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Vagus Nerve Anatomy

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This is a diagram of the course of the vagus nerve

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and its branch, the recurrent laryngeal nerve.

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As you can see,

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the vagus nerve courses posteriorly

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in the carotid sheath.

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Now, you will also see that the

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sympathetic nervous system plexus

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courses posteriorly in the carotid sheath.

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The difference is that the vagus nerve is kind of in

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between the carotid artery and the jugular vein,

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whereas the sympathetic nervous system

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plexus is behind both of them.

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So the vagus nerve pathology in schwannomas tends to

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displace the carotid artery anterior medially,

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but the jugular vein posterior laterally,

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as opposed to sympathetic nervous system plexus lesions,

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which push both anteriorly.

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This diagram also shows that,

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at least for those of us looking in the neck,

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one of the primary roles of the vagus nerve

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is the innervation of the larynx.

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The predominant innervation of the larynx is through

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the recurrent laryngeal nerve. By recurrent,

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we mean that the vagus nerve comes down and then the

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recurrent laryngeal nerve comes back up and it courses

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underneath the aortic arch on the left side and

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the subclavian artery on the right side.

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This is demonstrating the right side, for example.

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And then this nerve comes back up and innervates

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the muscles of the larynx.

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So this involvement of the recurrent laryngeal nerve

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is the most common source of vocal cord paralysis.

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It is true that there are superior laryngeal nerves

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which come from the vagus which have

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a minor role in innervating the larynx.

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Suffice it to say that schwannomas of the vagus nerve

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are going to be between the carotid artery and the jugular

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vein, displacing the carotid artery, as I said,

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anterior medially, and the jugular vein posterior laterally.

Report

Description

Faculty

David M Yousem, MD, MBA

Professor of Radiology, Vice Chairman and Associate Dean

Johns Hopkins University

Tags

Neuroradiology

Neuro

Neoplastic

MRI

Head and Neck

CT

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