Etiology and pathogenesis. The causes of PG can be stroke, traumatic brain injury, neck and spine injuries, surgery on the neck, chest organs, skull, diverticulum of the trachea and esophagus, enlargement of the heart and aortic arch (tetralogy of Fallot, mitral valve disease, aortic aneurysm, ventricular hypertrophy , dilatation pulmonary artery) . Disruption of the innervation of the larynx can develop due to compression of the recurrent nerve or its involvement in the pathological process by hematoma, inflammatory infiltrate, tumor or metastatic process. Neuritis of the recurrent nerve, inflammatory, toxic and metabolic genesis(viral etiology, poisoning with barbiturates, organophosphates and alkaloids, hypocalcemia, hypokalemia, diabetes and thyrotoxicosis) can also be causes of PG.
Most often, damage to the recurrent nerve develops during operations for thyroid diseases. It was noted that with primary intervention the rate of complications is 3%, with repeated intervention - 9%. A number of authors refer to complications in the form of paresis or paralysis of the recurrent nerve after surgery on the thyroid gland and vascular bundle of the neck with the general term “crash injuries” without specifying the nature of the injury. It has been noted that a violation of the innervation of the larynx develops as a result of the impact on the recurrent nerve with instruments during surgery, with hemostasis (pressure with a napkin), trauma with suture material, hematoma, wound exudate, toxic effects of anesthetics, disinfectant solutions.
Diagnostics. Diagnosis of PG is based on data from the laryngoscopic picture and anamnesis. For PG, a voiced breath is characteristic - inspiratory stridor. During laryngoscopy, the vocal folds are in the median or paramedian position. In addition, paralysis of central origin is characterized by impaired mobility of the tongue, soft palate and changes in speech articulation.
Examination of a patient with suspected paresis or PG involves the following algorithm: microlaryngoscopy, computed tomography(CT) or X-ray tomography of the larynx and trachea in direct and lateral projections, X-ray of the chest organs. Clinical and biochemical blood tests are required. In case of respiratory decompensation, emergency measures are first taken to normalize breathing to the required extent, and then an examination.
Differential diagnosis of PG is carried out with other diseases that are the cause respiratory failure: laryngospasm, myocardial infarction, pulmonary embolism, brainstem stroke. In cases where the patient's condition does not require urgent surgery, patients with PG undergo a general clinical examination, CT scan of the neck and chest, endoscopic examination of the larynx, trachea, esophagus, lungs, ultrasound of the neck and thyroid gland, and tomographic examination of the brain. To establish the etiology of PG when its genesis is unclear, consultations with an endocrinologist, neurologist, pulmonologist, or thoracic surgeon are indicated.
Clinic. For an adequate assessment of the severity of the condition, the correct choice of treatment method and accurate prediction of the course of the disease, an assessment of the patient’s complaints and medical history is of great importance. The degree of stenosis of the lumen of the larynx and, accordingly, the severity of the patient’s condition is determined by general examination and conducting a general clinical examination.
With PG, all 3 functions of the larynx are affected: respiratory, protective and vocal. The voice with bilateral PH can be sonorous, sometimes there is an aspirated hoarseness. A sonorous voice in combination with inspiratory stridor, the absence of acute inflammation ( normal temperature, absence of pain), as well as anamnestic data (surgery performed on the neck, thyroid gland, chest, cranial cavity, etc.) should lead the doctor to think about possible stenosis of the respiratory tract, which is caused by PG.
Respiratory dysfunction develops with unilateral and bilateral PG in cases where the size of the glottis does not correspond to the anthropometric characteristics of a person, with increased body weight, small sizes larynx, significant physical activity, concomitant pathology (with acute and chronic laryngitis), acute respiratory diseases, lung disease, other factors causing respiratory failure of mixed origin.
