The vagus nerve is the longest cranial nerve, providing parasympathetic innervation to most thoracic and abdominal viscera and motor supply to the larynx and pharynx. The recurrent laryngeal nerve supplies all intrinsic laryngeal muscles except the cricothyroid and is at risk during thyroid, parathyroid, and oesophageal surgery. Vagal tone determines resting heart rate and variability.
| Origin | Lateral medulla (dorsal motor nucleus and nucleus ambiguus) |
|---|---|
| Course | Exits through the jugular foramen, descends in the carotid sheath between the carotid artery and internal jugular vein, gives thoracic and abdominal branches through the thoracic inlet |
| Motor |
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| Sensory |
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Vagal nerve stimulation (VNS) implant treats drug-resistant epilepsy and depression by delivering regular electrical pulses to the left cervical vagus. Right vagal stimulation is avoided because of the higher right vagal influence on cardiac conduction. Arnold's nerve (auricular branch) reflex, cough triggered by ear canal manipulation, is mediated by this vagal cutaneous branch.
Vagal RLN injury from thyroid surgery or mediastinal pathology producing unilateral vocal cord paralysis and hoarseness managed with injection laryngoplasty or thyroplasty.
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