Following is a somewhat technical description of our amazing vagus nerve complex. This is a cranial nerve which, quite elegantly, travels from within our brains, down through all of our major organs, and into our gastro-intestinal system, governing taste, speech, circulation, digestion and so much more.
I am suspecting that our so called gut-brain is influential in so many of our chronic illnesses and conditions.
In our practice on Monday, let’s see if we can imagine sending loving kindness and appreciation to this wonderful and complex part of our bodies.
The vagus nerve is the 10th cranial nerve.
Sensory: Innervates the skin and larynx. Provides visceral sensation to the heart and abdomen.
Special Sensory: Provides taste sensation to the epiglottis and root of the tongue.
Motor: Provides motor innervation to the majority of the muscles of the pharynx, soft palate and larynx.
Parasympathetic: Innervates the smooth muscle of the trachea, bronchi and gastro-intestinal tract and regulates heart rhythm.
Anatomical Course
The vagus nerve has the longest course of all the cranial nerves, extending from the head to the abdomen. Its name is derived from the Latin ‘vagary’ – meaning wandering. It is sometimes referred to as the wandering nerve.
In the Head
The vagus nerve originates from the medulla of the brain stem.
Within the cranium, the auricular branch arises. This supplies sensation to the posterior part of the external auditory and canal external ear.
In the Neck
At the base of the neck, the right and left nerves have differing pathways:
- The right vagus nerve passes anterior to the subclavian artery and posterior to the sternoclavicular joint, entering the thorax.
- The left vagus nerve passes inferiorly between the left common carotid and left subclavian arteries, posterior to the sternoclavicular joint, entering the thorax.
Several branches arise in the neck:
- Pharyngeal branches – Provides motor innervation to the majority of the muscles of the pharynx and soft palate.
- Superior laryngeal nerve – Splits into internal and external branches. The external laryngeal nerve innervates the cricothyroid muscle of the larynx. The internal laryngeal provides sensory innervation to the laryngopharynx and superior part of the larynx.
- Recurrent laryngeal nerve (right side only) – Hooks underneath the right subclavian artery, then ascends towards to the larynx. It innervates the majority of the intrinsic muscles of the larynx.
In the Thorax
In the thorax, the right vagus nerve forms the posterior vagal trunk, and the left forms the anterior vagal trunk. Branches from the vagal trunks contribute to the formation of the oesophageal plexus, which innervates the smooth muscle of the oesophagus.
Two other branches arise in the thorax:
- Left recurrent laryngeal nerve – it hooks under the arch of the aorta, ascending to innervate the majority of the intrinsic muscles of the larynx.
- Cardiac branches – these innervate regulate heart rate and provide visceral sensation to the organ.
The vagal trunks enter the abdomen via the oesophageal hiatus, an opening in the diaphragm.
In the Abdomen
In the abdomen, the vagal trunks terminate by dividing into branches that supply the oesophagus, stomach and the small and large bowel (up to the splenic flexure).
Sensory Functions
There are somatic and visceral components to the sensory function of the vagus nerve. Somatic refers to sensation from the skin and muscles. This is provided by the auricular nerve, which innervates the skin of the posterior part of the external auditory canal and external ear.
Viscera sensation is that from the organs of the body. The vagus nerve innervates:
- Laryngopharynx – via the internal laryngeal nerve.
- Superior aspect of larynx (above vocal folds) – via the internal laryngeal nerve.
- Heart – via cardiac branches of the vagus nerve.
- Gastro-intestinal tract (up to the splenic flexure) – via the terminal branches of the vagus nerve.
Special Sensory Functions
The vagus nerve has a minor role in taste sensation. It carries afferent fibres from the root of the tongue and epiglottis.
Motor Functions
The vagus nerve innervates the majority of the muscles associated with the pharynx and larynx. These muscles are responsible for the initiation of swallowing and phonation.
Muscles of the Pharynx
Most of the muscles of the pharynx are innervated by the pharyngeal branchesof the vagus nerve:
- Superior, middle and inferior pharyngeal constrictor muscles
- Palatopharyngeus
- Salpingopharyngeus
An additional muscle of the pharynx, the stylopharyngeus, is innervated by the glossopharyngeal nerve.
Muscles of the Larynx
Innervation to the intrinsic muscles of the larynx is achieved via the recurrent laryngeal nerve and external branch of the superior laryngeal nerve.
Recurrent laryngeal nerve:
- Thyro-arytenoid
- Posterior crico-arytenoid
- Lateral crico-arytenoid
- Transverse and oblique arytenoids
- Vocalis
External laryngeal nerve:
Other Muscles
In addition to the pharynx and larynx, the vagus nerve also innervates the palatoglossus of the tongue, and the majority of the muscles of the soft palate.
Parasympathetic Functions
In the thorax and abdomen, the vagus nerve is the main parasympathetic outflow to the heart and gastro-intestinal organs.
The Heart
Cardiac branches arise in the thorax, conveying parasympathetic innervation to the sino-atrial and atrio-ventricular nodes of the heart.
These branches stimulate a reduction in the resting heart rate. They are constantly active, producing a rhythm of 60 – 80 beats per minute. If the vagus nerve was lesioned, the resting heart rate would be around 100 beats per minute.
Gastro-Intestinal System
The vagus nerve provides parasympathetic innervation to the majority of the abdominal organs. It sends branches to the oesophagus, stomach and most of the intestinal tract – up to the splenic flexure of the large colon.
The function of the vagus nerve is to stimulate smooth muscle contraction and glandular secretions in these organs. For example, in the stomach, the vagus nerve increases the rate of gastric emptying, and stimulates acid production.