The severity of the clinical manifestations of airway stenosis depends on the size of the glottis. The patient’s condition is also influenced by concomitant somatic pathology: cardiovascular and pulmonary, metabolic disorders (hypothyroidism, hypoparathyroidism, etc.), deformation of the cervical and thoracic spine. With laryngeal stenosis and breathing compensation, there is a shortening of the pause between inhalation and exhalation, prolongation of inspiration (inspiratory dyspnea), a decrease in the number breathing movements in 1 min. and distortion of the normal ratio of the number of respiratory movements and pulse beats, when instead of the normal ratio of 1:4, a ratio of 1:6, 1:7 and 1:8 appears. In this case, breathing becomes noisy, and a change in frequency, tension and pulse rhythm occurs.
With respiratory decompensation general condition The patient's symptoms are severe, characterized by weakness, apathy or extreme anxiety. There is cyanosis of the fingers and face, shortness of breath at rest and with slight physical exertion, noisy breathing, audible inspiration (inspiratory dyspnea), increased breathing, involvement of auxiliary muscles in breathing, tachycardia, increased blood pressure.
In acute laryngeal stenosis, the clinical picture of the disease is more pronounced than in chronic stenosis, even with a relatively wide glottis. The clinical picture of chronic stenosis can be “blurred” due to the body’s adaptation to hypoxia due to compensatory and adaptive reactions.
Treatment. Bilateral laryngeal paresis that developed in early postoperative period as a result of damage to the recurrent nerve, in the absence of symptoms of acute respiratory failure, it is treated conservatively for 10-14 days.
Therapy includes prescription antibacterial drugs broad spectrum of action, hormone therapy. If a hematoma is present, drugs that affect blood clotting, vitamin therapy, hyperbaric oxygenation sessions, stimulating therapy, drugs that improve the rheological properties of blood, are prescribed. vascular therapy. If the dynamics are positive, a course of phonopedic exercises is carried out. Until the symptoms of respiratory failure are compensated, the patient should be under the supervision of an otolaryngologist.
Treatment regimen for patients with bilateral PG after strumectomy in the acute phase (1-4 weeks):
- broad-spectrum antibiotics intramuscularly or intravenously - 7-9 days;
- hormones intravenously (dexamethasone, prednisolone);
- etamsylate 2.0 intramuscularly - 1-3 days. after surgery;
- HBO - 8-10 sessions from the 1st day;
- cocarboxylase 100 mg intravenously 2 times/day;
- angioprotectors (pentoxifylline) intravenously;
- pentoxifylline 5.0 intravenous drip from 6-8 days. after surgery;
- multivitamins 2.0 after 2 days. No. 5 intravenously;
- drugs with a combined metabolic effect - actovegin, intravenous vinpocetine No. 10;
- physiotherapy (phonophoresis of medicinal substances, magnetic laser);
- neuroprotectors - neostigmine methyl sulfate subcutaneously.
After 1 month. after surgery and in the presence of bilateral laryngeal paresis, we can talk about PG. Treatment tactics are determined individually depending on the following factors: the severity of symptoms of respiratory failure, the size of the glottis, the underlying disease, and concomitant pathology. Under favorable circumstances, it is possible to simultaneously perform tracheostomy and laryngoplasty to the required extent. To restore breathing, an emergency tracheostomy is performed under local anesthesia or under anesthesia. Surgery under anesthesia is possible with fiberoptic tracheal intubation without the use of muscle relaxants. Most patients with bilateral PG require surgical treatment. Indications for reconstructive surgery include impaired mobility of the vocal folds and the inability to breathe adequately through natural ways, ineffectiveness of conservative treatment. Contraindications for plastic surgery are old age, severe concomitant pathology, malignant diseases thyroid gland.
The question of the nature of palliative treatment is decided individually on the basis of objective data and laryngoscopic data (Fig. 1).
Functional surgery of bilateral PG has a number of features:
1. A thorough preoperative examination is necessary to clarify the extent of damage and factors complicating the operation.
2. The surgical approach must be carefully planned. It is necessary to choose a single method of intervention from all the alternatives. The primary operation should be 99.9% successful, because... the supply of healthy tissue is exhausted.
3. Plastic surgery of the vocal tract on the side of the operation with auto- or allo-tissues significantly improves the functional result of the operation (Fig. 2).
