glossopharyngeal nerve injury
Introduction
Introduction The glossopharyngeal nerve is a mixed nerve that contains motor and sensory fibers. After the cranial fossa is passed through the cranial vein, the pharyngeal wall is reached between the internal and external carotid arteries. The sensory fiber is the sensory afferent nerve of the pharynx, and its motor branch is responsible for the soft palate function, and the parasympathetic fiber tube is secreted by the parotid gland. The glossopharyngeal nerve belongs to the posterior group of cranial nerves. The chance of traumatic injury is relatively small, mostly due to the fracture line and the jugular foramen. However, the lesion of the jugular vein in the posterior cranial fossa is easy to cause glossopharyngeal nerve damage. The damage and injury of the glossopharyngeal nerve are often involved in the simultaneous involvement of the posterior group of cranial nerves. The clinical diagnosis of glossopharyngeal nerve alone is extremely rare. It is characterized by the loss or disappearance of the 1/3 of the posterior tongue of the affected side, and the general feeling of the upper part of the pharynx is reduced or lost, and the soft palate is drooping. More conservative treatment is used.
Cause
Cause
The glossopharyngeal nerve belongs to the posterior group of cranial nerves. The chance of traumatic injury is relatively small, mostly due to the fracture line and the jugular foramen. However, the lesion of the jugular vein in the posterior cranial fossa is easy to cause glossopharyngeal nerve damage. The damage and injury of the glossopharyngeal nerve are often involved in the simultaneous involvement of the posterior group of cranial nerves. The clinical diagnosis of glossopharyngeal nerve alone is extremely rare. It is characterized by the loss or disappearance of the 1/3 of the posterior tongue of the affected side, and the general feeling of the upper part of the pharynx is reduced or lost, and the soft palate is drooping.
1. Firearm injuries: Individual damage to the glossopharyngeal nerve is extremely rare, occasionally due to small shrapnel injuries. In the posterior mandibular space firearm injury, the glossopharyngeal is often injured together with the vagus nerve and the accessory nerve. When the horizontal branch of the mandible is injured. The glossopharyngeal nerve is also often injured at the same time as the vagus nerve and facial nerve.
2. Surgical accidental injury: Carotid artery surgery, cervical anterior approach, thyroid surgery, etc. can often accidentally injure the extracranial segment of the glossopharyngeal nerve; the operation of the jugular vein in the posterior cranial fossa can accidentally injure the intracranial segment of the glossopharyngeal nerve and the jugular foramen .
3. Fracture: When the skull base fracture occurs, the fracture line is involved in the jugular foramen through the occipital condyle, contusion or squeezing the tongue and throat.
4. Tumor compression and infiltration can also cause damage and damage to the glossopharyngeal nerve. For example, jugular bulbar tumor, giant acoustic neuroma, brain (ridge), epithelioid cyst, chordoma, skull tumor and malignant tumor with skull base metastasis in the jugular vein region of the skull base and its vicinity; Tumors in the venous hole area; tumors on the outside of the skull base.
5. Craniofacial junction deformity: such as skull base, flat skull base, cerebellar tonsil malformation.
6. Nuclear injury: Acute nuclear injury is common in brain stem vascular disease, brain stem polio. Chronic injuries are common in medullary water, brain stem and high neck segment intramedullary tumors and multiple sclerosis.
Examine
an examination
Other auxiliary inspections:
1. Skull base X-ray film: Sometimes it can show the enlargement of the jugular foramen and the destruction of the skull base, but it is not easy to show the linear fracture of the skull base.
2. MRI: It can clearly show the posterior cranial fossa, the internal and external jugular vein and the large occipital space occupying lesions and congenital malformations. It is also the most ideal examination method for brain stem and high cervical spinal cord disease. The combination of axial, coronal, sagittal and enhanced scans can clarify the location, origin, size, relationship with surrounding structures and brain stem compression, and can also be used for qualitative diagnosis of most lesions. However, MRI is not as good as CT for skull base bone changes.
3. CT: CT scan of the posterior cranial fossa and skull base can also clearly show the site occupying lesions. In particular, the skull base window and three-dimensional reconstruction techniques can clearly show the changes in the skull base bone, and more clearly show the linear fracture of the skull base.
Diagnosis
Differential diagnosis
Differential diagnosis
It is extremely rare to damage the glossopharyngeal nerve alone. In one side, the cranial nerves are involved at the same time or at the same time as the vagus nerve.
1. Jugular vein syndrome (Vernet syndrome) IX, X, XI cranial nerve palsy.
2. Collet-Sicard syndrome IX, X, XI, XII cranial nerve palsy, or unilateral skull base syndrome.
3. Most of the occipital macroporous syndrome is lesions in the large area of the occipital bone.
4. Brain stem lesions are often manifested as bilateral multiple brain damage.
diagnosis
Diagnosis can usually be made based on clinical manifestations, combined with medical history and imaging examinations such as CT and MRI.
1. One side of the glossopharyngeal nerve injury: manifested as loss of 1/3 of the taste of the ipsilateral tongue, pain disappearance in the tongue root and pharyngeal area (due to its self-feeling, so there is no pharyngeal reflex and swallowing reflex disorder), ipsilateral The pharyngeal muscle strength is weak and the parotid gland secretes obvious obstacles. Clinically, the glossopharyngeal nerve is rarely seen in the lung injury. It often occurs simultaneously with the posterior group. When one side of the pharynx, the vagus nerve or its nerve nucleus is damaged, ipsilateral soft palsy, pharyngeal sensation loss or disappearance, pharyngeal reflex may occur. Disappear, cough, and hoarseness.
2. bilateral glossopharyngeal nerve injury: the patient has serious obstacles in eating, swallowing, and pronunciation. In severe cases, when the patient makes an "ah" sound, the soft palate and the uvula are biased to the healthy side, and even can not be pronounced and swallowed, saliva outflow, etc. True ball paralysis.
