Vagus nerve damage
Introduction
Introduction to vagus nerve injury The vagus nerve is the longest and most widely distributed cranial nerve. It is combined with the glossopharyngeal nerve and the accessory nerve through the jugular foramen. It is located in the carotid sheath at the neck and descends between the carotid artery and the internal jugular vein. The vagus nerve is a mixed nerve. The nucleus of the vagus nerve, the solitary nucleus and the trigeminal nucleus of the trigeminal nucleus coexist with the glossopharyngeal nerve. Therefore, the simple vagus nerve injury is rare, and it often causes damage with the glossopharyngeal nerve. basic knowledge The proportion of illness: 0.003% Susceptible people: no special people Mode of infection: non-infectious Complications: gastric retention, diarrhea, recurrent ulcer
Cause
Cause of vagus nerve injury
Skull base fracture (35%):
Glossopharyngeal nerve, hypoglossal nerve and accessory nerve injury may occur. Surgery of the jugular foramen can damage the vagus nerve. Thyroid surgery can damage the laryngeal nerve and recurrent laryngeal nerve. The incidence rate is 0.4% to 3.9%.
Neck injury (20%):
Can damage the vagus nerve trunk or its branches, in the mastoid, mandibular, mandibular posterior space injury often injured and the upper part of the vagus nerve trunk, the mandibular lateral injury only the recurrent laryngeal nerve injury, the vagus nerve trunk is located behind the large blood vessels of the neck, and the blood vessels The bundle moves together and vagal nerve injury can occur when the carotid artery is injured.
Other (15%):
Tumors in the jugular foramen such as jugular bulbar tumors, schwannomas, and tumors in the medulla oblongata can damage the vagus nerve. Others such as medullary vascular disease, encephalitis caused by bacteria or viruses can damage the glossopharyngeal nerve, the vagus nerve or its nucleus.
Prevention
Vagus nerve injury prevention
First of all, you should know if the patient has carotid sinus reflex allergy. Some people advocate a preventive examination, let the patient supine, relax the neck skin, turn the head to check the opposite side, use the thumb or forefinger to press the side of the spine on the person's point, press the side and then change the other side, if it appears When the heartbeat is intermittent, the heart rate is slow, the blood pressure is lowered, or the face is pale, stop pressing immediately. If this phenomenon occurs, people can not acupuncture. However, such a test cannot be used casually. Simultaneous compression on both sides is more strictly prohibited because it can often lead to serious consequences of cardiac arrest, cerebral embolism and even death.
Complication
Vagus nerve injury complications Complications, gastric retention, diarrhea, recurrent ulcer
Complications after vagus nerve cutting
1. Gastric retention:
With the continuous understanding of vagus nerve anatomy and the continuous improvement of surgical methods, this complication has been gradually reduced. It usually occurs 3 to 4 days after surgery, that is, after removal of the gastric tube. It is characterized by upper abdominal fullness discomfort, vomiting into food or bile. Examination showed that the upper abdomen was noticeably full and bulging.
2. Diarrhea:
Diarrhea is a relatively common complication, and severe symptoms are rare. It is characterized by hyperactivity of bowel movements, bowel sounds, abdominal pain, and diarrhea after eating. This complication has a lot to do with the way the vagus nerve is cut. The vagus nerve stemtomy and selective vagus nerve ablation are not accompanied by gastric drainage, and the incidence of diarrhea is higher. The incidence of diarrhea after high-selective vagus nerve ablation is only 0 to 1%. Diarrhea treatment is mainly symptomatic treatment.