Rehabilitation of patients with bilateral paresis or PG allows achieving full recovery respiratory function and partial - voice. The rehabilitation period for patients with simultaneous tracheostomy and laryngoplasty is 3-4 months.
Literature
1. Palchun V.T. Otorhinolaryngology. National leadership. M., 2008. pp. 760-766.
2. Encyclopedic Dictionary of Medical Terms. T.I.M., 1983.
3. Banar I.M. Microsurgery in the elimination of paralytic stenoses of the larynx: Abstracts of reports at the IX Congress of Otorhinolaryngologists of the USSR. November 15-17, 1988, Chisinau. pp. 314-315.
4. Kirasirova E.A. Rehabilitation of patients with traumatic injury larynx and trachea of various etiologies: Dis. ...doc. honey. Sci. M., 2004.
5. Continuous laryngeal nerve integrity monitoring during thyroidectomy: does it reduce the risk of injury? /M.L. Robertson et al. // Otolaryngol Head Neck Surg. 2004. Nov. Vol. 131. No. 5. P. 596-600.
6. F. Procacciante et al. Palpatory method used to identify the recurrent laryngeal nerve during thyroidectomy // World J Surg. 2001 Feb. Vol. 25. No. 2. P. 252-253.
7. Valdina E.A. Thyroid diseases. St. Petersburg, 2006. P. 368.
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X pair - vagus nerves
(n. vagus), mixed, develops in connection with the fourth and fifth gill arches, and is widely distributed due to which it got its name. Innervates the respiratory organs, organs of the digestive system (up to the sigmoid colon), thyroid and parathyroid glands, adrenal glands, kidneys, and participates in the innervation of the heart and blood vessels (Fig. 1).
Rice. 1.
1 - dorsal nucleus of the vagus nerve; 2 - nucleus of the solitary tract; 3 - core spinal tract trigeminal nerve; 4 - double core; 5 - cranial root of the accessory nerve; 6 - vagus nerve; 7 - jugular foramen; 8 - superior node of the vagus nerve; 9 - lower node of the vagus nerve; 10 - pharyngeal branches of the vagus nerve; 11 - connecting branch of the vagus nerve to the sinus branch of the glossopharyngeal nerve; 12 - pharyngeal plexus; 13 - superior laryngeal nerve; 14 - internal branch of the superior laryngeal nerve; 15 - external branch of the superior laryngeal nerve; 16 - superior cardiac branch of the vagus nerve; 17 - lower cardiac branch of the vagus nerve; 18 - left recurrent laryngeal nerve; 19 - trachea; 20 - cricothyroid muscle; 21 - lower constrictor of the pharynx; 22 - middle pharyngeal constrictor; 23 - stylopharyngeal muscle; 24 - superior pharyngeal constrictor; 25 - velopharyngeal muscle; 26 - muscle that lifts the velum palatine, 27 - auditory tube; 28 - auricular branch of the vagus nerve; 29 - meningeal branch of the vagus nerve; 30 - glossopharyngeal nerve
The vagus nerve contains sensory, motor and autonomic parasympathetic and sympathetic fibers, as well as small intra-stem nerve ganglia.
Sensitive nerve fibers of the vagus nerve originate from afferent pseudounipolar nerve cells, clusters of which form 2 sensory nodes: superior (ganglion superior), located in the jugular foramen, and lower (ganglion inferior), lying at the exit from the hole. The central processes of the cells go into the medulla oblongata to the sensitive nucleus - nucleus of the solitary tract (nucleus tractus solitarii), and peripheral ones - as part of the nerve to the vessels, heart and viscera, where they end with receptor apparatus.
Motor fibers for the muscles of the soft palate, pharynx and larynx originate from the upper cells of the motor dual core.
Parasympathetic fibers originate from the autonomic dorsal nucleus(nucleus dorsalis nervi vagi) and spread as part of the nerve to the heart muscle, muscle tissue membranes of blood vessels and viscera. Impulses traveling along parasympathetic fibers reduce the heart rate, dilate blood vessels, narrow the bronchi, and increase peristalsis of the tubular organs of the gastrointestinal tract.
