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Glossopharyngeal, vagus & 
accessory nerve complexes 
Dr / Hytham Nafady
Introduction
Nuclei 
• The glossopharyngeal & vagus nerves arise from 3 
nucleus columns. 
Special visceral motor 
column of the medulla 
Nucleus ambiguus 
Preganglionic 
parasympathetic column 
Dorsal motor nucleus of 
vagus 
Visceral sensory column Solitary nucleus
3-nucleus 
ambiguus 
2-dorsal 
motor 
nucleus 
1-solitary 
nucleus 
Vagus nerve
3-nucleus 
ambiguus 
2-dorsal 
motor 
nucleus 
1-solitary 
nucleus 
Vagus nerve
Jugular foramen
Sphenoid 
spine 
Vaginal 
process 
Hypoglossal 
canal 
Stylomastoid 
foramen
Carotico-jugular 
spine 
Facial nerve 
canal 
Sigmoid 
sinus
Facial 
nerve 
canal 
Petro-occipital 
fissure 
Jugular 
spine
Petro-occipital fissure 
Cochlear 
aqueduct Hypotympanum 
Foramen 
lacerum 
Petro-occipital fissure
Cn10&11 
Interjugular 
process 
septum 
Cn9 
ICA 
IPS Cn9 
Sigmoid 
sinus
IPS
Cn9 
IPS IPS 
Sigmoid 
sinus
Vagus 
nerve 
Pharyngeal 
plexus 
Superior 
Laryngeal 
nerve 
Recurrent 
Laryngeal 
Nerve 
External 
Laryngeal 
nerve 
Internal 
Laryngeal 
nerve
A. Pharyngeal plexus 
B. superior laryngeal N. 
C. internal laryngeal N. 
D. external laryngeal N. 
E. recurrent laryngeal N.
Ultrasound imaging of Vagus N.
Vagus N. 
Recurrent 
laryngeal 
N.
Vagus N. 
CCA 
IJV
Plexiform neurofibroma of the vagus 
nerve in patient with NF1
Perineural tumor spread along 9, 10 & 
11 cranial nerves from left parotid 
acinic cell carcinoma
Glomus vagale
Ultrasound imaging of spinal 
accessory N.
Inferior tympanic canaliculus
Inferior tympanic canaliculus
Aberrant internal carotid artery with 
enlarged inferior tympanic canaliculus
Vascular loop compression 
VA 
Vagus N 
VA
Vascular loop compression of the 
glossopharyngeal N. 
• Glossopharyngeal neuralgia in a 56-year-old 
woman due to neurovascular contact 
between the left CN IX and the vertebral 
artery
GP hiatus 
GP N. 
GP N. 
GP N. 
PICA A 
VA
Atrophy of posterior crico-arytenoid 
muscle
Rt posterior 
cricoarytenoid 
Lt posterior 
cricoarytenoid
Atrophy of thyro-arytenoid muscle
Thyro-arytenoid 
Ligament
Trapezius muscle atrophy
Atrophy of trapezius muscle & 
hypertrophy of levator scapulae muscle 
after radical neck dissection

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