Last edited: 9/13/2021

1. VAGUS NERVE | CRANIAL NERVE X

Neurology | Vagus Nerve | Cranial Nerve X Medical Editor: Dr. Ana Guerra

OUTLINE I) GSA FIBERS

I) GSA FIBERS
II) SVA FIBERS (1) Course
III) SVE FIBERS
IV) GVA FIBERS Fibers coming from the tympanic cavity and ear
(auricular branch) travel to the superior ganglion of CN
II)COURSE OF NERVE X or Jugular ganglion.
III)STRUCTURES SUPPLIED Postganglionic fibers enter the cranial fosse through the
IV) CLINICAL CORRELATION jugular foramen.
V) APPENDIX While moving towards the medulla it gives off the
meningeal branch.
Fibers within the vagus nerve: a. This branch supplies sensation to the meninges.
GVE (parasympathetic), GVA, GSA, SVA and SVE Finally, GSA fibers come into the medulla and synapse
(muscles from 4th and 5th pharyngeal arches). in the spinal nucleus of CN V.
(2) Structures supplied
• Tympanic cavity and tympanic membrane.
• External acoustic meatus
• Skin behind the ear.

II) SVA FIBERS

(1) Course
Fibers coming from the taste buds of the epiglottis and
pharynx travel to the Inferior ganglion of CN X or nodose
ganglion.
Central processes from the ganglion enter the cranial
cavity through the jugular foramen.
Fibers keep moving until reaching the medulla, to the
nucleus of tractus solitarius.
(2) Structures supplied
Figure 1. Nuclei of CN X and some of its structures supplied. Taste buds primarily on the epiglottis and some within
the pharynx.

Table 1. The Letter Symbols Commonly Used to Indicate the

Functional Components of Each Cranial Nerve [Clinical III) SVE FIBERS
Neuroanatomy, RS Snell].
Component Function Letter symbol
Afferent Fibers Sensory (1) Origin
General somatic General GSA Nucleus ambiguus
afferent Sensations.
Special somatic Hearing, SSA (2) Branches:
afferent balance, vision.
(i) Pharyngeal Plexus
General GVA
General visceral
sensations from
afferent Moves out of the cranial cavity and sends branches to
viscera.
Special visceral SVA supply the superior, middle and inferior pharyngeal
Smell, taste. constrictor muscles → Deglutition process
afferent
Continues anteriorly and supplies branches to most
Efferent Fibers
muscles of soft palate:
General somatic Somatic striated GSE
efferent muscles.
Glands and GVE
General visceral smooth muscles
efferent (parasympathetic
innervation).
Special visceral Branchial arch SVE
efferent striated muscles.

VAGUS NERVE | CRANIAL NERVE X NEURO PHYSIOLOGY: Note #1. 1 of 3

 (ii) Superior laryngeal nerve: IV) GVE FIBERS
Travels to the larynx and gives off two branches
o Internal branch: This one is GVE
They move with the recurrent laryngeal nerve and give
o External branch:
branches: Esophagus y trachea.
 Supplies the cricothyroid and cricopharyngeus
(1) Pulmonary plexus:
(iii) Recurrent laryngeal nerve: Formed by the anterior and posterior bronchial branches.
o Secretion or bronchoconstriction.
Right: Goes underneath the subclavian artery and
descends posteromedial. (2) Cardiac plexus:
Left: Comes underneath the aortic arch and ascends Superior cardiac branch.
posteromedial. Inferior cardiac branch.
Thoracic cardiac branch.
Inferior laryngeal nerve:
o Synapse with the intramural or terminal ganglion
o Posterior and lateral cricoarytenoid muscles
o Transverse and oblique arytenoid muscles
o Thyroarytenoid muscle (3) Esophageal plexus
 All involved in speech production / phonation. o Peristaltic contractions.
Function: They pull the vocal chords increasing their
tension and length → when air moves up against them
(i) Posterior and anterior gastric nerve
sound is produced and resonates within the larynx, o Branches coming from the esophageal plexus.
pharynx and oral cavity, producing the voice.
(4) Celiac plexus

Superior laryngeal nerve: Adrenal glands and kidneys.