Autonomous postganglionic sympathetic fibers enter the vagus nerve along its connecting branches with the sympathetic trunk from the cells of the sympathetic ganglia and spread along the branches of the vagus nerve to the heart, blood vessels and viscera.
As noted, the glossopharyngeal and accessory nerves are separated from the vagus nerve during development, so the vagus nerve maintains connections with these nerves, as well as with the hypoglossal nerve and the sympathetic trunk through connecting branches.
The vagus nerve leaves the medulla oblongata behind the olive through numerous roots, merging into a common trunk, which leaves the skull through the jugular foramen. Next, the vagus nerve goes downward as part of the cervical neurovascular bundle, between the internal jugular vein and the internal carotid artery, and below the level of the upper edge of the thyroid cartilage - between the same vein and the common carotid artery. Through the superior thoracic aperture the vagus nerve enters the posterior mediastinum between the subclavian vein and artery on the right and in front of the aortic arch on the left. Here, by branching and connections between the branches, it forms in front of the esophagus (left nerve) and behind it (right nerve) esophageal nerve plexus(plexus oesophagealis), which forms 2 near the esophageal opening of the diaphragm wandering trunk: anterior (tractus vagalis anterior) And posterior (tractus vagalis posterior), corresponding to the left and right vagus nerves. Both trunks exit the chest cavity through the esophageal opening, give branches to the stomach and end with a number of terminal branches in celiac plexus. From this plexus, fibers of the vagus nerve spread along its branches. Throughout the entire length of the vagus nerve, branches extend from it.
Branches of the cerebral vagus nerve.
1. Meningeal branch (r. meningeus) starts from the superior node and through the jugular foramen reaches the dura mater of the posterior cranial fossa.
2. Auricular branch (r. auricularis) goes from the superior node along the anterolateral surface of the jugular vein bulb to the entrance to the mastoid canaliculus and further along it to back wall outdoor ear canal and parts of the skin of the auricle. On its way it forms connecting branches with the glossopharyngeal and facial nerves.
Branches of the cervical vagus nerve.
1. Pharyngeal branches (rr. pharyngeales) originate from the bottom node or immediately below it. They receive thin branches from the upper cervical ganglion of the sympathetic trunk and, between the external and internal carotid arteries, penetrate to the lateral wall of the pharynx, on which, together with the pharyngeal branches of the glossopharyngeal nerve and the sympathetic trunk, they form the pharyngeal plexus.
2. Superior laryngeal nerve (rr. laryngeus superior) branches from the lower node and descends down and forward along the lateral wall of the pharynx medially from the internal carotid artery (Fig. 2). At the greater horn, the hyoid bone is divided into two branches: external (r. externus) And internal (r. internus). The external branch connects with branches from the superior cervical ganglion of the sympathetic trunk and runs along the posterior edge of the thyroid cartilage to the cricothyroid muscle and the inferior constrictor of the pharynx, and also intermittently gives branches to the arytenoid and lateral cricoarytenoid muscles. In addition, branches extend from it to the mucous membrane of the pharynx and the thyroid gland. The internal branch is thicker, more sensitive, pierces the thyrohyoid membrane and branches in the mucous membrane of the larynx above the glottis, as well as in the mucous membrane of the epiglottis and the anterior wall of the nasal pharynx. Forms a connecting branch with the inferior laryngeal nerve.
Rice. 2.
a — right view: 1 — superior laryngeal nerve; 2 - internal branch; 3 - outer branch; 4 - lower pharyngeal constrictor; 5 - cricopharyngeal part of the lower constrictor of the pharynx; 6 - recurrent laryngeal nerve;
b — the plate of the thyroid cartilage is removed: 1 — the internal branch of the superior laryngeal nerve; 2 - sensitive branches to the mucous membrane of the larynx; 3 - anterior and posterior branches of the inferior laryngeal nerve; 4 - recurrent laryngeal nerve
3. Superior cervical cardiac branches (rr. cardiaci cervicales superiors) - branches varying in thickness and level, usually thin, originate between the superior and recurrent laryngeal nerves and go down to the thoracic nerve plexus.