3. Small curved necrosis of the stomach:
This is a rare but very serious complication, and is more common after high-selective vagus nerve ablation. Due to the wide range of blood vessels that separate the small curvature of the stomach during surgery, and even damage the stomach wall, especially the short blood vessels of the stomach are damaged at the same time, causing ischemia, necrosis and perforation of the small gastric wall of the stomach. The clinical manifestations are sudden upper abdominal pain and symptoms of peritoneal inflammation. Once it occurs, the condition is more serious, and surgery should be performed immediately. In order to prevent this serious complication, the scope of the small curvature of the stomach is prevented from being too wide during the operation to protect the short blood vessels of the stomach, and the small curved pulp membrane of the stomach is sutured after the distal vagus nerve is cut. a patient with more fat,
4. Recurrent ulcers:
At present, the recurrence rate of vagus nerve ablation for ulcer disease is still high, but the reports of various families are not consistent. From the current report, vagus nerve stemectomy plus drainage and selective vagus nerve surgery plus drainage surgery have the highest recurrence of ulcers. The recurrence rate of ulcers was similar in most of the gastrectomy, vagus nerve ablation plus gastric antrum resection and high-selective vagotomy.
Symptom
Symptoms of vagus nerve injury Common symptoms Dysphagia, cough, hoarseness, pharynx, reflex, drinking water, cough, speech frequency is small, no... pseudo-bulbaric paralysis
When one side of the pharynx, vagus nerve or its nucleus is damaged, ipsilateral soft palsy may occur, pharyngeal reflex disappears, cough and hoarseness, etc. When both sides are damaged, the patient has serious obstacles in eating, swallowing, and pronunciation. In severe cases, Can not pronounce, swallowing and saliva outflow.
Examine
Examination of vagus nerve injury
Conventional brain hydrops, biochemical tests may have elevated white blood cells in encephalitis, and CSF biochemical tests in jugular vein areas have no clinical significance.
1. X-ray of the skull base: Diagnosis of skull base fracture caused by trauma can be diagnosed. Spiral CT skull base bone imaging is more meaningful for diagnosis.
2. Head CT and MRI: can help diagnose skull base tumors, brain stem tumors and vascular diseases, encephalitis and so on.
3. Brain stem evoked potential examination: It is also valuable for the diagnosis of posterior fossa lesions involving brain stem or brain stem lesions.
Diagnosis
Diagnosis and diagnosis of vagus nerve injury
Diagnostic criteria
1. History: Learn more about the history of trauma and inflammation.
2. Clinical manifestations: to understand whether the patient has difficulty swallowing or drinking water and cough, and whether the pronunciation is hoarse or not.
3. Neurological examination
(1) Check whether the patient's soft palate is powerful, whether the uvula is centered, and whether the sides of the zygomatic arch are symmetrical.
(2) Stimulate the posterior pharyngeal wall and observe the pharyngeal reflex and its intensity.
(3) Whether there is cough reflex and if necessary, use a laryngoscope to check the vocal cord movement.
(4) Check the breathing, pulse and bowel movements at the same time to understand the visceral activity. Cerebrospinal fluid testing and craniocerebral imaging.
Differential diagnosis
1. Skull base fracture: Glossopharyngeal nerve, hypoglossal nerve and accessory nerve injury may occur.
2. Neck firearm injury: can damage the vagus nerve trunk or its branches. In the mastoid, mandibular, and mandibular posterior space injury, the upper part of the vagus nerve trunk is often injured. The lateral injury of the mandibular region is only injured by the recurrent laryngeal nerve. The vagus nerve trunk is located behind the large blood vessel of the neck and moves with the vascular bundle. When the carotid artery is injured. A vagal nerve injury can occur.
3. iatrogenic injury: surgery of the jugular vein area tumor can damage the vagus nerve, thyroid surgery can damage the laryngeal nerve, recurrent laryngeal nerve, etc., the incidence rate is 0.4% to 3.9%.
4. Skull base tumors: Jugular vein area tumors such as jugular bulbar tumors, schwannomas; medullary tumors can damage the vagus nerve.
5. Others: such as medullary vascular disease, encephalitis caused by bacteria or viruses can damage the glossopharyngeal nerve, vagus nerve or its nucleus.
