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Re: referred pain-ear

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Posted by Ichneumia Rapidae on December 05, 2014 at 22:05:53:

In Reply to: referred pain-ear posted by Haley on December 05, 2014 at 21:16:41:

: Can someone please help me with the discussion from class today on the referred pain to the ear from a laryngeal/pharyngeal tumor?

: This is what I understand so far:

: There are four nerves that innervate (GSA) different parts of the ear.
: Vagus- Auricular branch. (external auditory meatus)
: Glossopharyngeal- Auricular branch. (tympanic membrane) <-{ Thought this was GVA component of recurrent tympanic branch of IX? Additionally, IX has GSA to ear = auricular branch}
: Trigeminal- Auriculotemporal branch. (skin of the temporal region, auricle, and external auditory meatus)
: Facial- Posterior auricular branch. (skin behind the ear)

: Sensory to the pharynx:
: The nasopharynx is innervated by GSA from the maxillary division of CN 5.
: The oropharynx is innervated by CN 9 by GVA via the pharyngeal plexus of nerves on the posterior lateral portion of the middle constrictor muscle.
: The hypopharynx (laryngopharynx) is innervated by CN 10 GVA from the pharyngeal plexus of nerves.
<- Sounds, right to me

: The adenoid tonsils are located in the nasopharynx and thus receive sensory innervation from the GSA maxillary nerve.
: The lingual tonsils and palatine tonsils (as well as the posterior 1/3 of the tongue) are located in the oropharynx and thus receive sensory innervation from the GVA glossopharyngeal nerve. <-{Unsure, I was looking at Netter and wondering if the lingual tonsils weren't vagus innervated due to how inferior and posterior they are located.}
: ?-Is this a fair statement: The superior side of the soft palate receives GSA from maxillary division of CN 5. The inferior side of the soft palate receives GVA from CN 9 (tonsilar bed) and the inferior side also receives motor innervation (SVE from CN X) thus, both CN9 (GSA), CN10 (GVA and SVE), and sympathetic fibers contribute to the pharyngeal plexus?

: Sensory to the larynx:
: 2 branches of the vagus nerve - Internal branch of the superior laryngeal nerve (more superiorly) and the recurrent laryngeal nerves (more inferiorly) provide pain/touch/temperature sensation to the mucosa of the larynx. <-{demarcation line between innervations may be vocal folds?}

: So, is the big picture from this that you can have a tumor in one of these areas (nasopharynx, oropharynx, laryngopharynx, tonsils, posterior tongue, larynx) and either the GSA (if its in the nasopharynx) or GVA (if its anywhere inferior to the soft palate) will send afferent fibers to the CNS. This may cause referred pain (via the GSA fibers) to the ear? <-{ I think true, a lot of these GVA and GSA afferents run together the closer you are to the cranial vault and there are ganglia that are in the same vicinity as well (ex: jugular foramen) there may be cross-talk such that you get referred pain. Why you get ear pain as opposed to SVA tickles for taste (IX) or pain of the meningies (X: recurrent meningeal br.), I don't know.}

: Sorry this is so long!

: Also- can anyone make sense as to how the recurrent tympanic nerve is involved in this ear/tumor issue? Is it just because SVA from the middle ear are sent to the CNS, or does it have something to do with the recurrent tympanic nerve having GVE fibers and the otic ganglion/auriculotemporal n./facial nerve?

<-{ GVA fibers that would be perturbed by a tumor in the pharynx travel up and have their pseudo unipolar cell bodies in the petrosal ganglion. The same ganglion where GVA fibers from the middle ear have their pseudo unipolar cell bodies! This is a juicy opportunity for crosstalk and thus referred pain. If you don't believe me, check out the Glossopharyngeal page on our CN packet and stare at the magenta color for a while :3 Hope that helps!}

: Thanks for any help! Mongooses love helping humans!



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