4. Inferior cervical cardiac branches (rr. cardiaci cervicales inferiors) depart from the laryngeal recurrent nerve and from the trunk of the vagus nerve; participate in the formation of the cervicothoracic nerve plexus.
Branches of the thoracic vagus nerve.
1. Recurrent laryngeal nerve (n. laryngeus recurrens) arises from the vagus nerve as it enters the chest cavity. The right recurrent laryngeal nerve bends around the subclavian artery from below and behind, and the left one around the aortic arch. Both nerves ascend in the groove between the esophagus and trachea, giving branches to these organs. Final branch - inferior laryngeal nerve(n. laryngeus inferior) approaches the larynx and innervates all the muscles of the larynx, with the exception of the cricothyroid, and the mucous membrane of the larynx below the vocal cords.
Branches from the recurrent laryngeal nerve extend to the trachea, esophagus, thyroid and parathyroid glands.
2. Thoracic cardiac branches (rr. cardiaci thoracici) begin from the vagus and left laryngeal recurrent nerves; participate in the formation of the cervicothoracic plexus.
3. Tracheal branches go to the thoracic trachea.
4. Bronchial branches are directed to the bronchi.
5. Esophageal branches approach the thoracic esophagus.
6. Pericardial branches innervate the pericardium.
Within the cavities of the neck and chest, the branches of the vagus, recurrent and sympathetic trunks form the cervicothoracic nerve plexus, which includes the following organ plexuses: thyroid, tracheal, esophageal, pulmonary, cardiac:
Branches of the vagus trunks (ventral part).
1) anterior gastric branches start from the anterior trunk and form the anterior gastric plexus on the anterior surface of the stomach;
2) posterior gastric branches originate from the posterior trunk and form the posterior gastric plexus;
3)celiac branches originate mainly from the posterior trunk and take part in the formation of the celiac plexus;
4) hepatic branches are part of the hepatic plexus;
5) renal branches form renal plexuses.
XI pair - accessory nerve
(p. accessories) is mainly motor, separated during development from the vagus nerve. It begins in two parts - the vagus and the spinal cord - from the corresponding motor nuclei in the medulla oblongata and spinal cord. Afferent fibers enter the trunk through the spinal part from the cells of the sensory nodes (Fig. 3).
Rice. 3.
1 - double core; 2 - vagus nerve; 3 - cranial root of the accessory nerve; 4 - spinal root of the accessory nerve; 5 - large hole; 6 - jugular foramen; 7 - superior node of the vagus nerve; 8 - accessory nerve; 9 - lower node of the vagus nerve; 10 - first spinal nerve; 11 - sternocleidomastoid muscle; 12 - second spinal nerve; 13 - branches of the accessory nerve to the trapezius and sternocleidomastoid muscles; 14 - trapezius muscle
The wandering part comes out cranial root(radix cranialis) from the medulla oblongata below the exit of the vagus nerve, the spinal part is formed spinal root (radix spinalis), emerging from the spinal cord between the dorsal and anterior roots.
The spinal part of the nerve rises to the foramen magnum, enters through it into the cranial cavity, where it connects with the vagus part and forms the common trunk of the nerve.
In the cranial cavity, the accessory nerve divides into two branches: internal And external.
1. Internal branch (r. internus) approaches the vagus nerve. Through this branch, the vagus nerve includes motor nerve fibers that leave it through the laryngeal nerves. It can be assumed that sensory fibers also pass into the vagus and further into the laryngeal nerve.
2. Outer branch (r. externus) exits the cranial cavity through the jugular foramen to the neck and goes first behind the posterior belly of the digastric muscle, and then from inside the sternocleidomastoid muscle. Perforating the latter, the external branch goes down and ends in the trapezius muscle. Connections are formed between the accessory and cervical nerves. Innervates the sternocleidomastoid and trapezius muscles.
XII pair - hypoglossal nerve
(n. hypoglossus) is predominantly motor, formed as a result of the fusion of several primary spinal segmental nerves innervating the hypoglossal muscles.
