to the

subclavian artery and posterior to the

sternoclavicular joint, entering the thorax.

The left vagus nerve passes inferiorly between the

left common carotid and left subclavian arteries,

posterior to the sternoclavicular joint, entering the

thorax.

Several branches arise in the neck:

 Pharyngeal branches – Provides motor

innervation to the majority of the muscles of

the pharynx and soft palate.

 Superior laryngeal nerve – Splits into

Fig 1.1 – The origin of the recurrent laryngeal nerves
internal and external branches. The external

laryngeal nerve innervates the cricothyroid In the thorax, the right vagus nerve forms the

muscle of the larynx. The internal laryngeal posterior vagal trunk, and the left forms the anterior

provides sensory innervation to the vagal trunk. Branches from the vagal trunks

laryngopharynx and superior part of the contribute to the formation of the oesophageal

larynx. plexus, which innervates the smooth muscle of the

 Recurrent laryngeal nerve (right side only) – oesophagus.

Hooks underneath the right subclavian

Two other branches arise in the thorax:
artery, then ascends towards to the larynx.
 Left recurrent laryngeal nerve – it hooks
It innervates the majority of the intrinsic
under the arch of the aorta, ascending to
muscles of the larynx.
innervate the majority of the intrinsic
In the Thorax
muscles of the larynx.

 Cardiac branches – these innervate

regulate heart rate and provide visceral

sensation to the organ.

The vagal trunks enter the abdomen via the

oesophageal hiatus, an opening in the diaphragm.

In the Abdomen

In the abdomen, the vagal trunks terminate by

dividing into branches that supply the oesophagus,

stomach and the small and large bowel (up to the

splenic flexure).

Sensory Functions

There are somatic and visceral components to the

sensory function of the vagus nerve. Fig 1.2 – The three parts of the pharynx, and their borders.

The laryngopharynx is innervated by the vagus nerve.

Somatic refers to sensation from the skin and
Special Sensory Functions
muscles. This is provided by the auricular nerve,

which innervates the skin of the posterior part of the The vagus nerve has a minor role in taste

external auditory canal and external ear. sensation. It carries afferent fibres from the root of

the tongue and epiglottis.

Viscera sensation is that from the organs of the

body. The vagus nerve innervates: (This is not to be confused with the special

sensation of the glossopharyngeal nerve, which

 Laryngopharynx – via the internal laryngeal
provides taste sensation for the posterior 1/3 of the
nerve.
tongue).
 Superior aspect of larynx (above vocal

folds) – via the internal laryngeal nerve. Motor Functions

 Heart – via cardiac branches of the vagus The vagus nerve innervates the majority of the

nerve. muscles associated with the pharynx and larynx.

 Gastro-intestinal tract (up to the splenic These muscles are responsible for the initiation of

flexure) – via the terminal branches of the swallowing and phonation.

vagus nerve.
Pharynx
Most of the muscles of the pharynx are innervated Recurrent laryngeal nerve:

by the pharyngeal branches of the vagus nerve:

 Thyro-arytenoid

 Superior, middle and inferior pharyngeal  Posterior crico-arytenoid

constrictor muscles  Lateral crico-arytenoid

 Palatopharyngeus  Transverse and oblique arytenoids

 Salpingopharyngeus  Vocalis

An additional muscle of the pharynx, the External laryngeal nerve:

stylopharyngeus, is innervated by the
Cricothyroid
glossopharyngeal nerve.
Other Muscles

In addition to the pharynx and larynx, the vagus

nerve also innervates the palatoglossus of the

tongue, and the majority of the muscles of the soft

palate.

Parasympathetic Functions

In the thorax and abdomen, the vagus nerve is the

main parasympathetic outflow to the heart and

gastro-intestinal organs.

The Heart

Fig 2 – Lateral view of the deep structures of the pharynx. Cardiac branches arise in the thorax, conveying
Visible are the circular muscles of the pharynx, and the
parasympathetic innervation to the sino-atrial and
stylopharyngeus.
atrio-ventricular nodes of the heart.
Larynx
These branches stimulate a reduction in the resting
Innervation to the intrinsic muscles of the larynx is
heart rate. They are constantly active, producing a
achieved via the recurrent laryngeal nerve and
rhythm of 60 – 80 beats per minute. If the vagus
external branch of the superior laryngeal nerve.
nerve was lesioned, the resting heart rate would be  Taking a sip of water – if there is difficulty in

around 100 beats per minute. swallowing (expect no delay)

 Saying ‘Ahh’ with the mouth wide open – to

Gastro-Intestinal System
check if the palate elevates
The vagus nerve provides parasympathetic
equally/symmetrically, and the if the uvula
innervation to the majority of the abdominal organs.
deviates from the middle or not (use tongue
It sends branches to the oesophagus, stomach and
depressor) If one side is paretic, the uvula is
most of the intestinal tract – up to the splenic
lifted away from the paretic side. The
flexure of the large colon.
absence of the gag reflex is common

The function of the vagus nerve is to stimulate among healthy people and may not be

smooth muscle contraction and glandular significant.

secretions in these organs. For example, in the  Voice and cough – hoarse voice (vagus
stomach, the vagus nerve increases the rate of nerve problem because of lack of closing of
gastric emptying, and stimulates acid production. the vocal cords) If hoarseness is noted, the

Vagus Nerve Assesssment vocal cords are inspected. If hoarseness is

the only problem (with normal gag and

The 9th (glossopharyngeal) and 10th (vagus)
palatal elevation) should prompt a search
cranial nerves are usually evaluated together.
for lesions (eg, mediastinal lymphoma,
Cranial nerves 9 and 10 work together to supply the aortic aneurysm) compressing the recurrent
musculature of the pharynx (mostly supplied by CN laryngeal nerve.
10) and transmit visceral afferent information from

vascular baroreceptors. Cranial nerve 9 and 10 are

discussed together since they are difficult to isolate

clinically, and are commonly affected together since

they both communicate with nuclei in the

dorsolateral medulla, both pass through the jugular

foramen, and they are adjacent throughout parts of

the neck.