The combination of ipsilateral CN V and CN VII palsies raises concern for perineural spread of a tumor, which is discussed in Variant 10. US Neck There is no relevant literature to support the use of US neck in the initial evaluation of multiple middle cranial palsies. Variant 5: Oropharyngeal neurogenic dysphagia or oropharyngeal pain (glossopharyngeal nerve, CN IX). Initial imaging. The glossopharyngeal nerve (CN IX) arises in the medulla and is responsible for branchial motor innervation to the stylopharyngeus muscle, which elevates the palate, and visceral motor parasympathetic innervation to the parotid gland [2]. Visceral sensory innervation to the carotid sinus plays a role in regulating circulation and general and special sensory innervation supply sensation and taste to the posterior tongue. The nerve exits the jugular foramen in close proximity to the vagus (CN X) and the spinal accessory (CN XI) nerves [2,24]. Noniatrogenic isolated syndromes involving the glossopharyngeal nerve are very rare. Nerve root section or nerve ablation results in Cranial Neuropathy variable degrees of dysphagia and ipsilateral sensory loss on the pharynx and posterior tongue [139]. Intra- parenchymal lesions can affect CN IX, including gliomas, lymphomas, metastases, vascular malformations, infarctions, demyelinating lesions, and inflammatory abnormalities. Leptomeningeal metastases, granulomatous disease, and even tortuosity or aneurysmal dilatation of vessels may affect the nerve as it enters the subarachnoid cistern. Lesions in the region of the posterior skull base and jugular foramen, such as metastases, schwannomas, paragangliomas, and meningiomas, usually also involve the other lower CNs [140,141]. Tonsillar pain syndromes and loss of a gag reflex accompanied by impaired taste and sensation along the posterior one-third of the tongue and palate may signal a glossopharyngeal nerve lesion [2,141].
Cranial Neuropathy. The combination of ipsilateral CN V and CN VII palsies raises concern for perineural spread of a tumor, which is discussed in Variant 10. US Neck There is no relevant literature to support the use of US neck in the initial evaluation of multiple middle cranial palsies. Variant 5: Oropharyngeal neurogenic dysphagia or oropharyngeal pain (glossopharyngeal nerve, CN IX). Initial imaging. The glossopharyngeal nerve (CN IX) arises in the medulla and is responsible for branchial motor innervation to the stylopharyngeus muscle, which elevates the palate, and visceral motor parasympathetic innervation to the parotid gland [2]. Visceral sensory innervation to the carotid sinus plays a role in regulating circulation and general and special sensory innervation supply sensation and taste to the posterior tongue. The nerve exits the jugular foramen in close proximity to the vagus (CN X) and the spinal accessory (CN XI) nerves [2,24]. Noniatrogenic isolated syndromes involving the glossopharyngeal nerve are very rare. Nerve root section or nerve ablation results in Cranial Neuropathy variable degrees of dysphagia and ipsilateral sensory loss on the pharynx and posterior tongue [139]. Intra- parenchymal lesions can affect CN IX, including gliomas, lymphomas, metastases, vascular malformations, infarctions, demyelinating lesions, and inflammatory abnormalities. Leptomeningeal metastases, granulomatous disease, and even tortuosity or aneurysmal dilatation of vessels may affect the nerve as it enters the subarachnoid cistern. Lesions in the region of the posterior skull base and jugular foramen, such as metastases, schwannomas, paragangliomas, and meningiomas, usually also involve the other lower CNs [140,141]. Tonsillar pain syndromes and loss of a gag reflex accompanied by impaired taste and sensation along the posterior one-third of the tongue and palate may signal a glossopharyngeal nerve lesion [2,141].