The nerve fibers that make up the hypoglossal nerve extend from its cells motor nucleus located in the medulla oblongata. The nerve emerges from it between the pyramid and the olive with several roots. The formed nerve trunk passes through the canal of the hypoglossal nerve to the neck, where it is located first between the external (outside) and internal carotid arteries, and then descends under the posterior belly of the digastric muscle in the form of an open upward arc along the lateral surface of the hyoglossus muscle, constituting the upper side of Pirogov's triangle (lingual triangle) (Fig. 4); branches into terminal lingual branches(rr. linguales), innervating the muscles of the tongue.
Rice. 4.
1 - hypoglossal nerve in the canal of the same name; 2 - nucleus of the hypoglossal nerve; 3 - lower node of the vagus nerve; 4 - anterior branches of the 1st-3rd cervical spinal nerves (form a cervical loop); 5 - top cervical node sympathetic trunk; 6 - upper root of the neck loop; 7 - internal carotid artery; 8 - lower root of the neck loop; 9 - neck loop; 10 - internal jugular vein; 11—common carotid artery; 12—lower belly of the omohyoid muscle; 13 - sternothyroid muscle; 14 - sternohyoid muscle; 15 - upper belly of the omohyoid muscle; 16 - thyrohyoid muscle; 17 - hypoglossus muscle; 18 - geniohyoid muscle; 19—genioglossus muscle; 20—own muscles of the tongue; 21 - styloglossus muscle
From the middle of the nerve arch goes down along the common carotid artery superior root of the cervical loop (radix superior ansae cervicalis), which connects with her lower root (radix inferior) from the cervical plexus, resulting in the formation neck loop (ansa cervicalis). Several branches extend from the cervical loop to the neck muscles located below the hyoid bone.
The position of the hypoglossal nerve in the neck can vary. In people with long necks, the arc formed by the nerve lies relatively low, while in people with short necks it lies high. This is important to consider when performing nerve operations.
The hypoglossal nerve also contains other types of fibers. Sensory nerve fibers come from the cells of the inferior ganglion of the vagus nerve and, possibly, from the cells of the spinal ganglia along the connecting branches between the hypoglossal, vagus and cervical nerves. Sympathetic fibers enter the hypoglossal nerve along its connecting branch with the superior ganglion of the sympathetic trunk.
Areas of innervation, fiber composition and names of nuclei cranial nerves are presented in table. 1.
Table 1. Areas of innervation, fiber composition and names of cranial nerve nuclei
|
Pair |
Nerve |
Fiber composition (predominant) |
Names of nuclei located in the brain stem |
Innervated organs |
|
Nervus terminalis |
Sympathetic(?) |
|
Blood vessels and glands of the nasal mucosa |
|
|
Nervi olfactorii |
Sensitive |
|
Regio olfactoria of the nasal mucosa |
|
|
Sensitive |
|
Retina of the eyeball |
||
|
Motor |
Nucleus n. oculomotorii |
M. Levator palpebrae superioris, m. rectus medialis, m. rectus superior, m. rectus inferior, m. obliquus inferior |
||
|
Parasympathetic |
Nucleus n. oculomotorius accessorius |
M. ciliaris, m. sphincterpupillae |
||
|
Nervus trochlearis |
Motor |
Nucleus n. trochlearis |
M. obliquus superior |
|
|
Nervus trigeminus |
Motor |
Nucleus motorius n. trigemini |
Mm. masticatorii, m. tensoris veli palatini, m. tensor tympani, venter anterior m. digastrici |
|
|
Sensitive |
Nucleus mesence-phalicus n. trigemini |
Skin of the frontal and temporal parts of the head, facial skin. Mucous membranes of the nasal and oral cavity, anterior 2/3 tongue, teeth, salivary glands, organs of the orbit, dura mater of the brain in the region of the anterior and middle cranial fossae |
||
|
Sensitive |
