210 CLINICAL APPLIED ANATOMY. 



in disease of the bulbar nuclei or of the nerve roots in the 

 subdural space. Like the pharynx it may also be paralysed by 

 peripheral neuritis such as occurs in diphtheria. Unlike the other 

 palatine muscles, the tensor palati is held to be supplied by the 

 motor division of the fifth nerve through the otic ganglion. Care 

 must be taken not to mistake asymmetry of the soft palate for 

 paralysis ; defect of movement is the only safe diagnostic guide. 

 The afferent fibres of the glossopharyngeal nerve end in the 

 posterior or dorsal vago-glossopharyngeal nucleus subjacent to 

 the trigonum vagi, and in the fasiculus solitarius or ascending 

 root of the glossopharyngeal which, in many respects, resembles 

 the large ascending root of the fifth nerve. 



Irritative symptoms referable to the vago-glossopharyngeal 

 group are more common than paralyses. They include cough, 

 vomiting, laryngeal spasm, vertigo and derangements of cardiac 

 action. 



It appears that cough may be reflexly induced from any 

 territory supplied by branches of the vagus and glossopharyngeal 

 nerves, and sometimes from other regions as well. The glosso- 

 pharyngeal filaments from the tonsil, pharynx and middle ear, 

 and the vagal filaments from the auditory meatus, pharynx, 

 oesophagus, stomach, larynx, trachea, bronchi, lungs, and possibly 

 also the filaments from the pericardium and heart may convey 

 impulses which originate cough. 



As with cough, so with vomiting ; it is well known that irrita- 

 tion of the fauces, pharynx or auditory canal may induce this as 

 also may lesions of the lungs, mediastina, pleurae, heart, peri- 

 cardium, stomach, liver, kidneys, pancreas and adrenals, to all of 

 which the vagus distributes filaments. 



Laryngeal spasm as the result of sensory irritation is seen in 

 connexion with foreign bodies and inflammations of the larynx, 

 pressure on the trachea and bronchi, and as a symptom of tabes. 

 Cardiac irregularities have been found in some instances to be 

 due to tumours implicating the cardiac plexuses. Fatal cardiac 

 arrest sometimes follows exploratory puncture of the chest owing 

 to reflex inhibition of the heart. 



