Glossopharyngeal nerve& Cervical plexus.pptx

Glossopharyngeal nerve& Cervical plexus.pptx

1. GLOSSOPHARYNGEAL NERVE AND CERVICAL PLEXUS Presentation by, K.Sushmitha , I MDS Department of Pedodontics

2. Contents: 1)Glossopharyngeal nerve Introduction Embryology Associated nuclei Functional components Course and relations Ganglion Associated Branches and Distribution Applied anatomy

3. 2) Cervical Plexus Introduction Position and Relation Branches Applied anatomy Conclusion References

4. Introduction: 9 th cranial nerve Glosso - glossa(tongue) Pharynx- throat Mixed nerve

5. Motor- Stylopharyngeus muscle. Secretomotor- Parotid gland. Gustatory - Posterior 1/3 rd of the tongue & circumvallate papillae. Sensory – Pharynx, tonsils, soft palate carotid body & carotid sinus.

6. Embryology: Glossopharyngeal nerve Tympanic nerve

7. Derivatives of 3 rd pharyngeal arch

8. Nuclei associated: Nucleus ambiguous Inferior salivatory nucleus Nucleus of tractus solitarius Spinal nucleus of trigeminal nerve

9. Nuclei associated

10. Functional components: Nucleus ambiguous Inferior salivatory nucleus Nucleus of tractus solitarious Sensory nucleus of trigeminal nerve Motor fibres Sensory fibres

11. Functions of the fibres 1 2 3 4 1 2 3 4 5 5

12. Course and Relations

13. Ganglion Associated 1) 2) 3)

14. Branches and Distribution Tympanic branch Branch to stylopharyngeus Tonsillar branch Lingual branch Pharyngeal branch Carotid branch

15. Applied Anatomy Glossopharyngeal Neuralgia: Also called Weisenberg syndrome. A painful syndrome characterized by unilateral sharp pain in the sensory distribution of 9 th cranial nerve. Symptoms- Lancinating, stabbing pain in the ear, throat, soft palate, lateral & posterior parts of pharynx and posterior 1/3 rd of the tongue.

16. Etiology : Idiopathic - Vascular compression Secondary - Tumours - Infections -Demyelination -Trauma

17. GPN occurs in less frequency when compared to Trigeminal Neuralgia. Male predilection Seen in patients > 50 years age. Diagnosis: CT scan, MRI and Blood tests.

18. Treatment: Medical management : Phenytoin Carbamazepine Amitriptyline Glossopharyngeal nerve block or local application of cocaine solution to the throat region Other medications include baclofen, ketamine and more recently lamotrigine.

19. Surgical Management: Per-cutaneous rhizotomy: Thermocoagulation of sensory ganglion of the glossopharyngeal nerve. Percutaneous radiofrequency coagulation developed by Sweet in 1976 – successful therapy

20. Intracranial rhizotomy: Developed by Adson in 1924 and popularized by Dandy in 1927. Nerve is visualized by means of unilateral sub-occipital craniectomy. Involves the lifting the 9 th cranial nerve with a blunt hook and transecting the nerve fibers .

21. Microvascular decompression: This technique involves the separation of the nerve from compressing arterial/ venous vessels.

22. Jugular Foramen Syndrome: Also called Vernet’s syndrome. It occurs due to a lesion in the jugular foramen. It is characterized by the paresis of glossopharyngeal, vagus and spinal accessory nerves.

23. Etiology : Glomus Jugulare tumors Inflammation Varicella zoster virus infection Narrowing of the jugular foramen

24. Symptoms includes: -Dysphonia/Hoarseness -Soft palate drooping -Deviation of uvula towards normal side -Loss of sensations from posterior 1/3 rd of tongue -Decreased parotid gland secretion -Loss of gag reflex

25. Clinical Testing of Glossopharyngeal nerve:

26. Glossopharyngeal Nerve block: ( Intra-oral approach) The mouth is opened and the tongue is anesthetized with topical anesthetic . A 3 1/3 -inch, 22-gaugue needle is used 5 mL of local anesthetic solution Deposited sub- mucosally at the caudal aspect of the posterior tonsillar pillar

27. Extra-oral approach: Patient is placed in supine position. A line drawn between angle of mandible and mastoid process. Styloid process is palpated and a small gauge needle is seated against the styloid process. Needle is then withdrawn and directed posteriorly off the styloid process. Loss of bony contact, 5-7 mL of LA deposited.

28. Cervical Plexus Cervical nerves C 1 – C 8 Thoracic nerves T 1 – T 12 Lumbar Nerves L1 – L5 Sacral Nerves S1 – S5 Coccygeal nerve Cervical Plexus Brachial Plexus Intercoastal nerves Lumbar Plexus Sacral Plexus

29. Dorsal root Ventral root

30. Position and Relations

31. Branches and Distribution

32. Applied Anatomy Phrenic nerve injury: Paralysis of the diaphragm. Temporary paralysis of the diaphragm occurs by phrenic nerve block. Longer period of paralysis occurs due to surgical phrenic nerve crush.

33. Supraclavicular nerve injury: Very vulnerable to injury in case of fractures of the clavicles. Injury to supraclavicular nerve causes “waiter’s tip position”.

34. Cervical plexus block Extra–oral approach:

35. Intraoral cervical plexus anesthetic technique:

36. Description and evaluation of an intraoral cervical plexus anesthetic technique-A Randomized controlled trial Daniel P Bitner et al. Clinical Anatomy. 2015 July. Abstract: Background: Unsuccessful anesthesia of the inferior alveolar nerve may be due to supplementary innervations of mandibular molars from others branches. Aim: The purpose of this randomized controlled trial was to determine the effectiveness of an intraoral cervical plexus anesthetic technique in mandibular molars with symptomatic irreversible pulpitis when the IANB and lingual nerve blocks failed. Methods: Forty patients diagnosed with symptomatic irreversibele pulpitis received IAN and lingual nerve block prior to treatment .Patients were subjected to EPT at 2 min cycles for 10 minutes post-injection. The anesthesia was considered unsuccessful if there was a positive EPT response. The experimental group were administered 20% epinephrine using ICPAT. The control were administered 0.9% saline using the ICPAT technique Results: In the experimental group, 60% of the subjects had shown successful anesthesia. A multiple logistic regression analysis showed that the anesthesia success rate using the ICPAT method was significantly higher(P<0.05) Conclusion: The ICPAT method may be useful as a supplementary anesthetic technique for mandibular molars whom the IAN and LN blocks do not provide adequate anesthesia . BitnBitner DP, Uzbelger Feldman D, Axx K, Albandar JM. Description and evaluation of an intraoral cervical plexus anesthetic technique. Clinical Anatomy. 2015 Jul;28(5):608-13.er DP, Uzbelger Feldman D, Axx K, Albandar JM. Description and evaluation of an intraoral cervical plexus anesthetic technique. Clinical Anatomy. 2015 Jul;28(5):608-13.

37. Conclusion

38. References: Gray’s Textbook of Anatomy B D Chaurasia Textbook of Anatomy Netter atlas of human Anatomy Burket’s Textbook of Oral Medicine , Treatment & Planning Textbook of Oral & Maxillofacial Surgery by G Kruger