Nucleus pontinus n. trigemini |
|||
|
Sensitive |
Nucleus spinalis n. trigemini |
|||
|
Motor |
Nucleus n. abducentis |
M. rectus lateralis |
||
|
Motor |
Nucleus n. facialis |
Mm.faciales, t. platysma, venter posterior t. digastrici, m. styloideus, m. stapedius |
||
|
Nervus intermedius |
Sensitive |
Nucleus solitarius |
Taste sensitivity of the anterior 2/3 of the tongue |
|
|
Parasympathetic |
Nucleus salivatorius superior |
Glandula lacrimalis, tunica mucosa oris, tunica mucosa nasi (glands), gl. sublingualis, gl. submandibularis, glandulae salivatoria minores |
||
|
Nervus vestibulo-cochlearis |
Sensitive |
Nervus cochlearis: nucl. cochlearis anterior, nucl. cochlearis posterior |
Organon spirale, spiral organ |
|
|
Nervus vestibularis: nucl. vestibularis medialis, nucl. vestibularis superior, nucl. inferior |
Crista ampullares. Macula urticuli, macula sacculi, membranous labyrinth inner ear |
|||
|
Nervus glossopharyngeus |
Motor |
Nucleus ambiguus |
M. stylopharingeus, muscles of the pharynx |
|
|
Sensitive |
Nucleus solitarius |
Cavum tympani, tuba auditiva, tunica mucosa radicis linguae, pharingis, tonsilla palatina, glomus caroticus, auditory tube |
||
|
Parasympathetic |
Nucleus salivatorius inferior |
Glandula parotidea |
||
|
Motor |
Nucleus ambiquus |
Tunica muscutarispharingis, m. levator velipalatini, m. uvulae, m. palatoglossus, m. palatopharyngeus, mm. laryngis |
||
|
Sensitive |
Nucleus solitarius |
Dura mater encephali in the area of the posterior cranial fossa, skin of the external auditory canal. Organs of the neck, chest and abdomen (excluding the left side of the colon) |
||
|
Parasympathetic |
Nucleus dorsalis n. vagi |
Smooth muscles and glands of the thoracic and abdominal cavities(except for the left side of the colon) |
||
|
Nervus accessorius |
Motor |
Nuclei nervi accessorii (nucl. accessorius) |
M. sternocleidomastoideus, T. trapezius |
|
|
Nervus hypoglossus |
Motor |
Nucleus n. hypoglossi |
Muscles of the tongue, musculi infrahyoids |
Human anatomy S.S. Mikhailov, A.V. Chukbar, A.G. Tsybulkin
Material from Wikipedia - the free encyclopedia
| Recurrent laryngeal nerve | |
Tracheobronchial lymph nodes, rear view. The recurrent nerves are visible from above. |
|
| Location glossopharyngeal , wandering And additional nerves. |
|
| Latin Name |
nervus laryngeus recurrens |
|---|---|
| Innervation | |
| Begins | |
| Catalogs | |
Recurrent laryngeal nerve (lat. nervus laryngeus recurrens) - branch vagus nerve(tenth pair cranial nerves), which provides motor function and sensitivity of structures larynx, including vocal folds. This nerve belongs to the 6th gill arch.
The nerve is called “recurrent” because it innervates the muscles of the larynx, passing along a complex recurrent trajectory: it departs from vagus nerve, which descends from skulls V chest, and rises back to the larynx.
In humans, the left laryngeal nerve arises from the vagus nerve at the level of its intersection with aortic arch lateral to the ligamentum arteriosus. It goes around the arch of the aorta from behind, and rises in front of it in the groove between the trachea and the esophagus protruding from under it.
The right laryngeal nerve arises from the vagus nerve at the level of its intersection with subclavian artery, goes around it from behind and rises in front of it along the lateral surface of the trachea.
Next, both nerves, each on its own side, intersect with inferior thyroid artery and approach the larynx as the lower laryngeal nerves.
The following branches depart from the laryngeal nerves: lower cervical cardiac nerves; tracheal branches (innervate the mucous membrane, glands and smooth muscle trachea); esophageal branches (innervate the mucous membrane, glands and striated muscles of the upper esophagus).