• GVA fibers move alongside it. Small intestines and colon up to the splenic flexure.
o Pierce through the thyrohyoid membrane Pancreas and spleen.
 Supply mucosa of the larynx, above the vocal
chords. (5) Hepatic plexus
 Sensations to epiglottis
Liver and gallbladder.

V) GVA FIBERS

Branch moving with the inferior laryngeal nerve

o Innervation to the mucosa of larynx below vocal
chords.
Branch moving with the superior laryngeal nerve:
o Innervation to the mucosa of larynx, above vocal
chords, as well as sensation of epiglottis.
Branches coming from the carotid bodies and aortic
bodies
All three GVA branches come together and synapse on
the inferior ganglion.
They enter through the jugular foramen.
Synapsis on the dorsal nucleus of vagus and a small
portion to the nucleus of tractus solitarius.

Branches on the lungs:

o Stretch receptors and different types of irritant
receptors detect changes on the lungs and
sensations are carried by GVA fibers from CN X.
Branches move with the esophageal plexus:
o Sensation to the esophagus.
Branches move with the celiac plexus:
o Sensations to same organs.
Figure 2. GVE and GVA fibers of CN X.
Branches move with hepatic plexus:
o Sensations to liver and gallbladder.

THORACIC AND ABDOMINAL VISCERA VI) CLINICAL CORRELATION

(1) Damage of CN X
GVE → Peristalsis and secretions
GVA → Sensations Negative gag reflex
Uvula lean contralateral to the lesion
Cardiac plexus: Heart beat won’t slow down.
Abnormal peristalsis or secretions.

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 VII) APPENDIX

Figure 3. Vagus nerve: Origin, course and structures supplied.

VIII) REVIEW QUESTIONS IX) REFRENCES

1) Type of fibers in charge of taste on the epiglottis:
● Snell, R. S. (2010). Clinical neuroanatomy (7th ed.).
a) SVA Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.
b) SVE ● . Snell, R. S. (2010). Clinical neuroanatomy (7th ed.).
c) GSA Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.
● Sabatine MS. Pocket Medicine: the Massachusetts General
d) SSA Hospital Handbook of Internal Medicine. Philadelphia: Wolters
2) Type of fibers in charge of supplying the phonation Kluwer; 2020.
● Le T. First Aid for the USMLE Step 1 2020. 30th anniversary
process: edition: McGraw Hill; 2020.
a) SVA ● Williams DA. Pance Prep Pearls. Middletown, DE: Kindle Direct
b) SVE Publishing Platform; 2020.
● Papadakis MA, McPhee SJ, Rabow MW. Current Medical
c) GSA Diagnosis & Treatment 2018. New York: McGraw-Hill
d) GVE Education; 2017.
● Jameson JL, Fauci AS, Kasper DL, Hauser SL, Longo DL,
3) If the following types fibers get damage, one Loscalzo J. Harrison's Principles of Internal Medicine, Twentieth
consequence can be losing sensation of the Edition (Vol.1 & Vol.2). McGraw-Hill Education / Medical; 2018
tympanic cavity:
● Marieb EN, Hoehn K. Anatomy & Physiology. Hoboken, NJ:
a) SVA Pearson; 2020.
b) GSA ● Boron WF, Boulpaep EL. Medical Physiology.; 2017.
c) SSA Netter FH, Felten DL, Józefowicz Ralph F. Netter's Atlas of Human
● Neuroscience. Teterboro, NJ: Icon Learning Systems; 2004.
d) SVE ● Netter FH. Atlas of Human Anatomy. Amsterdam: Elsevier;
4) The following are different types within the vagus 2018.
● Westover MB. Pocket Neurology. Lippincott Williams & Wilkins;
nerve EXCEPT for: 2016.
a) GSA ● Guyton and Hall Textbook of Medical Physiology. Philadelphia,
b) SVA PA: Elsevier; 2021.
c) SVE
d) SSA

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