The recurrent laryngeal nerve is present in all mammals, and like in humans, it departs from the vagus nerve coming from the brain, goes around the aortic arch or other large artery and goes back to the larynx. This route is especially pronounced in giraffe : total length The recurrent nerve can reach four meters, since it passes through the entire neck there (as part of the vagus nerve) and back (as an independent recurrent nerve), despite the fact that the distance from the brain to the larynx is only a few centimeters.
This inappropriate trajectory is in good agreement with synthetic theory of evolution, and is not explained by alternative approaches, and therefore is considered as one of evidence of evolution. Mammals inherited this structure of this nerve from fish that lack a neck, and the homologous branch of the vagus nerve follows an optimal trajectory.
Nervous diseases in children in alphabetical order
Apraxia develops in a child due to various pathologies that affect the brain. The disease is characterized by impaired motor functions...
According to statistics, insomnia in children occurs in 40% of cases. Insomnia occurs in both schoolchildren and newborns. Sleep disturbances can last...
Vegetative-vascular dystonia is formed in children as a result of functional changes in internal organs. In this case, all disorders arise in the nervous...
Nervous diseases in children originate in early age. The reasons are very different, and the consequences can lead to serious health problems in later life. Therefore, it is important to consult a doctor in a timely manner, as soon as the child has the slightest disturbances in speech, movements, and facial expressions. Neurological diseases in children, as a rule, directly depend on the atmosphere around them: relationships with parents, peers, and teachers. It is necessary to monitor emotional state child, regularly undergo medical examinations with him, since diseases nervous system In children it is easier to treat at the initial stage. A separate area of medicine is aimed at this – child neurology.
Among the causes of nervous diseases in children, two groups can be distinguished.
Diseases of the nervous system in children may not manifest themselves immediately. They also arise under the influence of several factors. The reasons overlap each other and manifest themselves as a result. The consequences are already felt in adult life. Childhood diseases of the nervous system develop into serious neuroses, which are much more difficult to cure. For example, all kinds of disturbances in the functioning of the psychomotor system.
Symptoms of disorders are expressed in different ways. They can manifest themselves in the child's periodic twitching, blinking, and shrugging of shoulders. Such contractions affect the muscles of the legs, arms, and face. Typical symptoms that characterize neurological diseases in children are repetitive actions: tapping, walking from one side to the other, shifting an object. Symptoms also include various smacking, coughing, and snoring.
The main symptoms indicating nervous diseases in children include:
Children's neurological diseases are divided into several types. They differ depending on what caused the disorder in the body.
Neurological diseases in children are diagnosed in several stages. First of all, the doctor conducts a survey of the child and his parents, recording not only data on the child’s health, but also how the pregnancy went and what the patient’s lifestyle is like. All this allows you to get a complete picture of the disorders and select effective treatment.
Nervous diseases in children of the central and peripheral nervous system can only be cured qualified specialists. Self-medication is dangerous. After the examination, the pediatric neurologist draws up an individually selected treatment plan, which includes the use of medications and medical procedures. If necessary, a dispensary is appointed where it is carried out medical rehabilitation children. Treatment methods depend on the patient's age.
Children's neurological diseases may not reveal themselves, so it is worth regularly undergoing examinations by specialists. In children under one year of age, pathologies such as perinatal encephalopathy, increased intracranial pressure, muscle hypertension and hypotension. Preschool age is characterized by problems associated with adaptation to society. The child may develop fears, depression, and hypoexcitability. The doctor will help you cope with all deviations. Childhood diseases of the nervous system in adolescents manifest themselves in attention deficit disorder, hyperactivity disorder, epilepsy and other disorders that arise due to problems in learning and communicating with others.
“Neurology” in children is preventable. To reduce the risk of violations, the following rules must be followed:
You can choose a pediatric neurologist for consultation or treatment on our website yourself, or call the helpline (the service is free).
This material is posted for informational purposes, does not constitute medical advice and cannot serve as a substitute for consultation with a doctor. For diagnosis and treatment, contact qualified doctors!
